I met Joel on a hospital ship a few years ago. That year, the Africa Mercy, as that ship is called, was docked off the coast of Cotonou, Benin. Joel had just arrived from the US—California, specifically—having flown some 36 hours to get there. It was a Sunday night, and he was making himself a sandwich.

I’ve been working on these hospital ships for nearly two decades now. They’re like a second home to me. 

To new volunteers like Joel, however, the Africa Mercy can be a labyrinthine, creaky place with walls imbued with the weird accumulated smells of five decades in operation, air conditioning that runs either too hot or too cold, and salads that taste oddly of chlorine.

“First time here?” I asked, pulling up a chair and setting my own plate of chlorinated vegetables down in front of me. 

“First and last,” he said. “Probably. Just found out I have colon cancer. It’s what made me finally decide it was time to do this, before it was too late.”

I think about Joel a lot. He never made an unreasonable choice.

And he never got to live the life he wanted…

At fifty years old, I walked into a tattoo parlor for the first time.

My artist, a woman half my age with intricate ink climbing both her arms, greeted me with a smile. I found her through Instagram, paid her deposit, and then waited nearly six months for the date of my actual appointment. She knew it was my first time.

The bunch of trainees practicing their fine lines on what looked like pork trotters, on the other hand. They didn’t. One of them—I kid you not—looked up from her work, caught my eye, and said, “First time?” 

She read my nervousness like tarot cards.

That’s because I’d been thinking about this tattoo for ten whole years.

3652 days of a debate with myself. That’s a lot of days. That’s a lot of indecision. And that’s because I’d been looking at the decision wrong.

You’re probably doing the same thing with your decisions, and it might be leading to permanent consequences…

Last week, a new client texted me at 2 AM from the hospital parking lot. She was halfway through her third overnight shift in a row. “You know what,” she wrote. “I’m done. That’s it. This is killing me. I’ve got to quit.”

And then, 10 seconds later: “But I can’t quit.”

Another 10 seconds: “But I need to quit.”

The thing about Sandy’s story (not her real name) is that her husband had seen her burnout coming a decade ago. He’d also seen it absolutely tank her during the height of the pandemic. 

He’d been nudging her toward a change for years. He’d even gone so far as to plot out three different exit strategies. 

She found a reason why each one of them would never work.

Was she just stubborn? Or was something else going on?

Read on…

Growing up, I had a stuffed animal that I loved. My mom tells me that the mother of one of my dad’s colleagues gifted him to me when I was still in utero. And he was never far from Baby Me.

I still have that stuffed animal.

Despite the fact that the rabbit is ugly, stained, and probably a health hazard, the thought of losing it feels like losing something of infinite value.

Irrational? Definitely. I’m a deeply sentimental person.

And also, it’s emblematic of something called the endowment effect — the cognitive bias where simply owning something makes it feel significantly more valuable.

And a reason we stay stuck…

A friend of mine drank a gallon of milk, ate a live goldfish, got alcohol poisoning, and slept in a basement for a month, all to join a frat—where he then lived in literal squalor for the next academic year.

Nearly thirty years later, he still donates to their alumni fund.

In fact, there’s a weirdly inverse relationship between how much abuse he received at his frat and how loudly he defends the abuse. It was almost as if, the worse they treated him, the more loyal he became. 

Why? Read on, because it might just explain why we get stuck in toxic relationships, bad jobs, and expensive clubs..

You’re late to work. Again. 

As you sneak into the conference room, avoiding eye contact with your notoriously crotchety boss, your brain’s already machine-gunning a litany of perfectly reasonable explanations. 

Bad traffic. 

Your kid couldn’t find their science project. 

The coffee maker broke. 

You forgot your umbrella.

Thankfully, your boss never asks. He just glowers.

Right after you take your seat, your colleague also sneaks in. Your boss starts to look a little like a thwarted Yosemite Sam.

And you know what? He’s right to be angry. 

Sarah’s always late and this is just classic. She’s so irresponsible. She probably stayed up binge-watching Succession again. 

Welcome to the actor/observer bias, the reason you keep dating the same bad people and finding the same toxic jobs

In the produce section of a grocery store, a micro-drama unfolds between a couple. The two of them stand in front of a pile of tomatoes. She picks one up, inspecting its shine, its smoothness, its lack of flaws—and, having deemed it worthy, she places it in a clear plastic produce bag. 

While she searches for the next one, her deadpan partner grabs a tomato from the same produce bag and hands it to her. 

She evaluates his chosen tomato—ones she’s already selected. Her lips thin a little bit, and she rejects it. 

In the video’s 26 seconds, we’re witness to an intricate web of four different cognitive biases—four different patterns that distort our decisions….

There’s no quick fix for a hole it took years to dig

On a call with a client the other day, she dropped a line that I haven’t stopped thinking about.

She’s a physical therapist—I’ll call her Chrissy. She’s been in practice for 20 years. And she’s tired. Exhausted. 

She told me she wanted out, but also she had no idea what to do next. Did she want to stay in corporate PT? Start her own practice? Leave the bedside care?

