I had a very interesting exchange with a colleague recently. We were discussing the things women in medicine discuss when we let our guard down: emotional labor, exhaustion, guilt, and the ever-elusive concept of self-love. She told me she had taken a day off to tend to her own needs, doctor's appointments, errands, the things physicians do when they finally carve out a sliver of time for themselves. When she came back the next day, she was buried. Inbox overflowing. Messages piling up. Patients waiting. Chaos.

She said something that stopped me in my tracks: "It's the price I pay for that day off."

And I thought, why is there a price? Why does taking care of ourselves come with a penalty? Why do we treat a single day of self-care like a debt we owe, a tax we must repay with interest?

Because that is exactly what we do. We internalize the idea that rest is a luxury we have not earned, that stepping away, even briefly, is a transgression. And the system reinforces this at every turn.

I know this because I have lived it.

When my mother was dying, I was a resident. My mother was a physician herself, and I had chosen to do my residency at the same hospital where she had done hers, specifically so I could stay home and take care of her. She was on hospice, and I was trying to coordinate an emergency plan for her care while simultaneously showing up for my shifts, because that is what we do. 

We show up.

Except that night I was supposed to be on “short call.” I couldn't and didn’t show up. So that shift had to be covered-I believe that task fell Nadine, who admittedly had covered me once before. The truth is, I simply forgot, and when the MAR notified me I was too overwhelmed. I was ordering a hospital bed, on the phone with hospice nurses, arranging home care, and moving her furniture around to make room for the new bed. On top of all that, I had to coordinate morphine administration with her new nurse, as mom was no longer capable of doing so by herself and would no longer allow me to give her anything because of the fear I was "poisoning her." As if things couldn't get worse, mom now couldn't remember my name.

She died in my arms, later that night.

That's when my autopilot kicked in, the one that is always running, the one we are trained to never shut off. I called the MAR in a flat, hollow voice and said, "I'm sorry. I don't think I'll be able to make it to work today. My mother just died. I don't know if I'll be able to get to work the day after tomorrow either." I did not cry. I did not ask for help. I reported my absence like I was calling in a lab result.

They gave me three days. Three days of bereavement for the woman who raised me, the woman who inspired me to become a physician, the woman I had restructured my entire career to care for. Three days.

I came back after those three days. I lasted another two and a half before I broke. I had to take vacation immediately. Two of my four yearly weeks. Not because I wanted a vacation, but because I physically and emotionally could not function.

And when I returned, officially, after my mother had died from cancer, they put me on the hematology-oncology ward.

I begged them. I said, please, I will do the dreaded unit. I will do the step-down. I will do zombie night float, because I am not sleeping anyway. Please do not put me on heme-onc. My mother just died from cancer.

They did not just put me on heme-onc for one month. They put me on for eight straight weeks. Back to back. Eight weeks of watching other people's mothers die from the same disease that had just taken mine. 

Agony.

That was the price I paid for three days of bereavement. Not even self-love. Just grief.

And here is the part that haunts me still. That a colleague had to cover my call the night my mother died. To this day, sixteen years later, I carry guilt about that. I cannot even remember if I paid her back for that shift. I probably did, or maybe she told me not to worry about it because- well, my mother had died. It was all such a fog. But years later, I am still carrying it. Sixteen years of guilt over a single missed call on the night my mother died.

That is what this culture does to us. 

It teaches us that our grief is an inconvenience, that our humanity is a scheduling problem, and that the appropriate response to personal devastation is to apologize for the disruption.

We are trained into this. It starts in medical school, intensifies in residency, and by the time we are attendings, it is so deeply embedded that we do not even recognize it as abnormal. We carry it into private practice, into leadership roles, into our own clinics. We build entire careers on the foundation of guilt and self-denial, and we call it work ethic. We call it dedication. We call it professionalism.

But let us call it what it actually is: a system that profits from our suffering.

Because here is the truth.  To the corporations and health systems that employ us, we are a profit margin. Our lives, our health, our grief, our burnout are line items on a spreadsheet. They do not care about our mental health days. They do not value our vacation time. They do not understand the purpose of an admin day. These things are not seen as necessities. They are seen as lost revenue. Worse, they are weaponized against us. Take a day off, and you will pay for it with chaos when you return. Take bereavement, and you will be punished with the worst rotation cruelty can find. Ask for any accommodation, and you are labeled difficult and need to pay it back in spades.

And we accept it, because we have been beaten into submission. We fight tooth and nail to keep our positions, and the system knows this. It knows we will not walk away, because we have sacrificed too much to get here. It exploits our dedication and calls it a staffing model.

Meanwhile, the same corporations that squeeze every last hour out of us are eager to replace us. First with non-physician practitioners, and now with artificial intelligence. They want to hand over the most complex, nuanced, deeply human work in existence to algorithms, without accepting any of the liability, without understanding why Amazon and Walmart and every other corporation that has tried to practice primary care has failed.

Primary care is arguably the most difficult discipline in medicine precisely because of the depth and breadth of knowledge it requires, the relationships it demands, the judgment it depends on. It cannot be replicated by a chatbot. It cannot be reduced to a decision tree. And yet, these systems are ready to try because it is cheaper.

They see us as means to an end. Replaceable. Expendable.

So maybe it is time we start treating them the same way.

Not with their brand of cruelty, but with clarity. We need to stop giving more to systems that repeatedly diminish us, erase us, and replace us. We need to stop sacrificing our mental health, our days off, our vacations, and our admin time on the altar of a culture that does not reciprocate. We need to stop paying a tax on self-care as if rest is a debt we owe.

Just because we think we should not take a day off does not mean we should not. Just because we have always done it this way does not mean it is right. Just because they are thinking about replacing us does not mean they can, or that they should, or that we should make it easier for them by burning ourselves to the ground in the meantime.

The change does not happen in a vacuum. It happens when we talk about it. It happens when we stop normalizing the expectation that a physician's humanity is negotiable. It happens when we refuse to accept that grief is a scheduling inconvenience and that rest is a punishable offense.

I hate seeing my colleagues suffer like this. I hate that my friend came back from one day off and immediately framed her own self-care as a cost. I hate that I still carry guilt from a single missed call sixteen years ago. I hate that any of us have ever had to apologize for being human.

This is not fair. I do not know what else to call it except completely unfair and ridiculous. And it needs to stop.

We deserve to take a day off without paying a price. We deserve to grieve without punishment. We deserve to rest without guilt. It makes us better doctors to our patients.

We need to stop pretending otherwise.

And thank you for covering for me, Nadine.

Please know that I still thank you to this day.