Euphraim is about 30 years old, but the wheelchair he rides into my consulting room is older than that and much the worse for wear. Yesterday, a doctor saw him then asked him to stay overnight so he could see me this morning. That doctor now guides Euphraim’s wheelchair over the concrete bump at the doorway and onto the hodgepodge tiles of the exam room floor.

The first thing that anyone would notice about Euphraim is the myriad flesh-colored skin lesions that cover his face and entire body, almost like berries hanging off his skin. But he’s had those his whole life, and they’re not why he’s here.

For the past several months, the left side of his body has slowly stopped working. He uses his right hand to move his useless left arm from the armrest of the wheelchair to his lap. The problem is getting worse and worse. Now he’s unable to stand.

Talking with him and examining him a bit, it’s clear that his weakness is coming from a problem in his brain, and the facts start to come together: His skin lesions are typical for a relatively rare genetic disease called neurofibromatosis. Neurofibromatosis is associated with lots of different brain tumors, many of which are not cancerous and could be removed with surgery. Euphraim is likely to have developed one of these brain tumors. As it grows bigger and bigger, it causes more and more problems for him.

To figure out if he has such a tumor, though, Euphraim needs a CT scan, which would cost him about $100. But he doesn’t even have the money to pay for transportation to one of the three hospitals in the country with a scanner.

Even if he did, there is no surgeon within our national borders who would operate on his brain. This is Burundi, which by most measures is the world’s poorest country.

It couldn’t have been easy for Euphraim, with his significant disability, to get to the hospital and wait overnight in some borrowed bed, just to be able to talk with me, hoping I could fix this problem. I can’t fix it, but what’s worse is that no one will.

We talk about his problem. We analyze what we can do to make his life better, given that a cure is out of his reach. We seek out one of our hospital chaplains to spend some time praying with him.

And all the while, the line of other sufferers extends down the bench outside my door.

For the past eight years in rural Burundi, one in seven of my hospitalized patients has died before being discharged.

The reaction of my heart to Euphraim’s tragic story is not the same as it would have been 15 years ago. I can see the sadness, but I don’t feel connected to it the way I used to. Who am I becoming?

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After describing the neighborliness of the Good Samaritan, Jesus told the expert in the law to “go and do likewise” (Luke 10:37). In this parable perhaps most clearly, Jesus shows he wants his people to care for those in dire straits.

Not all of us will (or should) do this professionally, of course. But of those called to care professions, many will be repeat witnesses to danger, death, and suffering. Many of us return over and over to situations where we try to improve and even save lives. But sometimes it seems like our efforts are wasted.

Compassion fatigue, and the similar experiences known as vicarious trauma or secondary traumatic stress, are a response to dealing with people in traumatic situations. It has been receiving growing attention for several years now, with an uptick in interest because of the COVID-19 pandemic.

Our world’s disasters keep getting upstaged by worse ones: overloaded hospital units, deaths by the million, mental health crises, civil unrest, wartime atrocities—it seems impossible for our hearts to not feel worn out.

It’s hard to track the prevalence of compassion fatigue or whether it has in fact increased during the pandemic. Compassion fatigue can mimic or even open a pathway to posttraumatic stress disorder (PTSD).

Compassion fatigue doesn’t always take you to PTSD, though. Sometimes, it just leaves you feeling exhausted, hopeless, irritable, and dreadfully responsible. It imposes a perspective that leaves no room for awe, gratitude, and grace. Most characteristically, it muffles or eliminates your ability to care appropriately.

Though compassion fatigue certainly keeps company with burnout, it has an additional layer of challenge: While you can burn out on anything, compassion fatigue is the challenge of persevering precisely where you have decided to open your heart to someone else’s trouble.

The word compassion means literally to “suffer with” another. Thus it’s not surprising that our compassion feels limited and risks depletion. Theologian Frederick Buechner calls compassion a “sometimes fatal capacity.”

There are times when I have thought that a good callus on my heart would come as a relief, but my experience is usually the opposite. Sometimes, when the 15th Euphraim-like patient sits down in front of me, my heart just dries up. Far from feeling compassion, I want to shout that it’s unfair for all their suffering to enter my life. My heart closes.

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Yet instead of feeling relief, the realization that I’ve lost my compassion—my orientation toward suffering with someone else—compounds my sense of having drifted from my vocation and purpose.

As Christians, our vocation is fundamentally to love—with our actions and our minds, but also with our hearts. We know that we are called to compassion, but the obstacles can seem overwhelming.

How necessary is compassion to Christian calling? “Weep with those who weep,” Romans 12:15 (ESV) tells us in a list of ways to live in loving community. The words are Paul’s, but they also describe Jesus. Jesus, moved with compassion by the crowds of sufferers. Jesus, weeping with Mary in the grief of Lazarus’s death.

Even at the pinnacle of the Triumphal Entry, a celebratory and joyful event, Jesus breaks into tears for Jerusalem’s coming sorrow (Luke 19:41).

