The Middle Part: What I Didn't Share When I Left Kaiser
The season between certainty and clarity—and what helped me through it.
When I stepped away from my executive role at Kaiser, I knew I was heading into something exciting. I had found a tribe in General Medicine
that inspired me, and the potential for what we could build felt real. But what I haven’t really shared is what happened in the middle.
The truth is: I struggled. Initially it was tough. Change can jack you up.
I worried about money. I worried I’d made the wrong decision. I worried something would break in the house, that taking a vacation would be irresponsible, that somehow everything might collapse. It wasn’t one big, obvious problem. It was a hundred tiny ones. All buzzing in the background, day and night.
It was the first time in my physician career that I wasn’t working full time. Except for those early days when I just finished residency, when I took Wednesdays off to spend with my baby daughter, who’s now about to start high school. That’s how long it’s been.
The worry and anxiety crept in slowly. Subtly. I kept moving forward, doing the work, crossing off to-dos, but something wasn’t right. I couldn’t sleep (my Eight Sleep was telling me with real data.) I may have appeared ok, but wasn’t present. I told myself I just needed to power through. Like I always had.
But it didn’t get better.
Eventually, my wife, who I had been confiding in, sat me down and said plainly: “You’ve got to get help.” That moment cut through the fog. I knew she was right. But I was still scared.
Even before that conversation, I suspected this was anxiety. It runs in my family, and I had naively hoped I’d escaped it. I hadn’t. I took a GAD-7 screening and was honest with myself. The results were…not good.
I also noticed something else: I felt at ease after a drink. That classic line, “I just have a drink to take the edge off”? That’s not a good sign. That’s a call for help. And I finally heard it.
I didn’t jump into therapy right away, though in hindsight I wish I had. I was hesitant to start medication, too. But eventually, with the help of my wife’s Cigna plan (we were in between coverages at the time), I started on sertraline, an SSRI, first-line for generalized anxiety.
A few weeks in, things began to shift. I was sleeping better. My brain wasn’t constantly scanning for something to worry about. I felt lighter. I could start thinking critically and creatively again.
I wanted to build. I wanted to fix healthcare problems again. It was a tough stretch of about 4-5 months that felt like it was never going to improve.
Looking back, I can see I’ve had similar episodes before, always linked to a new job, more responsibility, ambiguity. But I’d managed to push through those. They always got better. This time was different.
During this stretch, I stopped posting. The NerdMDs blog paused. The podcast slowed down. A few friends reached out to check in. They noticed. I’ll never forget that. Sometimes the signs of mental health struggles are subtle: someone pulls back from conversations, from hobbies, from showing up in familiar ways.
That’s why I’m writing this now.
If you notice a change in someone, reach out. It might be nothing. Or it might be the nudge they need help.
Today, I feel better than I have in years. Problems feel solvable again. Life feels really fun again. And fun feels better than sad and scared.
So if you’re in that middle part, or you see someone who might be, don’t wait. Ask. Share. Help.
