I was an economics major in college who did not intend on going to medical school. However, like many other idealistic young people, when the time came to choose, I thought about how I would view my life at the end. What would I be able to say that I was proud of? In medicine, I would always be able to say that I helped people.

In retrospect, much of my life was driven by the postponement of enjoyment and the fear of failure. When I did well on an exam, for example, I did not feel joy for testing well. Instead, I felt relief for not doing poorly. I understood this as part of the process of delayed gratification. It is the ”work hard now, play later” mentality. It starts with, “I’ll be happy when I get into medical school.” Then it becomes, “it’ll be better when I finish residency.” In my practice as a urologist even now, I do not find myself celebrating the good outcomes, but instead, perseverating on the complications. “Just wait until you retire.” But retirement is not a bite-sized 5 years away. Twenty to thirty years is a long time for this train of thought.

Medicine has an insidious way of taking its toll. By its nature, it tends to attract the empathic individuals susceptible to altruism. As physicians, we have internalized a moral obligation to always “show up.” While caring for someone else’s loved one, we neglect our own. We find ways, usually at our own personal cost, to maintain quality care despite continuing hospital budgetary cut. The lack of personal protective equipment during a pandemic was unique, not because of the lack of adequate equipment and support, but mostly because of this particular deficiency was publicized. We are the face of a broken insurance system, bearing the brunt of the same patient’s frustrations while being the main (only) person advocating on their behalf. I found myself dreading work, getting heart palpitations with being on call, and setting a countdown timer until retirement. I could not get myself to read anything and felt completely unmotivated.

Given all this negativity, I thought that I must be burnt out. Was I really the same idealistic person who entered into medical school? Did I just have a bad attitude?

The structure of medicine also makes it difficult to escape. I had invested almost a decade to train. My parents had mortgaged their house to help me avoid debts. Society had also made a significant commitment to my training. Guilt becomes another powerful motivator, as is the fear of disappointing those that have supported you. Similarly, after all these years dedicated to a specific field, I felt unqualified to do much else. Once you leave medicine, it is also difficult to return. Understandably, a substantial time away from clinic practice would result in the loss of the practice I had built, as well as require retraining and proctoring to resume.

At 15 weeks pregnant, I decided that I had to reassess either my calling as a physician or perhaps my current job itself. I decided to quit. In fact, I made a timeline of the dates in which I would notify my partners and the last day I planned to work. Then I had a miscarriage. This was followed by the D&C (x2). The sadness during this time period was overwhelming, and I actually found enjoyment in my job again. The ability to help others was cathartic. The personal pain seemed to break the numbness of the burn out, and I could empathize with the pain of my patients.

I could hear my patients again. In particular, I listened as accomplished women describe the embarrassment and shame that they derived from incontinence. These women were mothers who were simultaneously balancing being pioneers in their fields, business women, lawmakers. It seemed absurd to me that these amazing women should feel limited as a result of a common condition, which may have arisen from something of which they should be proud, like motherhood.

I conceived of an underwear company with the aim of destigmatizing incontinence and empowering women and men, by producing underwear that marries aesthetics and function. The fear of failure again prevented me from acting on this idea for many years. At some point, I realized that the risk of not knowing what this company could have been was greater than the risk of failure and I finally jumped in.

I realized now that with renewed purpose, I do have energy and motivation. Ironically, more work has made all work more enjoyable.

Jessica Lubahn, MD is urologist in Portland, OR. She is the founder of ONDRwear (ondrwear.com) which are luxe leak proof underwear, whose mission is to destigmatize urinary, menstrual and any other leakage through products that are both highly effective and beautiful. She can be followed: Instagram @ondrwear, Twitter @jessicalubahnmd