Just before dawn on a Sunday, I wake to a frightening declaration in my head: “I don’t want to be a doctor anymore.” I try these words on like they are foreign and dangerous. I don’t want to be a doctor anymore. To be the doctor I want to be, I should be, I want everyone to be, takes more of myself than I am willing to give, more than I even have left, certainly more than I can take away from her.

I creep out of bed and sit alone at my desk to consider it. Tinny drips from the shower faucet slit the blue-gray silence. I picture my energy as discreet quanta, finite expenditures like so many drops in a drain. Where has each bit gone?

My sister and I take turns feeding pureed lunch to our father, suffering from progressive dementia these last ten years. He lived at home until our mother died, abruptly on the edge of her bathtub, and we moved him from one facility to another until we found someplace that could bathe him without our help. We packed our childhood home and sold it to pay for his care, under a cloud of grief so dense we could barely breathe.

Then came the spate of marriage and first home and a baby soon after. An hour after childbirth I had a cardiac arrest, they said from amniotic fluid embolism, so in the bewildering haze of nascent parenthood with all its attendant joy and exhaustion, there lingered a sobering truth that our daughter might not have had a mother. Between follow-up medical appointments and a second emergency surgery, I sought therapy for the panic invading my sleep. How many quanta of energy could these sessions rescue? I hoped more than they cost.

I returned to work after two months, making up all the shifts I had missed during maternity leave in the next two. I pumped breastmilk in the car on the advice of colleagues and became a master at the energy-sucking mul-titask. At night I pined for sleep with a will too sharp to allow it, then returned to work in the morning to hold children’s lives in my shaking hands. Fatigue corroded my defenses so thoroughly that caring for critically ill children became almost unendurable. I laid hands on my daughter’s back at night to feel the steady rise and fall of her sleeping breath.During rare quiet moments alone, usually driving to work, I implored the universe never to take her from me.

My forehead bears a sharp dent when I finally raise it from the edge of the desk. The room is lighter now but still soundless except for the leaking shower. Each ping now dictates full stop. My quanta are gone. More black hole than supernova, my star has died. I guess this is burnout.

I attended a lecture about burnout during residency, an annual mandate established after five interns quit in one year. The solution was to achieve work-life balance through self-care, the speaker said. When work drains us, life will restore us. I was neither a partner nor a parent yet andmy father’s symptoms could still be explained without using the word dementia. Work eclipsed all else for at least eighty hours a week soI never questioned the reverse scenario—what happens when life drains us instead?

At its best, medicine does restore us. It is exactly through caring for others that we strengthen ourselves, except when our daily quanta of energy are spent before we meet a single family or patient. We cannot escape so much of what consumes us as physicians— cumbersome electronic health records, archaic communication, relative value units—at least not as individuals in the short-term. Simultaneously, we are all mortal. We have babies, mourn deaths, heal scars, and between it all we still need food, sleep, and love. We are humans doing a superhuman job. To overcome epidemic burnout, to quell the incomprehensible rate of depression and suicide among our colleagues, we can start by acknowledging it.

The very words we use—balance, burnout, self-care—fail to admit that when our professional and personal duties swell in a culture that refuses to align them, it is too much to ask. Burnout infers insufficient energy from within, as if one’s spiritual well were too shallow or constitution too weak. The word too sharply implies internal deficiency when the inciting problem is excessive demand, when work or life (or both) delivers a load too great for one sane person to bear. It’s really more like human fracking—a solid stone, once impressive and strong, is fissured by external pressure to release the fuel within.

Balance connotes a precarious state navigated by grace. Just when two pans steady toward even, when joys and responsibilities level imperceptibly, something uncontrollable pitches the scale. The human fulcrum must then restore equilibrium against the laws of physics. This paradigm pits work and life at odds, framing them as counterweights against each other, as if their union isn’t the deepest kind of joy. I can think of no other dichotomy so damaging to a young physician or the patients he or she will treat, than to imagine that life begins only once a shift has ended.

As for self-care, the term must apply to the medical profession as a whole if it is to be expected of any individual. Leaders in medicine should take notes from technology firms, law practices, and corporations that provide emergency childcare, sick day coverage, and humane leave for new parents. This support is essential to recruit and maintain talent, because stress begets negativity like a contagious disease and it is spreading in medicine.

If any industry should care for the caretaker, it’s ours. But we have not done it well.

To this end, everyone should eat lunch. Not while charting or reading email, but preferably with another person. Encourage your colleagues to do the same, and don’t expect everyone to be as strong as you imagine yourself to be. I teased a fellow once for always eating lunch. No matter how busy the unit was or how many codes we ran, he visited the food court. My colleagues and I viewed him as soft because we never ate once during our fellowships. The truth is, he was in a better mood than we were most of the time and didn’t complain nearly as much. Medicine could stand to drop the attitude that we are somehow immune to the same basic physiology we have devoted our lives to understand. We must cultivate balance around us and among us, not just within us.

I rub away the crease on my forehead and listen for the leaking shower. Morning’s din has muted its drops. The sun is up and so is she. With one lungful of her scent, baby shampoo tinged with sweat and whatever forgiveness smells like, a quantum of energy surges back. Like after a night in the pediatric intensive care unit, just before I collapse from the weight of it, she stacks the lenses of work and life on top of each other to magnify all that is right in my world. Buried in the place where her neck meets her hair, I revoke the declaration that woke me. I do want to be a doctor still, but I also want to be a mother and a partner and a sister and a daughter to my dying dad. I am not weak or burned out; I have been fracked to the core.

My sense of fault erased, something else surges through me. It is not fresh energy or comfort like that which emanates from her nape. It feels somehow different, as foreign as the words that woke me. I think it must be hope.