I have wanted to be a doctor for as long as I can remember. I played hospital with my dolls as a child. I never thought of alternative career paths. I climbed the long, sometimes unbearably steep mountain to reach the top.

I loved clinic medicine for many years. Most days, I still do. Until recently, I had never considered leaving, choosing a different path.

Then, I walked into the clinic and found out my patient had a bad outcome. As I reviewed the chart looking for anything I could have done differently, a switch flipped. I was done. I was done practicing clinical medicine. I felt the system had let my patient down, me down.

I have been an oncologist for over 15 years. I am not new to death or dying. I take care of very sick patients. I give very high-risk treatments. What was different today? I have seen many adverse outcomes. I had never had this reaction before. I had never before said to myself, let alone others, that I was done. It was a visceral feeling. Time to retire from clinical medicine. Enough with life-or-death decisions. I was just done.

I felt sure of my decision. So sure, I was concerned. What had happened?

Was this burnout? I truly did not believe so. I had experienced burnout about nine months prior. I hired a physician coach. I took a serious look at what I needed in my life to keep my batteries charged. I felt I had made lots of progress. I am no longer a people-pleaser. I learned fierce boundaries. I obtained my coaching certification to help other physicians going through what I had experienced. I felt like I was in a good place. I was managing my mind. I had a toolbox full of tools. I was going to weather the health care storm. I was not going to be another statistic of the great resignation.

Yet here I was. What had happened? The tools were no longer enough.

I was mad. I was shocked. I was confused. Most of all, I was disappointed. Profoundly disappointed.

I consulted close friends, my physician coach, other coaches, and colleagues, looking for an answer. What had changed? The term “moral injury” was thrown out. Hmm? I was referred to an editorial entitled, “Reframing Clinician Distress: Moral Injury Not Burnout.” This editorial described moral injury as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints beyond our control.” Bingo! I was experiencing moral injury. I did not have a tool in my toolbox to deal with moral injury. It had been months of experiencing moral injury on different levels: insurance companies, staff shortages, bed shortages, IV contrast shortages, and EMR changes. The list went on and on. This was the proverbial straw that broke the camel’s back.

Then it dawned on me. It was a boundary. I was coming from a place of empowerment. The same tools I had learned while recovering from burnout were now leading me to question whether I was willing to continue dealing with moral injury. I realized I had the ability to choose to stay or go.

This was not a decision to make lightly. I needed to be sure. I was sure. I made myself a deal. I made a chart, much like you make for a toddler. Each day if I did not lose my $#*%, walk out, quit, and did my best to take care of the patients, I got a sticker. Enough stickers; I got to buy myself a reward. Hey, I needed to do what I needed to do.

I wanted to stay, but my heart and gut said to go. The following week in the clinic, when another situation beyond my control occurred, I asked myself, “How does leaving help the patients?” Ow. Punch in the gut.

As a physician, I have always been taught that the buck stops with me. I had to realize that this was no longer true. The problems are bigger than I am. I do not have the power or the resources to fix a broken system. To stay in clinical medicine, I must learn to work within the broken system.

All I can do each day is my best. I hope my best is good enough.

I have chosen to stay. But I will stay empowered. I realize it is my decision. Right now, I grieve the fact that each day I have to make the decision to stay. To stay in what was once a dream of mine. Health care is no longer what it once was. Where are we heading? What is the future? Today I am celebrating that I once again decided to stay—another sticker. Hopefully, one day I will no longer need that chart.

Deborah Bradley is a board-certified medical oncologist, certified executive coach, avid mountain biker, and adrenaline junkie. She can be reached at her self-titled site, Debbie Bradley, MD, and on Instagram @debbie_bradley_md, Facebook, and LinkedIn.

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