Although becoming a doctor is a rigorous endeavor, the journey is somewhat prescribed. I made a decision to become a doctor at seventeen; I boarded that train and rode it through college, medical school, residency, and fellowships. All the while so focused on the destination that I never got off to explore, rarely looked out the windows, and never reconsidered where I was headed.

Now, almost forty, I look around at what was once my dream and think: Is this it? Is this where I meant to end up? Is the decision I made for myself at seventeen one I would make now?

I grew up in a small town where many never leave, and even fewer pursue graduate-level education. Going into medicine felt like a way out and a way to prove my worth. I struggled through my pre-clinical years, but the first time a patient looked me in the eye and gave a sincere “thank you,” I knew I was home.

I was drawn to academic medicine because I idealized it. To me it represented the highest expression of the profession. I was barely aware that over time my entire identity was reduced to “academic physician.” I romanticized the grind, always putting the patient and academia first, dressing it up as “ambition.” I didn’t think too much about the sacrifices I was making along the way, because I felt important. Medicine was the perfect ecosystem for someone like me. It rewarded me in ways that felt deeply familiar. Throughout my life, I had learned to equate achievement with worthiness. Good grades, hard work, kindness, excellence: These things were praised and reinforced. I became very good at performing in ways that earned validation.

And with that mindset, I built the career I had envisioned. My first job out of fellowship was at a large academic institution as a pulmonary and critical care physician, a pulmonary hypertension specialist, the co-chair of the hospital’s ethics committee, and core faculty within the school of medicine. My first year I gave grand rounds across virtually every department at my institution, published three peer-reviewed papers and two book chapters. Because we lacked administrative support on our team, I was even the one who made our schedules, organized meetings, created calendar invites, designed handouts, printed business cards, made team shirts, blind to the gendered expectations I was quietly reinforcing. At the end of the day, I was all the way in. This was my dream, and I pursued it with everything I had.

I remember filling out my first year-end faculty report thinking, “My boss is going to be so impressed with me.” My husband, several years my senior, watched me poring over it and said simply, “No one reads that.”

And he was right.

I had given lectures, taught extensively, volunteered my time, and poured enormous emotional energy into patient care. I began to wonder if the system was counting on me doing just that. After all, those most likely to go into and succeed in medical careers derive meaning from pleasing others, exceeding expectations, and being needed. We are rewarded constantly for saying yes. A lecture invitation feels like an honor, not unpaid labor. Writing a book chapter feels prestigious, not extractive. Covering additional call, answering inbox messages late into the evening, carrying a pager overnight without compensation, spending extra unpaid time with patients: All of it becomes framed as evidence of dedication and professionalism.

Furthermore, the incentive structure rewarded throughput, not presence. I was disincentivized to discuss the results of a patient’s right heart catheterization immediately after the procedure, but I did it anyway, unpaid. My colleagues in the ICU were chronically overworked and under-supported, leaving little time for meaningful conversations. I would often rotate on service to realize that certain families had no grasp of the gravity of the medical situation. The message was subtle but unmistakable: quantity over quality. Keep the machine running at any cost.

I started to wonder if my whole career I had been groomed to do just this (to put the patient first, to go above and beyond) so that when I finally arrived, the institution could count on those tendencies. Did they know all along that doctors will always do the “right” thing? Of course I’m calling that worried patient back, compensated or not.

And it’s not just the system; even among one another the unspoken lessons students and trainees absorb about what it means to be a “good doctor” are pervasive. We teach them to power through anything. Keep your head down. Keep working. Do not be emotional. Do not burden others with your struggles. The patient comes first, always. There is nothing more important than the work.

But the lack of humanity for the trainees directly affected their work. Residents in the ICU would say things like “This family just doesn’t get it” or “They’re being unreasonable.” Imagine meeting someone on the worst day of their life and being annoyed with them for “not getting it.” These were young doctors, still in training, and already the empathy fatigue had taken root. I would do my best to model something different, to sit with the family and find the fear underneath the frustration, but the moral injury was emotionally exhausting, and lonely. Every mislabeled family, every rushed conversation, every patient who deserved two hours but got ten minutes left a mark.

