It is exactly 49 steps from my bedroom to my garage.  It is a 23-mile drive to the hospital and 75 steps to the unit.  It takes 10 seconds to walk to the nursing station.  I can measure what it takes to get me to work each morning with absolute certainty.  I know because I have measured it a million times hoping something will prevent me from reaching my destination.  I live 49 steps, 23 miles, 10 seconds and another 75 steps from my job.  And it has taken me over a decade to find the courage to actually quit.

I was forty-three years old and five months into my new life when I realized I had to return to my old job.  Having served two stints as a psychiatrist at a very busy hospital, I was enjoying a lovely period I like to call “the second time I quit my job.”   The decision to leave my job the second time was less of a choice and more of a mandate; it came on the heels of an almost nervous breakdown when I was blasted with words like, “You’re just not strong enough.”

These words peppered me like bullets, and I believed them.  I decided I would leave immediately (or in six weeks when my boss could write me out of the call schedule), and I would do it without guilt.  But I would still work at least one weekend a month.  My nervous breakdown aside, we needed the money.

I met the day of my departure from the hospital with a mixture of elation and paralyzing fear.  I mean, what would I actually do?  I had been a practicing physician for nearly 20 years.  My crowning achievement as a working mom was returning to my full-time job, fourth child in tow, three weeks after her C-section birth. I was a worker bee, not a princess.

I couldn’t look back to the first time I quit my job for answers because at that time I was just doing what I thought every other working mom in the universe did: Go, go, go!   It was my oldest child that stopped me in my tracks.   Five at the time, she had written a book about a child whose mother works. A lot. The words screamed accusingly at me: “If your mommy works don’t be sad.” “If your mommy doesn’t have time for you it doesn’t mean she doesn’t love you.”

I thrust the pages at the medical director of the hospital.  “Read this.” He turned them quickly.

“Well I have to leave,” I said.  Childless, he agreed, grudgingly, to my departure.  The problem was no one else around me seemed to agree.  I had just completed over a decade of training to become a psychiatrist.  The pressure from internal and external sources to do something with my education was extraordinary.  It soon became abundantly clear: I could quit the hospital but quitting psychiatry was out of the question.  I needed a plan B.

I opened a private practice.  I accepted a number of jobs working at various outpatient facilities.  I became the medical director of a drug rehab.  I attended law school with my husband.  I continued to work too many hours a week and spent too little time with my children.  I was miserable.  And then it got worse.

One day my phone rang as I was leaving a law school class.  The hospital was losing a doctor due to illness.  They remembered how much everyone liked me there.  They remembered I did a great job.  They remembered they never wanted me to leave in the first place. I hung up the phone with a sinking feeling in my stomach.

I consulted with my family, my husband and anyone else I could find. It was a very good opportunity.  It was a chance to help a lot of people and make a good living doing it.  It was everything a hard-working gal should want.  And who was I to think I could leave inpatient medicine anyway?  Ridiculous.  No one said, “Don’t go back.”  And I can’t blame them.  I would return to inpatient psychiatry for what I now call a second tour.

The thing is, now I had four children instead of three, and a much busier life.  I struggled to keep up.  I began leaving the house earlier in the mornings and picked up the children later in the afternoons.  Everything was justifiable in my mind.  My family needed me to earn as much as I could.  They needed me to fulfill my potential.

It never escaped my consciousness that in those in-between years after my first departure, despite always working jobs in psychiatry even while attending law school, I didn’t make as much money as I would have had if I had never left the hospital.  Yes, I always earned.  The problem was, I could have been earning more.  More than one person on more than one occasion reminded me of this fact. And it felt awful.

So I continued to see patients and scramble to make things work at home and see patients and ignore the overwhelming sadness that was brewing deep inside of me and see patients.  I stopped driving the kids to school myself and started leaving earlier.  I relied heavily on my nanny.  I felt extreme guilt.  The job was harder than I remembered and the patients sicker.  I was devastated by the mental illness I saw on a daily basis and felt powerless to change it.  I started to cry on the way to work.  My dreams were desperately scary.  I prayed for an illness, an accident a miracle.  And then my almost nervous breakdown hit and I was free. Sort of.

Save for weekend calls, I began a five-month exploration into happiness. An art major in college, I joined a painter in his studio as an apprentice.  I began to write.  I considered getting a tattoo.  A small one, on my pinky finger, but a tattoo nonetheless.

I accepted a stint as a volunteer in my first grader’s classroom.  I stayed up later because I was no longer tired all the time.  My depression lifted.  I was the mom I wanted to be.  I became more of the wife I wanted to be.  It was wonderful.  And then it wasn’t.

The reduction in income came at a terrible time for my family.  Various factors contributed to a very difficult financial scenario for us, and my weekend work just wasn’t enough.  The family felt it.  Reality crept in.  We couldn’t maintain our current living situation.  My life as a one-time artist was simply not sustainable.   None was surprised when I decided to go back.  And, no one really tried to stop me.

I returned to the front lines on October 19, 2015.  For two weeks I rode a wave of adrenaline and denial.  I approached this with a healthy serving of “you have to do this for your family’s survival” and equal parts of “stay neutral — don’t let them get to you” and “it’s just a job.”   But by Thanksgiving, I was praying for a miracle again.  And on December 22, 2015, I began coverage of the hospital that included myself and one other doctor.  Together we saw every patient in the hospital every day for nine days straight without a break.

My children and husband barely saw me at what my family considers the most important time of our year.  I missed my kids’ winter vacation.  I missed Christmas morning with my children.  I was overwhelmed and exhausted.  I thought if I could just make it to New Year’s it would turn around.  Nothing was further from the truth.  The guilt I felt permeated every move I made.  “Not good enough” rang in my ears as my own negative self-talk became uncontrollable.  I knew it was time to leave for real.  I had to take my life back or risk losing it for good.

There are lessons to be learned from any situation.  And there is information. I choose to share my experience as a means to help others in any way I can.  I am no longer seeing patients, but that does not mean I do not see my patients.  My experience in medicine is worth something to me and to so many others.  I hope by transitioning away from what I know I am no longer called to do and into something new, I can continue to help people.  Choosing to leave direct patient care is scary and different.  But different can be good.  And good can be wonderful.

This essay is cited in the KevinMD record on physician careers.

Rebecca Reyes is a psychiatrist.

Image credit: Shutterstock.com