Leaving an Abusive Relationship (and Why It Takes So Long)

I didn’t even realize I was leaving while it was happening. I thought I wanted to stay. I did want to stay. I kept believing there was a version of the job where things would get better if I just adjusted a little more, gave a little more, bent a little longer.

But over time, I slowly realized something quieter and sadder: I couldn’t keep doing it and still be myself. I couldn’t keep waiting for the system to change or suddenly see me as human.

Leaving corporate medicine doesn’t happen all at once. It happens slowly. Quietly. With a lot of self-doubt.

For years, I told myself things were fine.
That exhaustion was normal — that it was what I had signed up for.
That the needs of the system mattered more than my own.
That if something felt wrong, it was probably because I wasn’t resilient enough.

That’s how unhealthy systems survive — they normalize the harm.

Over time, the message becomes clear: being a “good doctor” means being endlessly available, endlessly energetic, relentlessly optimistic, and always ready to dive in for the team — with little room for limits or humanity.

When personal or family needs inevitably arise — illness, caregiving, grief, mental health — the response is rarely true support. More often, it is comparison. Quiet judgment. The spoken or unspoken message that you just need to be a team player, that this is what you signed up for.

The cost of that environment is not just burnout. It is erosion — erosion of trust in your instincts, erosion of permission to be human, erosion of clarity about how much of yourself you are allowed to keep.

We tell physicians to “put the patient first,” without acknowledging how easily that phrase can be used to justify martyrdom. We praise overwork as dedication. We celebrate self-sacrifice as excellence.

Recently, I watched a colleague receive a well-deserved award. She was praised for always staying late, overbooking, and giving endlessly of herself. She is an excellent physician. There is no doubt about that. And still, something inside me felt off as I listened to the speech, delivered by a bright-eyed male resident.

When did we decide this is what excellence looks like?

What makes this hardest to name is that much of the pressure didn’t come from men in suits. It came from women I cared about — women who kick ass at their jobs, save lives, perform extraordinary surgeries, and provide truly exceptional care. Women who believe deeply in their work and in their patients. And also women who, having been shaped by the same system, too often enforce its rules on other women, questioning boundaries, judging those who couldn’t or wouldn’t self-sacrifice in the same ways, and unintentionally continuing a cycle they themselves never chose.

At some point, I realized I was grieving something I hadn’t formally lost yet — the version of medicine I thought I could practice, and the community I hoped I could remain part of.

Building an independent practice has not been about rebellion or proving a point. It’s been about recovery.

Recovery of time.
Recovery of trust in my clinical judgment.
Recovery of boundaries without guilt.
Recovery of joy in my work.
Recovery of the art of medicine — not rushing through algorithms or living on the treadmill of an unending inbox.

There’s also something else I didn’t fully appreciate at the time: this decision coincided with one of the best parts of midlife. Perimenopause and menopause get framed almost exclusively as loss — of energy, youth, fertility, and desirability. But there is another side. A clearer sense of self. Stronger boundaries. Less tolerance for bullshit. More bravery. And a growing freedom from the need to be liked by everyone.

Leaving coincided with a season of becoming more honest about what I need, what I value, and what I’m no longer willing to sacrifice.

And maybe most importantly, midlife gave me back a belief I didn’t realize I’d lost — that good medicine does not require self-erasure.

I share this because my experience isn’t unique. So many women in medicine are quietly asking themselves the same question:

“Is it supposed to feel like this?”

If that question has crossed your mind, you’re not weak. You’re not uncommitted. And you’re not failing your patients.

Sometimes the bravest thing a woman can do is leave — even when she never planned to.

And to my friends who stay: I see your bravery too. Staying takes courage — setting boundaries, pushing back, and trying to create change from within a system that doesn’t always make room for it. I’m rooting for you. I still care deeply about the colleagues and teams I left behind, and I hope you succeed in breaking cycles that never should have been normalized in the first place.

I couldn’t stay. And so I’m deliberately building a version of a career in medicine that leaves room for good care, for time to listen to women and make them feel seen, and for the kind of thoughtful decision-making that isn’t rushed or constrained by algorithms. It also leaves room in my own life to practice the habits I talk about but so often couldn’t live — movement, rest, laughter — and to be both mentally and physically present with my children while they still live under my roof.

And I hope that someday soon, when we celebrate excellence in medicine, we do it for wisdom, judgment, and care — not for how much of ourselves we were willing to lose.