Compassion—real, suffering compassion—is not exceptional in the Christian life. It is everywhere. As in the Triumphal Entry, it is even commingled with our joy. This centrality of compassionate sorrow is consistent with a biblical narrative that shows, as Timothy Keller says, “The road to the best things is not through the good things but usually through the hard things.”

Compassion is a type of self-giving,and I believe, quite ardently, in this kind of self-giving. My decision to pursue a career in medicine and specifically medical missions in Africa is born directly from a conviction that there is greater joy to be found in giving myself away than in walling myself off from suffering.

But it can be so hard. Hard to put one foot in front of the next, and even harder to keep my heart open to suffering with the next person who comes to me for help.

There are some known ways to help people with compassion fatigue, which can and often does heal. We should pursue changing our work systems to minimize risk factors, like too many work shifts in a row, bullying, or other elements of a hostile work environment. We can and should screen early and often for acute stress, depression, and trauma in caregivers. We should call attention to symptoms like insomnia, taking bad risks, and angry outbursts. We should encourage people—especially those whose work puts them at risk—to take real sabbaths and to make adjustments that help them maintain a healthy lifestyle and perspective.

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But as the world talks more about burnout and compassion fatigue, it is crucial to note that these problems are not fundamentally technical problems with technical solutions. We cannot ignore their theological nature, the call to and consequences of suffering with others.

Where do we find strength to keep our hearts open to people in our lives and world who need our compassion? There are probably as many answers to that question as circumstances that threaten our hearts.

For a starting point to address compassion fatigue theologically, we can look at lament. Biblical passages of lament give voice to hearts that have been stretched to the breaking point. The deepest question of lamenters in the Bible is addressed to God, asking if our hope will let us down. Perhaps this is the deepest question for those in a heart battle against compassion fatigue.

I remember Odette, a young woman in her 20s who was hospitalized in Burundi with terrible kidney failure. By “terrible,” I mean most American doctors would not believe that someone with kidney disease this severe would still be alive.

Odette’s family was willing to pool their money to send her to a kidney specialist in the city. But as we discussed it, knowing that long-term dialysis was not an option, it wasn’t clear the expense of such a trip would change anything for her. Still, her family decided to try, and so they went to the city.

A month later, I was at home answering some interview questions via email regarding my work. “How have you overcome the fear of hoping in order to reach for God’s promise of hope?” As soon as I read the question, my heart sank because the question was asking how I did something that I felt utterly incapable of doing.

I fear to hope sometimes. My recent weeks had been filled with tragedies like Odette’s. More than that, there had been several times when it seemed like someone was going to recover but then suddenly died. “Hope deferred makes the heart sick,” says Proverbs 13:12. Exactly; my heart was sick.

Sitting at my computer, I stared blankly out the open window onto the bright green of a day in equatorial Burundi, unable to answer the question. After a minute, my phone chimed.

Actually it chimed half a dozen times in a row, a sure sign the message was from a Burundian colleague, since Burundians tend to send their messages in a staccato series of short sentences.

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Looking down at my phone, I saw that the messages were from a friend named Onesphore, who was once my student and then my coworker. Now he works at a hospital in the city.

Good morning doctor, he wrote. I just wanted to let you know that we have been caring for Odette. The young woman that you had seen last month. We have not been able to do much. But some fluids and careful observation have resulted in her kidneys returning almost to normal! We’re sending her home today. I just thought you would want to know. Praise God!

The goodness of this news was obvious. Not only was Odette healed, but I got to know about it from someone I had helped to train for his current job.

This was all fantastic and encouraging, but what really struck me was that the message arrived precisely when I was sitting there thinking about how afraid I was to hope and how I had no idea how to reply to those asking me how to hold on to hope.

I turned my head and saw my own reflection in the glass of the window pane. The idea that God was present was no longer theoretical; it was real and sudden. In a moment, the revealing of this whole story filled me with tearful joy, not a small amount of fear, and a renewed hope.

We cannot continue in compassion without hope. Where do we find it? Just as Jesus allowed Thomas to put his hand in his side (John 20:27), he also warned the disciples that following him would require many to live by faith without getting to examine all the evidence (v. 29). That is, sometimes we can see God overturning evil. At other times, we may be unable to see what God is doing. Because God actually is at work in the world, hope may come as an unexpected gift. But we also need to cultivate hope by thinking about these struggles in light of what we believe about the character of God.

The story of Odette’s healing and Onesphore’s texting unfolds like a small eucatastrophe, where at the end, victory is snatched out of the jaws of defeat. It was both a surprise and a new perspective on the whole story. As J. R. R. Tolkien (who coined the term) pointed out, the incarnation of Christ and the resurrection of Christ were eucatastrophes.

Those who seek to preserve compassion and hope in the daily work of a broken world must keep in mind that God is the God of eucatastrophes, both big and small. He seems to have a penchant for surprising us with his unexpected victories. He glories to show his strength in our weakness. Not all turns are turns for the worse. We want to know that we are not alone in our labors. “My Father is always at his work to this very day, and I too am working,” says Jesus in John 5:17. Still, when good news is infrequent, we sometimes feel there is a paucity of evidence for this.

