Leaving her practice to reinvent herself from scratch [PODCAST]

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She built a thriving practice in Manhattan and appeared all over the media. Then she walked away, and it was never burnout. Samantha Nazareth is a gastroenterologist and the author of the memoir I Left Anyway: The Life I Was Supposed to Want. In this conversation she describes a deliberate triple exit from her practice, her home, and a ten-year relationship, and the six-week sabbatical that became years of travel. You will hear why she did not wait for retirement or a collapse to ask whether medicine could be all of her. She talks candidly about learning to swim as an adult, rebuilding an identity when your career is no longer the center of it, and sitting with the messy, uncertain in-between that most stories skip. If you have ever wondered what happens after the leap, this is the part no one describes. You will hear why the free fall after the leap is the real work, and what it takes to stay a student when the map runs out.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Samantha Nazareth. She’s a gastroenterologist, and her new memoir is out, I Left Anyway: The Life I Was Supposed to Want. Samantha, welcome to the show.

Samantha Nazareth: Thank you. I’m excited to have this chat with you.

Kevin Pho: All right, and we were talking offline. I think we met about 10 years ago at some type of medical marketing conference, and it’s safe to say that, of course, you’ve had quite the journey since then. So from all outward appearances, when I first met you, you were a very successful gastroenterologist in New York City. I saw you all over the media. You were on CNN. Was that perception accurate? What was your life like when we first met about 10 years ago at that marketing conference, as a physician?

Samantha Nazareth: So back then, I was already practicing. I was in private practice, and we met because it was sort of an unusual conference, a type of conference meant to think outside of the box. So I was already thinking, “OK, what else can I do?” now that I had finished all the training. I was early in my career at that point.

And at that point, let’s see what happened after. I had a solo practice. The path kind of led me to that, which was amazing. Especially in Manhattan, it’s quite difficult to have a solo practice with overhead being so high, but I had an opportunity that was presented, and it was actually great. I really was happy to have that experience.

A couple of things led to, well, you had mentioned my book, and what someone would call a big rupture or a big transition, and it was a culmination of a couple of things. One, my mother had passed in 2021, and we were very close, and that put things into perspective very quickly of how I was living my life.

She retired into home hospice, which was something that really made me look and see, OK, do I have this opportunity to wait until retirement? And that’s what we’re always sold, right? Wait until retirement to live your life or to live a free life. And clearly my mom didn’t have that opportunity, because she passed away shortly after.

So that weighed on me after the grief, of course, and I had already been looking to take a break from New York City itself. I had been in the area for as long as I can remember. A little break for school, but otherwise, I had done my residency and fellowship. I was born and raised in Hoboken, New Jersey, so I was immersed in that world for quite a bit of time.

And I was in a 10-year relationship that I was also questioning if I wanted to be in any longer. So I kind of describe it as almost a triple exit. And for medicine it was more nuanced, and we’ll discuss that a little bit, but I had this idea to start the new year, because that’s what people do, right? With a sabbatical. That’s how it started really, was a six-week sabbatical, and that was the first pause or exit that I took. But it was really like a triple exit. It was from home, the relationship, and traditional practice. And physicians, especially someone early in their career, they normally don’t get that opportunity to take that sabbatical.

Kevin Pho: And I remember I follow you on Instagram, and you were posting these exotic pictures from overseas, and those pictures just really never stopped. So tell us, where did you go for that sabbatical, and what happened next?

Samantha Nazareth: The sabbatical started in Puerto Rico, and it was a significant and meaningful place. Actually, that’s where the book starts, right then. And my family’s from Puerto Rico. They had left many, many years ago. I don’t have much family left there. Whoever’s left is extended, and I’m not very close with them.

But I think when anybody is in a questioning phase, they always return home, and home can mean different things to different people. For me, it could be an ancestral home. That’s what it was for me. It could be something else. But I’ve read, and as I’ve gone through this journey, I’ve met people who have had similar breaks or transitions, and they went somewhere where they felt that they were going back home.

And I actually didn’t post it. It’s funny that you mentioned the posting on Instagram, because I didn’t post at all the first year. Firstly, I thought that the sabbatical actually was six weeks. I went into it thinking that, and that I would go back to New York. Puerto Rico wasn’t that far. It would be a nice place to enjoy the winter as a break, and then return back when the weather was warming up.

But I also felt like everything was reversible at that point, and that’s why I didn’t post. Because it was the exact thought that I was worried someone would have. Like, what is she doing? She’s posting all these beautiful tropical photos. What happened? Or what does that mean?

