A colleague recently recommended licensed clinical social worker Terri Cole’s book Too Much after seeing a quote I shared on social media about no longer accommodating people who refuse to take responsibility for their own emotional work. Her timing was remarkable.

As I read, I felt as though Cole had somehow studied the way I lived for much of my life. I recognized the constant monitoring of other people’s emotions, the anticipatory problem-solving, the compulsion to make things easier for everyone else, and the quiet belief that being useful meant I was valued.

Cole calls this pattern high-functioning codependency, or HFC. She describes high-functioning codependents as people who become overly invested in the feelings, circumstances, decisions, and outcomes of others, often at the expense of their own peace and well-being. They are frequently smart, successful, reliable, and deeply capable. They handle everything, anticipate what everyone needs, solve problems before anyone asks, and make the whole operation look effortless.

As a certified registered nurse anesthetist who has spent nearly three decades in health care, I had an immediate thought: Is this the definition of high-functioning codependency, or the unofficial admissions criteria for a career in health care?

The acronym HFC also reminded me of another acronym we use in medicine: HFpEF, or heart failure with preserved ejection fraction. Ejection fraction measures the percentage of blood the left ventricle pushes out with each contraction. In HFpEF, that percentage can remain within the normal range. The heart is still contracting, but the ventricle has become stiff and cannot relax and fill normally between beats. The number can look reassuring while the patient is still experiencing heart failure.

High-functioning codependency and HFpEF are not equivalent conditions. One is a behavioral and relational pattern, and the other is a complex medical syndrome. Still, the parallels were obvious to me. From the outside, function can appear preserved. A health care professional may be succeeding at work, caring for a family, covering the open shift, remembering every detail, anticipating every complication, managing other people’s emotions, and remaining the person everyone can depend on. Their function is preserved. Their capacity is not. People praise the person’s output while no one, often not even the person themselves, asks what it is costing them to keep producing it.

Health care is particularly skilled at rewarding this pattern. Health care systems call it dedication when someone habitually stays late. They call it teamwork when the same person repeatedly absorbs work that belongs to others, and they call it resilience when a clinician continues functioning under conditions that are steadily eroding their well-being. Because the person remains competent, productive, and outwardly composed, their distress becomes easy to miss. They look OK. They may even believe they are OK because nothing has fallen apart yet.

But high functioning does not necessarily mean healthy. Sometimes it means the system is still compensating.

This pattern can be difficult to recognize in health care because many of the underlying qualities are genuinely valuable. We want clinicians who are observant, thoughtful, prepared, generous, and responsive to the needs of others. Caring deeply is not the problem. The problem begins when we assume that noticing a problem means we must solve it, that understanding someone’s feelings means we must manage them, or that seeing a need means we should carry it, whether or not we actually have the capacity to do so.

For many health care professionals, professional competence and personal overfunctioning become tightly intertwined. We learn to anticipate needs before they are spoken. We become comfortable in crisis. We receive affirmation for remaining calm while carrying extraordinary responsibility. Those skills can make us excellent clinicians. They can also follow us home, where we may continue scanning, anticipating, fixing, and protecting long after the shift has ended. Eventually, we may become able to recognize everyone’s needs except our own.

Healing from high-functioning codependency is not about becoming less loving, generous, or capable. It is not about refusing to help or abandoning the people who depend on us. It is about developing the discernment to ask: Was my help requested? Is this responsibility actually mine? Am I offering support, or am I taking over? What is this costing me, and do I truly have it to give? Can I allow another capable adult to experience discomfort, make a decision, or live with the outcome of that decision without rushing in to manage it?

These questions may sound simple, but for someone whose identity has been built around being dependable, stepping back can feel more threatening than continuing to overextend. That discomfort does not mean the boundary is wrong. It may mean we are interrupting a dysfunctional pattern that has been rewarded for a very long time.

We also need health care organizations to examine the patterns they reward. We cannot continue to celebrate self-abandonment as professionalism or treat endless personal accommodation as the solution to structural failure. A workforce should not have to become progressively depleted to prove its commitment to patients. Simply put, health care organizations need to stop expecting individuals to be the sole solution to high-level system failures.

Looking OK is not the same as being OK. Continuing to function is not proof that the conditions are sustainable. Sometimes the most courageous thing a health care professional can do is stop proving how much they can carry and begin asking whether it was ever theirs to carry in the first place.

Sarah Bergakker is a nurse anesthetist, educator, speaker, and the founder of MOOXLI, a continuing education organization offering community and a supported path forward for health care professionals. She practices with Just Breathe Anesthesia Staffing and is a repeat invited guest lecturer at Oakland University in Rochester, Michigan.

Rooted in mindfulness, self-compassion, and boundaried agency, her work helps clinicians move their mindset, oxygenate their soul, and live differently without abandoning themselves in the process. Through immersive learning experiences, the MOOXLI Membership, the MOOXLI App, and her writing, she equips health care professionals with practical, evidence-based tools to build sustainable, values-aligned careers.

Her writing on clinical education, simulation training, and clinician well-being has appeared in the AANA Journal, Home Health Care Management and Practice, and The Pulse Magazine. She also writes on the MOOXLI blog and MOOXLI Substack, and shares updates on Instagram and LinkedIn.