I Couldn’t Not Do It

“Can you take it back?”

That is what my dad said in 2020 when I told him I was resigning from The Permanente Medical Group after 22 years.

It was not an unreasonable question.

I had a bustling pediatric practice. I was chief of physician wellness and had recently been chief of my pediatric site. I had a family, a husband, a house, a dog, a pension, and lifetime health insurance for Mark and me if I stayed until I was 60.

I had even won a “Top Dog” award for patient-satisfaction scores.

The prize was a stuffed dog.

Not exactly commensurate with the level of work it takes to have the top patient-satisfaction scores in your department, but an acknowledgment nonetheless.

I loved medicine. I was good at it. I worked in a good healthcare system.

From the outside, leaving made absolutely no sense.

From the inside, I could not not do it.

I became a pediatrician because I loved children, science, and medicine.

When I was 11 and a half, my baby brother was born. There were almost 12 years between us, with no one in between. I was present at his birth and went to his pediatrician appointments with my mom.

I was hooked.

I loved science. I loved children. I loved the feeling of being able to make a difference in pivotal moments. My brother had some issues beyond well-child care in his early years, which made it even more interesting.

When I said I wanted to be a doctor, I got so much positive feedback. Becoming one became inevitable.

Once I decide to do something, it is usually as good as done.

I had no idea what was ahead. No one in my family was in medicine. Medical training was harder and longer than I expected.

I had babies during medical school and residency. I learned to care for children while raising my own.

And I noticed things.

We told kids to sleep, eat well, listen to their bodies, and use the bathroom when they needed to.

We did not pee.

While pregnant with my first child in medical school, I developed a kidney infection because I was not taking bathroom breaks when I needed to.

We told patients to show themselves compassion. We were taught that self-criticism and judgment were signs of excellence.

We told families and patients that rest mattered. We treated rest for ourselves as a lack of commitment.

None of this made sense to me.

I grew up in Berkeley, so I am not particularly good at quietly accepting something as inevitable when it does not make sense.

So I spoke up.

When you speak up in medicine, you end up in charge.

I became chief resident. Then, in my first year as an attending, I became chief of physician wellness. I wanted to help make medicine work better for patients and physicians.

I worked at it from inside the system for a long time.

Twenty years.

Along the way, I started to feel restless.

I changed facilities. I went back to inpatient work. I gave up my leadership roles—until I got all of them back.

At one site, I looked out at a gas station.

At the next, I had a spectacular view of San Francisco. I thought that would make me happy.

It did, for a little while. And then the restlessness recurred.

Then I was asked to open a brand-new pediatric facility.

It felt like a golden ticket.

I got to build it the way I thought it should be. We had a beautiful new building. For six months, largely thanks to my impeccable design and planning, we maintained perfect patient satisfaction scores.

Perfect.

I was busy. Important. Making a difference.

And I was still living in inner unrest.

Frustrated. Reactive. Always noticing problems and solving problems.

Very, very busy doing important work.

I did not know then that I had been trained not to be satisfied.

Medicine teaches us that the next achievement, the next role, or the next thing we do for someone else will finally make us feel fulfilled.

That’s not how it works.

We are also taught that satisfaction is complacency. That if you feel content, you might stop contributing to the world in the best way you could. Or that something bad will happen if you let down your guard.

Not knowing how to be satisfied was a big problem. But it was not my only problem.

Around that same time, my husband—my high-school sweetheart—developed a severe depression.

Over time, his law career had become deeply misaligned with who he was.

My response was to do what I had always done.

I researched. I managed. I controlled. I looked at the data. I weighed the risks and benefits. I tried to find the right doctors. I tried to hold our family together.

None of it worked.

What frightened me was not just what was happening to him, or what could happen to our family.

It was that I could see a version of myself in it.

We had both done what we were supposed to do.

We had Ivy League educations, professional school educations, and sought-after jobs in a sought-after city. We had built a life that looked very good on the surface.

Over time, we had drifted out of alignment.

There was grief in that.

Grief for what he was living. Grief for our kids. Grief for myself. Grief in letting go of the belief that a life that looked good on the surface must be the answer.

Grief for the parts of myself I had learned to override and let go. As well as the parts my husband had.

I was a psychology major, a personal development junkie, and a physician wellness leader. I knew about coaching long before it was a thing in medicine.

I decided to hire a coach and go back to yoga.

In yoga class, a question came to me:

What would love do?

For me?

For my family?

For my patients, colleagues, and the world?

The answer was not, “Quit your job.”

What the question offered was clarity—about my husband and his situation, and about my own.

For me, this question makes it impossible not to “see with your heart” as Dr. Rachel Naomi Remen describes it.

When I hit rock bottom while my husband was sick, even as chief of physician wellness, I could not find the support or help I needed within the system.

I had to go outside the system to find it.

Along the way, I had acquired a wealth of incredible tools that could actually help my physician colleagues.

The secret sauce for putting them together strategically was too important not to share.

And sharing it made me feel alive.

When my dad asked, “Can you take it back?” I heard, “You do not believe in me.”

We talked about that moment recently, and I have reflected on it a lot since.

Of course I heard doubt. I had plenty of my own.

I did not know exactly what I was building.

I did not have a perfect plan. I did not have a trust fund. I was giving up an amazing pension and lifetime health insurance for me and my husband.

My dad was not wrong to worry about his daughter.

But I had spent nearly 20 years helping physicians survive and thrive inside medicine.

When my own life became very hard, I had found something outside the system that helped in ways I could not find inside it.

A blend of coaching. Mindfulness. Yoga. Physiology that led to a different way of thinking. A different way of listening. A different way of practicing medicine.

This approach was too important not to share.

The question that helped me choose the risk was:

What will the world miss out on if I do not do this?

A lot was all I knew.

I did not know exactly what this was.

But I knew I could not not build it.

I still practice medicine.

I just practice it differently.

I now offer potent medicine for those who practice medicine.

The healing I offer happens in yoga rooms, in nature, on Zoom, around tables and under trees at retreats, on stages, and in conversations with physicians who are standing where I once stood.

I used to get thank-you cards from families after caring for their children.

Now I get emails and cards from physicians who carry what they are learning into their families, teams, leadership, and patient care.

It has a different radius.

Most physicians I work with do not leave medicine. Most can find ways to stay and change something: how they work, where they work, what they create, what they stop doing, or how they think. Some, like me, have a different mission at this point in their life. These tools help them feel less alone and navigate the challenges in between with grace, compassion, and dexterity.

My dad was right that it was a big risk.

It was 100% worth taking.