And usually the question really references medicine. It seems never to go back to the relationship or home of New York City. I think the part of my identity that people can’t usually understand why I would, quote-unquote, “leave,” the life I was supposed to want, hence the subtitle of my book, was always the medicine part.

It wasn’t the 10-year relationship. It wasn’t leaving home. The greatest number of questions that I get is about medicine. Why would you leave a thriving solo practice in Manhattan, in the traditional sense? And it came up everywhere. It didn’t matter, really.

I’ve been to, I hate to say quantity, but just to give you scope, I’ve been to 90 countries, and I’ve been to very, very remote places. Well, I’ve been to an island where there were only three of us, but the one place that I was thinking of had 30 people, and I specifically have this memory sitting at a remote island. It’s called Fakarava. It was in French Polynesia, and it’s a resort that you dive at. It was like a scuba diving place, so everybody eats together and then dives together.

So during one of our meals, everybody had questions about this. “What? What did you do?” And there was a dentist there. He said, “Oh, but you can go back.” And I said, “But that’s not the whole point.” That was an intentional choice. So it has definitely been the topic of conversation, at least the medical part.

Kevin Pho: Now, when I saw all your pictures on Instagram, you had already been on leave for a year, because you hadn’t posted since then. Now, when you said that it was intentional, what was going through your mind? What were some of your thoughts at the beginning of your sabbatical? What were some of the goals that you had, and did you think that it could evolve into what it has become?

Samantha Nazareth: The blessing, and the part that made it very easy for me to do it or to say six weeks, was that I had already been consulting virtually, and that was something I had been doing alongside my clinical career for a while. I had been involved in health tech for a while. So things were always remote, virtual just by design, because everybody was always from different parts of the world.

So I had already been carrying that into this break, because a lot of people ask, “Well, how did you finance it?” And luckily, I already had something that was still ongoing that I could just continue, and it was remote.

But I would say that starting out, I had this magical idea that I was going to create something after six weeks. I mean, can you imagine, just out of thin air, thinking of something in six weeks? That’s what I believed. And when I had even read about pivots and transitions, I read a timeframe saying that it could take up to five years. So this idea of six weeks was a little ridiculous on my part. I was humbled, because obviously after six weeks, that didn’t happen, that I created this magical new life.

But essentially, it was to have space and some distance from what I was familiar with to get perspective, and have that time in a different setting and completely different environment, to perhaps create something fresh and emerge from something.

Kevin Pho: Now, is something like this something you could have fathomed when you were younger or earlier in your career? Is this something that in the back of your mind you’ve always wanted to try or do?

Samantha Nazareth: No, because I went into medicine thinking I would practice the way that people practice, the traditional way, until, you know, you say you die on the table, right? I really thought that that was going to be it. When I signed up for the eight-year medical program back when I was a teenager, I thought this was it. I was in it for the long haul.

So I didn’t have this desire for this type of life. I definitely had this inkling of being abroad, though, when I studied abroad as a college student. I studied abroad in Australia, and I was quite sad when I was returning back to the U.S. I remember at the end of that semester just thinking, “When will I ever have a break like this to go abroad,” being in a medical program.

So the idea to be traveling was already planted then, but the professional part, I had no idea how it was going to look at all.

Kevin Pho: So tell me about the evolution while you were away from your practice and you were processing your relationship and the grief that you were experiencing. Tell us a little bit about that process as you were abroad.

Samantha Nazareth: I want to make it clear that this wasn’t about burnout. That was not part of my story. My journey really started to question if medicine can be all of me. That was it. I’ve always had this inkling to be a student, to be a beginner again, to have this curiosity to do new things, and I wanted to be a beginner again in some capacity. That’s really what the heart of it was. I wanted the next mountain.

Especially at that point, I mean, I’m mid-career, and you get to a point, especially as a specialist, where you feel like you’ve attained some competency. So that question of, “Well, do I coast on competency?” I can. I mean, that’s what I was trained for, to be a competent physician. And I decided, at least making that first step to the sabbatical, well, maybe there’s something else I can do.

And that’s a huge part, because I think people seek pivots, and I certainly saw this as, some people have to wait for a collapse to actually then question, “Well, does this life really fit?” I didn’t, and I didn’t feel medicine was a villain for me. I actually was very fulfilled. I just had other desires that were brewing more and more.

So certainly going into the sabbatical and traveling was, I would describe, a messy, a very messy in-between. Very messy.