I once read an essay from one of my medical students describing an attending physician she admired. One of the qualities she praised most was that he stayed late in clinic and missed his daughter’s recital. She framed this as evidence of extraordinary commitment. I remember how misaligned this felt. What are we teaching them?

Worse? The physician she was writing about was my boss. He had so thoroughly internalized the culture of self-sacrifice that missing important moments with his family had become normalized, even admirable. And for me, personally, it was that same culture that made it difficult for him to recognize when I was going under.

I graduated fellowship, over Zoom, during a global pandemic. And from there, as a new attending, life came at me with all of the excitement, stress, and loss it had. My grandparents passed within a week of each other, a parent suffered a medical emergency, and I became pregnant with my first child.

Then, on December 18, 2021, we lost Santosh, suddenly, impossibly, at only thirty-nine years old. He left behind his wife and two little girls. The grief that followed was unlike anything I had known: not a wave, but a collapse. The kind that rewires your brain and changes the fabric of your being. Two months later, when I became a mom, we named our son Santosh Bodhisattva.

It was apparent right away that motherhood was something to work around, not something institutionally supported. Our hospital did not offer true paid maternity leave. Instead, I strung together FMLA and PTO to stay home with Bodhi. Once back at work, I looked around to realize there was only one other attending physician in my division who was a mom. I felt sidelined, no longer able to make the 7 a.m. lectures and the 6 p.m. journal clubs that are incompatible with daycare hours. Still reeling from the loss of Santosh, and adjusting to motherhood, I continued working full time. The universe must have decided that I hadn’t woken up yet, because the hits kept coming. At one point I was juggling rounding on the pulmonary hypertension service with visiting my stepmother in the very ICU I staffed where she ultimately died.

Running on empty, I continued to place my patients’ needs above my own, giving whatever remained to academia, trainees, and colleagues. Family emergencies were squeezed into the cracks of my life. There were only scraps left for my husband and baby. Nothing left over for me.

After months of silently unraveling, I finally sent this email to my boss and my immediate team:

“The past two years I have taken care of everyone else and have not taken care of myself. I have experienced a lot of change and significant loss. I feel like I am doing my best just to get through the day, both at work and at home.”

The response?

“You’re so strong.”

At the time, those words shattered me. Because strength had become the reason nobody noticed I was drowning.

A few short days later, feeling the defeat of asking for a life raft and being told to swim, I sent another email. This time to my division chief: “I am having a really hard time. I need to take time off for mental health reasons. My therapist has recommended three months. I need this to start immediately. I do not have the capacity to tidy up loose ends.”

I took time off to grieve and heal. At first, that looked like a lot of Netflix, Ben & Jerry’s, and shame. Why couldn’t I handle it all? But I wanted to heal, genuinely, deeply, and to find my way back to myself.

So I made a decision. I would return, but differently. Part time. With boundaries around the unpaid labor that I once gave freely, as it now directly competed with motherhood. I recommitted to academia, because despite everything, I still loved it and wasn’t prepared to let it go.

Back at my institution, though, I felt a shift in how I was perceived. There is a culture within academic medicine that equates suffering with virtue. The people sacrificing the most, working the hardest, enduring the greatest personal depletion are seen as the most committed physicians. By trying to find balance in my life, I somehow felt disqualified from belonging.

The irony was that when I went part time, I became the most academically productive I had ever been. I published in JAMA and the ATS Blue Journal. I gave an invited talk at Harvard Medical School’s Center for Bioethics. I was appointed to the American Thoracic Society Ethics and Conflict of Interest Committee. I won the Best Teacher Award from the school of medicine. I created a novel pulmonary hypertension curriculum and presented at two national conferences. When my JAMA article got circulated to our division, none of my colleagues replied. The silence said everything. The unspoken rule had made itself clear: If you weren’t also breaking yourself in the process, you hadn’t really earned it. Was I imagining it?

