The room was still dark, my cat curled next to me, when I looked at the clock: 4:18 a.m. It was well before my alarm was set to go off, but I knew I wasn’t going to fall back asleep. Reluctantly, I grabbed my phone, put on my slippers, and shuffled downstairs to the coffee maker. While the coffee brewed, I skimmed my email and read the news headlines. Coffee in hand, I opened my laptop and started the day. In the first fifteen minutes of being awake, I had checked in with everyone except myself.
As a professor of hematology, vice chair of faculty development, and section lead of classical hematology, I found that work had expanded into every part of my life. Even when I wasn’t working, my mind was spinning through issues to be solved, conversations to revisit, and responsibilities I might be forgetting. My mind never stopped. Life felt heavy with the burden of responsibility. I was angry, tired, and struggling. But because I could still push through every day, see the patients, answer emails, and get done what needed to get done, no one knew. And I was also too afraid to let anyone know.
Eventually, I named what was happening as burnout and got help. But over the years, I’ve learned that although burnout described what happened to me, it didn’t fully explain how I had gotten there.
The thing underneath burnout
Burnout didn’t happen overnight. I had arrived there through years of tiny acts of self-abandonment. There wasn’t one dramatic moment, just ordinary decisions. Working when your body says stop. Saying yes when you mean no. Swallowing disagreement. Taking responsibility because you can. Ignoring resentment because someone needs you. Choosing what will disappoint others least rather than what you know is right for you.
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Self-abandonment is the repeated practice of overriding what we know, need, feel, and value to meet an external demand or expectation. I had been doing this for years. And I was surrounded by people doing much the same.
Although medicine reinforced it, it didn’t invent all of it. Many of us arrived at medical training already oriented toward achievement, praised for responsibility, and exceptionally good at meeting expectations. Medicine gave those tendencies space to flourish.
Why would intelligent, accomplished physicians do this?
We learn that achievement provides evidence that we are competent, that we belong, and that we’re valuable. You publish the paper, get the promotion, receive the compliment, solve the problem, or take on the leadership role. It feels good, for a moment. And much of that evidence has an expiration date. You are promoted, make partner, take on a new responsibility, or see a patient with a diagnosis you’ve never seen before. At each achievement level, you feel like you need new evidence.
Proving doesn’t always feel like proving, which is why it can be difficult to recognize. It can look admirable: being dependable, helping the colleague, taking the extra patient, or agreeing to another committee.
When proving your worth requires repeatedly overriding yourself, achievement and self-abandonment become intertwined.
The cost isn’t only exhaustion. It’s losing trust in yourself.
Every time I knew I needed rest but kept going, I didn’t just become exhausted; I taught myself that my needs are less important than what needed to be done. Every time I knew I didn’t want something but said yes anyway, I didn’t just get busier; I taught myself that someone else’s expectations mattered more than my own knowing. Every time I waited for permission to make a decision I already knew I needed to make, I wasn’t just making the decision harder and slower; I reinforced the belief that authority lived somewhere outside me.
I had become skilled at reading the room and anticipating what others needed from me, yet I was uncertain when asked: What do I want? What do I need? What do I know?
I had abandoned myself so that I could hold everyone else. The demands were real, but I had picked up some of what I carried myself. No one else had handed it to me without me accepting it.
My own realization: I was waiting for permission
What I really wanted was permission to stop carrying everything. Permission to disappoint people. Permission to let go of the version of myself everyone expected. I didn’t realize I was waiting for someone else to give it to me. No one could give you that permission.
What I needed wasn’t simply to rest more, manage my time better, or become more resilient. I needed to hear myself again, to discern fear from what I knew to be true, and to trust what I heard, including when acting on it disappointed someone else. Over time, the source of my safety and validation shifted from something I sought from others to something I found within myself.
Perhaps recovery asks a different question
A physician experiencing burnout understandably asks: How do I make this more manageable? But perhaps we also need to ask: Where am I abandoning myself? What am I still trying to prove, and to whom? What do I already know that I’m waiting for someone else to give me permission to act on?
Burnout may have been what finally made me stop. Self-abandonment was what I needed to understand. And rebuilding self-trust meant learning that I no longer needed someone else’s permission to listen to myself.
This essay is cited in the KevinMD record on physician burnout.
Christine Kempton is a physician, certified coach, and former academic hematologist who spent more than two decades caring for patients, mentoring physicians, and leading in academic medicine at Emory University, where she holds emeritus status.
Today, through Christine Kempton Coaching, she works with high-achieving women in medicine who look successful on the outside but often find that work and life feel heavier than they expected. Many learned to handle pressure by pushing harder, carrying more, being the responsible one, and looking outside themselves for certainty. Over time, those strategies can erode self-trust and leave them disconnected from themselves.
She helps women reconnect with themselves, rebuild self-trust, and create a more sustainable way to lead, practice, and live without giving up ambition. Her work draws on her experience as a physician and leader, along with evidence-based coaching and emotional regulation, helping women create success that feels as good on the inside as it looks on the outside.
Her research spans patient-reported outcomes and quality of life in people with hemophilia, racial and ethnic disparities in hemophilia care, differences between men and women with hemophilia, immune tolerance induction, and representation in clinical trials. Her work has appeared in Blood Advances, Haemophilia, and the American Journal of Medicine, where she has also written about burnout in health care. She shares updates on LinkedIn, Instagram, and Facebook.
