I want to share something personal today, partly because writing it helps me understand it, and partly because saying it to you makes it real.
There is a decision I have been circling for a while, and I am putting it in writing here so I actually follow through. It touches everything about how I show up for patients, which is why it belongs alongside the things we ask of you rather than hidden behind them.
Why does modern life feel so directionless?
Because the structure that used to supply direction has quietly diminished. In the past, life came with built-in directionality. The institutions, the milestones, the expectations told you where to go and when. The old maps do not point the way they used to, and we are left to draw our own.
I have been working with a coach named Patrick Harbula, of the Living Purpose Institute, and our conversations have shifted something in me.
As someone who has been a skeptic since I was young, I love part of this. There is freedom in getting to choose how to move through life.
But on the other side of that freedom sits something harder: uncertainty, a lack of clarity, and sometimes a quiet absence of meaning.
What does long-term joy actually mean?
It means using joy and freedom as a compass rather than chasing momentary comfort. Working out may not be your favorite thing in the moment, though we still practice learning to like it. Long-term joy is the steadier question: how do I want to spend my time in this one precious life?
What struck me most about Patrick is that he lives by following long-term joy and freedom. Those two words landed immediately.
Many of us were raised to take care of everyone else first, to put all others ahead of ourselves. So centering on joy and freedom felt a little scary. It also felt liberating.
Here is what I am learning. When joy and freedom are your center, the people around you want that for you too. And from that place, which is really just deep self-care, you become more able to take care of others, not less.
So what is the decision?
Over the next few months I am titrating down my nights working in the hospital, and eventually I will stop. I have been a hospitalist since I finished residency and have kept doing nights all this time, partly to stay connected to hospital medicine and partly because I have four daughters to support.
That work has meant a great deal to me. But when I hold it up against long-term joy and freedom, the answer becomes clear.
I am choosing to sleep in the same bed as my wife. I am choosing not to be sleep-deprived and irritable when I am trying to be present with my family.
I am choosing to feel joy and motivation about the things I am building, rather than running on a depleted nervous system and calling it duty.
This is not a decision against hospital medicine. It is a decision toward the life I actually want to be living.
I share these reflections because I am on the path too, not above it. I stumble through this work the same way anyone does. Writing it down is part of how I hold myself to it, and maybe, in seeing my journey, you find something useful for your own.