I wasn’t. A colleague sent an email to my entire team and my boss criticizing that one member of the team was “not pulling their weight,” without speaking to me directly or including me on the message. When I later confronted him about it, he responded with a shrugging emoji. I have thought about that a lot. After a three-month leave for my mental health, burying a friend and my stepmother, and becoming a new mom, a grown man, with an MD behind his name, felt that a shrugging emoji was a sufficient response to causing harm to a colleague. No one intervened. No one was held accountable. The lack of support from leadership said everything. This was simply how things were.

When I advocated for paid leadership roles, I was dismissed. When I got excited about academic opportunities, I was told to “calm down.” I pitched integrating advance care planning into our clinic and was met not with discussion, but with vague resistance. The culture began to feel strangely devoid of support or collective joy. I didn’t feel safe at work, to share my academic interests, my ideas, or the good things happening in my life.

Adding to the dissatisfaction, as my patient-facing time lessened, the administrative burden of medicine remained the same. The hassle factor, the modules, the compliance trainings, the inbox, the documentation, all of it persisted regardless of how much clinical time I reduced. The parts of medicine that once felt sacred (human connection, listening, sitting with suffering, helping families make sense of impossible situations) were increasingly limited in relation to the busy work.

I was standing in front of medical students giving lectures on wellness, self-care, and the hidden curriculum. I was coaching students on professional identity formation and well-being. I was invited to speak on hope and resiliency panels. All the while coming home to my new family defeated, feeling like an outcast, emotionally drained and exhausted. Not by the doctoring, but by the people I was working with, the expectations of the system, and the menial tasks that gave no fulfillment.

So I started to disengage.

Through all of this, I sought therapy. I found a life coach. I was trying, genuinely, to find a way to stay, to reconcile who I was becoming with the career I had given my entire life to. But the more I looked for answers, the more strongly rooted I became in my own values. I had been asking the wrong question. It was not: How do I make this work? It was: Does this deserve to be made to work?

I named my son Santosh Bodhisattva. Santosh, after our friend, but also a Sanskrit word meaning joy. Bodhisattva, a concept from Buddhist tradition, refers to one who is on the path toward awakening. I chose those words deliberately. And somewhere in the quiet, it occurred to me: If I believed in those things enough to give them to my child, didn’t I owe it to myself (to him, to this one life) to actually pursue them?

What I came to understand is that I had not fallen out of love with medicine. I had fallen out of love with a version of success that required chronic self-abandonment, one built on external validation, prestige, publications, and performative achievement, while quietly crowding out connection, simplicity, and joy.

During training, I had accepted the terms. Missing weddings, birthdays, milestone moments. The sleepless nights, the pager, the endless sacrifice. I wore all of it like a badge. That was the deal, and I had made peace with it. But I had arrived. Where was the life I had been promised on the other side?

What I wanted was simple: to be fully present with my son, to giggle until our tummies hurt, to walk my basset hound through the park on a cool afternoon, to actually show up for date nights with my husband. Small things. Real things. Medicine made it too easy to treat them as optional.

After Santosh’s death, after becoming a mother, after watching how fragile and finite life truly is, those sacrifices stopped feeling noble. They started feeling tragic.

And now, on the other side, all I want is something simpler. Slower. Softer.

So now I am choosing alignment over achievement, intention over autopilot, and leaving academic medicine. I boarded that train at seventeen. I am almost forty now and am finally stepping off. For the first time, the destination is mine to choose. After all, what’s the best that could happen?

Liz Sonntag is a board-certified pulmonary and critical care physician, a medical ethicist, and a physician coach. She is the founder of Say More Coaching.

She recently pivoted out of clinical medicine to focus on coaching medical students and physicians. Her professional background spans critical care, palliative care, and clinical ethics, and her scholarship reflects that range: ethics and social medicine education under political pressure, advance care planning in cystic fibrosis, access to medically necessary reproductive care for patients with pulmonary hypertension, and the ethics of mechanical circulatory support and surgical decision-making. Her work has appeared in JAMA, CHEST, and the American Medical Association Journal of Ethics.

She writes on Substack and shares updates on LinkedIn and Instagram.