Kevin Pho: Tell us about some of those other mountains that you conquered, some of the new skills that you learned during this journey.

Samantha Nazareth: I didn’t know how to swim. Sometimes it’s embarrassing to say that as an adult, and especially being in a place like Puerto Rico, where I was living on the beach. And I was faced with that reality. For meditation, grounding, I would go out on the beach, usually sunrise and sunset, and I was really faced with the fact that I couldn’t swim, because I was observing everyone enjoying the water as they should.

I had this idea actually presented to me to dive, to scuba dive, on this remote island. And Puerto Rico’s an archipelago, so there are multiple islands. Usually people think of San Juan and that one, but there are other islands, and there was one that was remote. Like, monkeys only inhabited that island, but you had to be a certified scuba diver to actually go there. You couldn’t go as a try or a discover dive.

So I already had this goal in mind. I need to certify, and I knew I needed to pass a swimming test to get to that point, to certify. So then, because I was already going to the beach sunrise and sunset, I put myself in the water, and I had some friends help me. I didn’t take any formal swimming lessons. I probably should have. It would have expedited my confidence in swimming, or made it at least more formal and more technical.

But I learned how to swim to pass this scuba diving exam, and that was in Puerto Rico. And two years after that, I actually became a scuba instructor, just for pure passion.

Kevin Pho: I understand you learned a new language as well while you were in Paris?

Samantha Nazareth: Yes. So that was another humbling experience. I started in Paris and I didn’t take a French class. Some people take it in high school or college. I’ve never taken French. But I quickly realized that my life would be 100 times better if I learned the local language.

So then, definitely for that, I did take classes just to get a working knowledge. I’m certainly not fluent now, but I know enough to order and get by on a day-to-day basis. It’s hard because I didn’t stay in Paris for a long, long stretch of time to really deepen the skill. But certainly I’ve spent enough time there to pick up on phrases and converse in a casual way.

But it is very humbling. Especially the pronunciation in French is very difficult, I would say. I mean, I confuse two body parts, because the words are so similar, and it’s a difference of like u and ou, just very slight. So even to a friend, I basically said to her in French, “I have an ant and it bit me.” And I meant to say it bit me on my neck, but it came out that it bit me in my ass, in French, because the words are very similar. And she looked at me like, “What do you want me to do about that?” And I kept saying it. I kept saying it.

Kevin Pho: You were so confident, I’m sure.

Samantha Nazareth: Yeah, I was. I’m like, “I know that’s the word.”

Kevin Pho: A lot of your story and your memoir is about identity, of course. And you mentioned that you were in the eight-year medical program, and I went to a seven-year program, one of those combined programs. Very similar, where your life seems to be charted literally right out of high school, right? So you didn’t even have to apply to medical school, because right out of high school you’re already accepted to medical school. You just have to go through the eight years. And of course, your identity now is much, much different than what it was back then. Knowing that your career path was set relatively early, how difficult was it for you to course-correct and really adopt these new passions?

Samantha Nazareth: Very difficult. It’s this idea that you can, and I had this idea that with certainty you have control. But life isn’t like that. Life is very uncertain, and understanding that on the professional side is very difficult, because obviously we’re all high achieving and we’re used to plans and credentials and next steps.

And really my one step was taking a six-week sabbatical to this destination. That was it. There was a sort of a blueprint of, OK, maybe go back to New York and then Paris later, but I didn’t really know how all that would look years later, like a year, two, three.

I mean, now I’m on year four. So it’s almost year four, I guess year three technically. Year three and a half now, and it’s very difficult. Sometimes I don’t know where I’ll be in a week, in two weeks, and every day I’m sitting with it, like, I don’t know what’s the next even location or destination, and even that uncertainty can be a little bit jarring.

But that’s one of the reasons why I wrote the book, because this messy in-between is navigating that. The leap can be interesting, and that’s what most people talk about, this before and after picture, but what happens in the middle? What happens during that journey, and what does that look like, and how uncomfortable is that? One life has sort of ended, but the new life hasn’t started, and really grappling with that uncertainty. I would say, if I have to say one word, it’s uncertainty. That’s really what it is. Feeling it, living it every day. It’s daily. It’s every day.

Kevin Pho: Do you feel like you’re still in transition and you’re not quite at that endpoint yet?

Samantha Nazareth: I don’t think so. I guess who’s to say when you’re at the end? I think I have clarity around certain parts of this.