I started describing how I work with clients to get them out of burnout. It takes eight weeks, I told her. In that time, we tackle some very big questions.

She took a deep breath.

“I was hoping there was just an antibiotic I could take for 10 days, and it would all get better.”

Noah Wyle never wanted to do another medical show.

The star of the ER, the show that launched the entire medical drama genre, refused to take a single medical role for fifteen years after the series ended in 2009. 

“I wouldn’t take a script if it was to play a doctor, even if it was a veterinarian,” he says. “The idea of putting a stethoscope around my neck just seemed like a really bad idea.”

And then Covid happened. To quote his 2025 interview with Variety:

As the world was just starting to retreat into lockdown in 2020, Wyle began getting DMs on Instagram from first responders overwhelmed by the first lethal waves of COVID-19. Some simply thanked Wyle for inspiring them to pursue a medical career with his performance on “ER.” But most of the messages were laced with an unmistakable desperation about the precarious state of the country’s health care workers — and how no one was telling their story.

“They were saying things like, ‘Carter, where are you?’” he says. “‘It’s really hard out here.’”

Wyle, meanwhile, was confronting his own pandemic-fed crisis…. “I just thought the world was coming apart. I didn’t know how to contribute anything of meaning or value anymore.”

And so The Pitt was born.

According to the National Center for Health Workforce Analysis, we’re recruiting new doctors just fine. The number of medical school entrants has increased nearly 6% since 2019:

By comparison, the US population has grown by only about 1.8% in that time. So, medical school recruitments are outstripping population growth.

And yet.

The US is projected to be short nearly 200,000 healthcare professionals in the next 10 years. That’s despite recruiting tons of new medical students.

What’s happening?

Well, imagine an old pipe. It’s faithfully carried water from a reservoir to your house for decades, making sure your sink works, your shower has enough pressure, your kids have water to drink, and your shower has the pressure it needs.

Over the decades, it’s started to show its wear… 

A year ago, a friend of mine took a senior leadership position at an NGO he’d admired for years. I’ve known Christiaan (not his real name) for at least a decade—he’s a soft-spoken, gentle, diplomatic Dutch guy. So, when I asked how it was going, I expected an equally diplomatic description of his new job in response. 

I got something altogether different instead. His answer was firm, immediate, and direct:

“Honestly, Mark, I love it. The best part is that my CEO sets the vision clearly, gives me everything I need, and then trusts me to get it done.”

Which got me thinking about the CEO we each have in our heads…Does that CEO trust us to “get it done”?

On the face of it, wellness programs sound awesome — resilience, well-being, work-life integration, and fostering growth of the person as a whole .

But wellness programs don’t work — at least, not in the way that increases actual physician wellness. 

What they do instead is keep physicians indentured to the system that burns them out in the first place. 

I sat at the airport café table, my flat white untouched, staring at my phone. I thumbed my passport absent-mindedly. The choices I'd made to get me to JFK that day felt heavy. What if I moved and hated it? Worse, what if I didn't move? What if I stayed put and resented never trying?

What was I supposed to do with all the potential regret? Could I really YOLO my way through life?

Can you?

Early in residency, doctors learn an important rule about working in a hospital: The longer you stay, the longer you stay.

In other words, the longer you stay at the hospital, the more work will be assigned to you, which, in turn, leads you to staying even longer. 

And that’s true in jobs, too.

But Job Lock doesn’t have to be permanent…

The whole scene reminded her of the humans in Wall-E, slouched in their hover-chairs, Food-in-a-Cup in their right hands, and limpid smiles on their rotund faces. It was almost like she'd unwittingly made a left-hand turn on a Tuesday in 2016, and she'd been shopping at the same grocery store for the nine years since; like she didn't exactly pick this direction, but here she was, gliding forward anyway.

You've felt it too, right? The gravitational pull of a professional identity you chose (or had chosen for you) long before you understood what it meant, long before your pre-frontal cortex was even a glimmer in your midbrain's eye.

I did. My friend Margaret did. She always knew she was going to be a doctor. The daughter of two physicians, she deeply admired her mother. At age 6, she confidently declared she'd be following in her parents' footsteps. And she did. A prestigious university, a top-tier medical school in New York City, residency and fellowship at the top hospital in the US, where she then rose through the ranks as faculty.

And she felt empty.

For those people in identity professions, transition often comes with a familiar dysequilibrium: 'I’m good at this, and I hate it.'

Research shows that our calling can evolve alongside the work we do. A surgeon’s precision may find new expression in process optimization, just as another’s quick decision-making can find new life in algorithm development.

Calling isn’t a cage—it’s a compass. Identity isn’t fixed. It flows, carrying your values into ever-changing contexts.

We've all got that friend. The one who's decisive as hell in part of his life-but couldn't choose a salad dressing if that life depended on it.

Let's talk about that friend, because not only is their way of living a fascinating peek under the hoods of our brains, but it also exposes one of the subtle ways our brains keep us stuck in the status quo.

Being a surgeon was my identity. For five years, ninja warrior had also become an identity.

Now that I no longer did those, who was I without them?