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Sometimes hope grows slow and steady like a field of healthy crops, but more often than not, if we have eyes to see it, there is a surprise that teaches us what we so desperately need to know: that the good, redeeming work of God in the world belongs to him, not to us.

Years of medical training and practice mean that, when I walk through the local village market, I can’t help but see things I wouldn’t have before. Swollen feet, a particular kind of gait, a scar where a thyroid surgery was done. A habit of searching out such things has taught me to see what was invisible before. Some of them indicate lives saved and hope restored.

In a similar way, maybe we can find hope more often if we have a persistent curiosity and trust that there is hope to be found.

If we follow God’s call to enter the world with compassion, we should not be surprised if we find ourselves identifying with Jacob, wrestling with God in the dark and facing our fears in the morning with a permanent limp.

Such moments often feel like God’s absence but may actually be a sign of his presence. Indeed, our lives can be like that, but that is not the end of the story. God is with us, and he is doing something. His tendency toward eucatastrophes means that we have good reason to look for unexpected hope.

Years ago when I lived at a hospital in rural Kenya, a woman named Mercy came to us with difficulty breathing. Our initial tests suggested heart failure. She was just a few years older than me, and she spoke some English. She would greet me every day, and I would shake her hand and the hands of her two small children who accompanied her. As days passed, I was puzzled by her lack of improvement on our heart-failure treatment. She just wasn’t getting better.

Around 10 days into her hospitalization, her left leg swelled up. As soon as I saw her leg, all my assumptions about her problem resorted themselves. Her swollen leg meant a big clot in her vein, which meant that her difficulty breathing was due to a clot that went to her lungs.

What’s more, when I told her this, she mentioned she had had a clot like this before. She hadn’t told me that before, and I hadn’t asked. We changed her treatment immediately, but the next day, while walking to the shower, she fell over and died.

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And maybe, if I had been more thorough, or more perceptive, or more attentive, and we had changed her treatment sooner, she would have lived. Maybe not. But maybe.

Mercy is one of a thousand stories that haunt me. I could have done more. I should have done more. I know the counterarguments and the words of reassurance, and I believe them, for the most part. But sometimes I have a hard time not feeling like they are excuses.

The most famous scene in the film Schindler’s List is like a mirror for me. Oskar Schindler helped save hundreds of Jews from the Holocaust, and to thank him, a large group of those he saved present him with a gold ring.

Schindler is overwhelmed, dropping the ring, sobbing, exclaiming that he could have done more. He could have sold his car or his gold pin and saved more people, but he didn’t. Those around him attempt to console him by pointing out all that he did do, but he is impervious to these consolations.

Keller commented in a sermon that the reason Schindler is not comforted is that Schindler is right and he knows it: He could have done more, and he didn’t. He is haunted by this truth, and no one can change his mind or his heart. My own experience as a medical missionary is completely in agreement.

What is going on in our haunted hearts? Why do we always feel like we have never done enough?

I think we are wanting God to tell us that we have done enough. We want to hear “Well done, good and faithful servant.” But we know that we have left work undone, and we’re not sure that God would say we have done enough. If we haven’t done enough, will he still love us?

God, do you love me? The answer to this question is important in our fight to have compassion without compassion fatigue. We can only persevere in giving what we believe we have received. He is the well, but our tendency is to think the well is only as full as we deserve it to be, and not as full as God says it is.

God’s love is not, and has never been, contingent on us having done enough or done well enough. We proclaim again the gospel of Christ: that God’s love is a free and unmerited gift.

Such love is the only starting point for a heart that would serve compassionately. Anything else, and we will be Oskar Schindler.

But also, as Paul says in 2 Corinthians 1:4, we give comfort out of the comfort that we have received. The same compassion, co-suffering, that breaks us open in tears flows from a heart restored by the unmerited grace of God.

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And so compassion, like hope, is also a gift. For most Christians, this is not news. But it may be a new application as we consider the suffering around us. It is, at any rate, a necessary application for people who have been troubled by a lack of compassion and hope.

Jesus, when faced with the sure knowledge of what he was to suffer—and that the friends he was speaking to would abandon him—said, “In this world you will have trouble.” Work and weep for it with compassion for the suffering. “But take heart!” Be hopeful. “I have overcome the world” (John 16:33).

God’s compassion doesn’t wear out or go cold. This compassion he gives us to give others doesn’t wear out or go cold. For those striving to persevere serving those in need in Jesus’ name, such an image feels beautiful but perhaps impossibly aspirational. After all, the exhaustion and disappointment are real.

In a world so full of brokenness and suffering, where the call of Christ to enter the brokenness is nevertheless so relentless, lament is an appropriate first response. How can we recover, let alone persevere, not just in our actions but in our heart responses? We know the fragility of our hearts, and we are so afraid. It feels like we cannot possibly remain deeply engaged in a world such as this.

Nevertheless, our cries of lament have answers. God will mend and renew—and he often does! We find hope in the knowledge that the work before us is ultimately God’s, and that his love is always ours.

Eric McLaughlin is a missionary doctor at Kibuye Hope Hospital in Burundi and the author of Promises in the Dark: Walking with Those in Need Without Losing Heart.

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