One, I’ve discovered that I like to write, which, actually the book came from the first chapter I wrote. I woke up in the middle of the night to write the first chapter. It just poured out of me. And I’ve read about this from artists and people who have these thoughts that they’re just bursting with in the middle of the night. And I thought that was maybe it, but I didn’t know that. That came during year one, towards the end, when that started, because the book took a year to write and then another year that I was too afraid to publish it. But it came at the end of year one, that moment of, “Oh, I should write, I should write this.”

My life became clearer. Because of my love of diving, I found myself mainly in Southeast Asia. And so, in terms of where I’ve been traveling, Southeast Asia became a destination for me because of scuba diving. So that became clear also with time.

Kevin Pho: So tell us, right now your life revolves around scuba diving. What role does medicine still play in your life?

Samantha Nazareth: Yeah. So hence the question that I always get. How it’s changed is that my relationship with medicine changed. And I would say that as the world became more global, mobile, and virtual, so did my work. My work evolved into telehealth consulting and AI. So the only thing I left was a windowless basement office with artificial lighting. That’s the version of myself, that’s the version that I left. But it evolved, kind of like what happened during COVID. Many professions evolved and expanded beyond what was traditionally practiced.

Kevin Pho: So tell us what your days are like right now. Obviously scuba diving is a big part. What other things are you passionate about right now?

Samantha Nazareth: Well, scuba diving, writing. The location that I’m at is actually a big surfing destination. So I started surf classes, which is really wild also, as a non-swimmer not too long ago, because surfing is very hard if you’re not a strong swimmer. Have you ever surfed?

Kevin Pho: I haven’t, no. So I’m so interested to hear.

Samantha Nazareth: OK. So I’ve described this to the other surfers here. They’re like, “Oh yeah, that’s normal.” Like, whoa, OK. If you don’t ride the wave, you can basically do a full 360 on the board, dipping into the water and then popping up. It’s almost like a washing machine.

And if you’re not really comfortable doing that underwater, or spending quite a bit of time dunking yourself underwater, it’s very frightening as a wave is coming. The surfers seem like they’re not bothered by it, but this relationship that I have with the water definitely is being tested taking surf lessons. So it’s again more expanding, getting into discomfort or very uncomfortable situations, but also learning a skill. And that’s driven really by the destination that I’m in. Usually something is there that I should learn, or there’s a school.

Like, I became a free diver simply because I found a school in the Philippines. The school was in a vegan restaurant, and I’m not vegan, but I really like this restaurant. And I was going there to eat, and I met the instructor, and we started chatting, and I said, “I never really considered being a free diver. I’m a scuba diver.” And we spoke and spoke, and then I took the first level with him, and it was also very challenging as a non-swimmer, or a recent swimmer, to go to those depths. So it’s almost like the destination speaks its own language to tell me, “This is what you need to learn now.”

Kevin Pho: Well, it’s so incredible to hear where you are now, considering when you started this journey, like you said yourself, you didn’t even know how to swim, and look at you now. Now, as you reflect on your journey to where you are now, do you think if you were to replay it, is there anything that you would have done differently knowing what you know now?

Samantha Nazareth: I think probably the most important part of this story, this in-between, was probably that Puerto Rico chapter, because I really started from ground zero. Now I have the ability to go into a country, and I’ve been traveling alone, I’ll add that too. And for a long time with just a carry-on. Now it’s a little bit bigger, the luggage, because now I have scuba diving equipment. But for a good two years I was in a carry-on, and going from really just random places, and alone.

I didn’t have that skill set at my first destination in Puerto Rico. So if I’m redoing Puerto Rico, it would be a completely different experience now. Because now I know, oh, I have these passions, and that’s how I meet new people, and this is how I tap into the communities that exist there, and I know what that part looks like.

But going from medicine, like a very structured day, to absolutely nothing, that’s the hardest part. Because you think it sounds exciting to have all that freedom. Like, oh yeah, I can wake up whenever I want and have the whole day to myself, and that sounds really great for maybe a week, like as a vacation. But when you realize this is actually my life now, it becomes really scary. Because now I have to really figure out what I’m doing with myself, because I can’t do this every single day.

So would I have redone that chapter? No. But I know if I went back. I ended up being there for six months during that time, so the six weeks turned into six months. But if I had done that now, it would have looked very different. So if I had to change anything, probably not, because then I wouldn’t be where I am now. But I know if I went back, it would look completely different.

Kevin Pho: We’re talking to Samantha Nazareth. She’s the author of the memoir I Left Anyway: The Life I Was Supposed to Want. Samantha, for those who pick up your book, whether it’s physicians or non-clinicians, what are some of the main messages that you want them to get after reading your story?

