“I’m surprised I haven’t had a kidney stone.”

It’s a running joke among my co-residents, when it’s 3 o’clock in the morning, with over 20 patients in the waiting room, and nobody can remember the last time they had water. Most days, my fluid intake is limited to the sips needed to swallow my antidepressants (to quote my parents, “you can’t just take them whenever you feel sad,” and “it’s not ibuprofen”). During a shift, I’m too busy in a perpetual state of fight-or-flight to think about hydration. And after work, it’s a miracle if I have energy to do anything else. If I’ve learned anything throughout my medical education, it’s that inadequate fluid intake is a risk factor for kidney stones. Yet here I am, living exclusively on coffee, energy drinks, or nothing at all. By all accounts, I should have been a patient in my own emergency department by now.

Oh, how quickly small habits disappear. We know they matter, and we tell our patients they matter. When counseling on how to prevent kidney stones, the first recommendation is always: Drink more water. It seems so easy. But it’s hard for them, and it’s hard for us. When I’m running on empty, even the simplest tasks feel impossible. And despite knowing their importance, I rarely practice what I preach.

Developing a scarcity mindset

Somewhere between medical school and residency, I developed a scarcity mindset around self-care. I started treating downtime like a finite resource, something to be hoarded rather than nurtured, because who knew when there would be more? Rest stopped being about recovery and became about shutting down. Drinking water, taking my antidepressants, and even eating, exercising, and connecting with others felt like too much effort. I told myself: This is good. This is what you need. You deserve this. But over time, my version of rest transformed into doing absolutely nothing, not because it restored me, but because it required the least amount of energy. I found myself drained and disconnected from the life I wanted outside work.

The trade-off of neglect

It brings to mind a study published several years ago in the American Heart Association Journal. It asked participants how much of their life they would trade to avoid taking a daily pill. 21 percent said they’d trade anywhere from a week to a year, and more than 8 percent said up to two years. The authors didn’t necessarily explore the reasoning behind these responses, but my personal interpretation is that many of us are willing to give up far more than we realize. I see it in myself, all in the name of simply getting through the day.

Working in health care, that trade-off often feels reasonable. We tell ourselves we’re being gracious with our limited time and energy. But grace without intention is neglect, and as we know in medicine, neglect is invisible, until it isn’t.

Reclaiming self-care

I love my job, but it doesn’t define me. When my days consist of either lying in my bed or running around the hospital, it’s output without input. We need a variety of both to function in and beyond work, and what is considered life-giving looks different for everyone. My therapist suggested a strategy called the “rule of threes”: three daily, three weekly, and three monthly goals (in case anyone was concerned, drinking more water is one of my daily goals).

I’m still figuring out what it means to combat a scarcity mindset and reclaim the little things. Yes, time is precious, but there is enough, and that time should be used to take care of ourselves with intention. Maybe it’s a sip of water before seeing the next patient. Maybe it’s finally replying to a text that’s been sitting unanswered for two weeks. Maybe it’s choosing a walk over doomscrolling on the couch.

And maybe (just maybe) getting ahead of that first kidney stone.

Amanda Shim is an emergency medicine resident.