Most of us know the experience of something unexpected happening and reacting before we pause long enough to engage our frontal lobe. We hear ourselves say something we do not mean, feel anger surge before we understand why, or watch ourselves react in a way that feels misaligned with who we believe we are. We say, “I saw red,” “It felt like I was outside my body,” or “I do not know why I responded that way; that is not who I am.”

One reactive moment does not define us. But when the same reaction keeps appearing, it begins shaping our relationships, our work, and our lives. We may feel like passengers on a plane hijacked by our own nervous system, watching ourselves respond in ways that do not reflect who we are or who we intend to become.

So why do these reactions keep taking over, especially when they feel so unlike us? Because the nervous system is often responding not only to what is happening now, but also to what happened before. It remembers experiences in which we did not feel safe, supported, seen, protected, or allowed to have needs, and it develops rapid responses intended to prevent that pain from recurring. Those responses may once have been adaptive and necessary. Years later, they can continue taking control when the situation has changed, and the old strategy no longer serves us.

Many health care professionals begin their careers carrying experiences they have never had the capacity, language, safety, or support to process. We then enter environments that demand high-level functioning under pressure and begin experiencing our work through the lens of what happened rather than seeing clearly what is happening before us.

What is happening in health care is already enough. We care for people in pain, make high-stakes decisions, witness suffering, manage emergencies, work inside strained systems, and hold the emotional weight of moments most people will never see. The work gives us new chapters of what happened: the patient we could not save, the unexpected outcome, the preventable error, the violent encounter, the critically understaffed shift, or the moment we were asked to carry more responsibility than one person should be expected to hold.

Health care professionals are often praised for moving immediately to the next patient, room, case, or shift. We learn to remain functional and set our emotional responses aside because someone else needs us to be clear, capable, and present. That ability can be lifesaving in the moment. But surviving an experience is not the same as processing it.

When difficult experiences are internalized but never worked through, they do not simply disappear. They become part of the lens through which we experience the next patient, conflict, request, or moment when the nervous system senses that something may not be safe. The body may react to a familiar tone of voice, facial expression, power dynamic, clinical scenario, or feeling of helplessness before our frontal lobe can intervene.

Eventually, holding everything that happened while trying to survive everything that is happening can overwhelm our most practiced coping strategies. It can feel as though everything comes crashing down overnight: who we are, who we want to be, who we love, what we love, and whether we can continue doing the work we once felt called to do.

But the crash rarely happens overnight.

The nervous system may communicate for years before we recognize what it is saying. It tells us what is too much, what needs our attention, where we need to say no, and where a boundary has been crossed. It communicates through irritability, numbness, hypervigilance, withdrawal, disrupted sleep, emotional reactivity, physical tension, exhaustion, and the growing sense that we are no longer ourselves.

When we repeatedly push those signals offline, our view of the present can become distorted. We may begin treating every request as a demand, every disagreement as a threat, every mistake as proof of failure, or every difficult emotion as something that must be controlled. We lose the ability to distinguish between the danger that is present and the danger our body remembers.

Before I understood this, I felt as though my own life and career were collapsing without warning. After two decades in health care, first as an emergency department nurse and then as a certified registered nurse anesthetist, I did not know how I could continue doing the work and emotionally or physically survive it. A decade ago, I came close to walking away because leaving felt like the only way to save myself.

Today, I am still practicing as a CRNA, and I feel more empowered, clear, and energized in my work than ever. I did not get here by becoming tougher, caring less, or learning to tolerate more. I got here by returning, over and over, to what happened and becoming honest about how it was influencing what was happening. I learned to recognize when my nervous system was responding to the present and when it was trying to protect me from the past. I began pausing long enough to ask: What is actually happening right now? What does this moment require? What belongs to this situation, and what am I carrying into it?

Healing did not require me to erase what happened or pretend it no longer mattered. It required me to stop allowing it to remain in charge.

There is tremendous hope in understanding the difference between what happened and what is happening. Our automatic responses are not character flaws. They are learned patterns of protection, and learned patterns can be recognized, interrupted, and changed. We are not powerless inside our reactions. We are not destined to repeat the same responses because they once kept us safe. We can honor what happened without allowing it to dictate every experience we have now.

Sometimes the most important question a health care professional can ask is not, “Why am I like this?” but rather, “Am I responding to what is happening, or to what happened?”

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.