Samantha Nazareth: It’s this idea that, again, the leap is interesting, but actually the free fall that happens after is part of the work. It sounds very woo-woo, but it doesn’t look like anything is happening, because you’re still in this transition.

And actually, my book was called Liminal. That was my original title, which means an in-between. And it depends on what culture you’re from, but it can mean different things, like a bardo state, just this in-between one and another. But it is work, and something is happening even if you feel like, “Oh, there’s nothing. It can’t come fast enough.” But there is something happening, and it’s still part of the pivot, or part of the journey.

So if you feel like you’re thinking about it, you only need to take one step. For me, it was just, I kind of negotiated in my mind, it was this six-week sabbatical. Like, this is still reversible. Even if it’s just that, you just don’t know what the next step and the next step and the next step, where one step will lead you.

But know that that in-between state, while it’s messy, it’s still doing quite a bit of work, and you really just need to have that faith and courage just to do that first step, and be as honest as you can with it.

Kevin Pho: Do you have any advice for physicians? Because, as you know, on my podcast and on KevinMD, they talk a lot about leaving that linear path that they had in medicine. It could be burnout or whatnot. And a lot of physicians, like we talked about earlier, they’re used to jumping through that next hoop. It’s pretty much the opposite of being in a liminal space. But you’ve actually made that journey, that step, that transition. Any specific advice for physicians who may be listening to you who are interested in leaving that linear path?

Samantha Nazareth: I think solitude of some sort is necessary. That can mean different things to different people. It could be some time in nature briefly if you’re around a park. It could be by the beach. It could be Vipassana, like a 10-day silent retreat.

But there needs to be a state of solitude to really get into the thoughts, and also to step out of the structure and familiarity, because that’s when things come to light, when everything else is at a standstill and you’re really forced to think about, what am I doing? And this is something that medicine doesn’t train us to do, to really be attuned to our needs. We’re not meant to. We’re meant to override them and perform and save people’s lives, for a reason. But then afterwards, then we have to think about, oh, what do we want? What am I desiring? What are my needs?

But having that solitude, you kind of come back to yourself a little bit, and at least put that part of your brain, or waken it up just enough, to maybe get to that first step. But you do need a little solitude.

Kevin Pho: And just a few more questions. I know that you’ve been very generous with your time. So in terms of next steps, in terms of where you think your journey would lead, any general path, general idea? How do you chart that out, if you do?

Samantha Nazareth: My hope is, now that I’ve written a book, I have a second book in mind and a third book. Ideas kind of start pouring out as you birth one baby. And once that’s settled, then others can kind of take root, and I feel like that’s what’s probably going to come next, is more books, more writing.

And the whole vision for the book is really just to show people that it’s possible, and it doesn’t have to be just physicians. It could be anybody that’s taking this leap, or some big change in their life, that it can happen at any time in their life. It doesn’t matter how old. But as a source of, “Hey, this is my story,” maybe it can inspire someone else. Maybe it can guide somebody else. Maybe it could just shine a light into a part of their lives in any way. That’s at least the first book.

Some people connect it with my mother’s loss. I have a whole chapter about it. And some people wrote these really wonderful messages about when they had a parent that passed away and how they felt. Some people connect with what does it feel like to be single after a decade? I wasn’t married, but some people just describe it as a marriage for me, because I was with this person for a decade. So what does it feel like after divorce? And then obviously the professional part of how does it feel when your whole identity is this profession, and now it’s not, or it’s not a big part of your identity anymore.

So the story, I’m hoping someone connects with some part of it, to help guide, inspire, connect with me in some capacity, just any aspect of it. That’s really my vision with keeping with the writing, and I enjoy it. It’s just, I would say it’s selfish, really. It helped me process this transition with writing, and a lot of writers say that, because I’ve read a lot of writers’ writing processes, and that it helps process feelings, emotions, transitions by writing, looking at the words, creating the sentences, reading back and editing, and really getting back into that time period. So it’s selfish, too, but I hope that aspect of it does help someone else in the end.

Kevin Pho: And my last question, any take-home messages that you want to leave with the KevinMD audience?

Samantha Nazareth: Always stay a student. Be a student, stay curious. Learn something really uncomfortable. I’m still doing it. You can do it anytime. Just keep doing it.

Kevin Pho: The book is called I Left Anyway: The Life I Was Supposed to Want. Samantha, thank you so much for sharing your story and for coming on the show.

Samantha Nazareth: Thank you.

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