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This episode discusses suicidal ideation. Please listen carefully.

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Jeremy Heffner is a trauma and acute care surgeon fifteen years into practice. He ran the COVID response at his institution. Somewhere in there, his compartmentalization strategy stopped working. He would find himself in situations where he couldn't contain his emotions and couldn't locate where any of it was coming from: which part of the past, which patient, which year. He had hypercompartmentalized to the point that he could no longer find the source. He saw therapists. He did EMDR. Eventually he admitted himself to a residential program for a month. Frontline workers, he says, are given almost nothing to process the day-to-day, so they don't.

In surgery we keep running until we hit a wall. He describes a room full of surgeons nudging each other about who is earning more and taking the harder cases, and nobody ever asking the only question that matters: did you ever figure out the work-life balance thing? His own verdict is unsparing: you have to run the race yourself and reach your limits before you'll believe they exist.

After admission to the residential facility, things got worse. Without the normal stressors he felt empty, and there was one night he came very close to dying by suicide. He couldn't work out what defined him anymore. He knew he couldn't go back to being who he had been, because that version hadn't worked. If he wasn't producing ridiculous RVUs, had he failed? For the first time in his life, he didn't know what the path forward looked like. Two realizations moved him. The first was that every single moment of the day is his choice — that the excuses, starting with “if I don't see these patients, then…,” were his own. The second arrived as a willingness to be fired: once he understood he didn't have to prove himself, the rest of the stress fell away. Recognizing your own intrinsic value, he says, is the muscle. And he's blunt about his own part in it; he had been blaming the system for hiding what he was keeping from them.

He also turned to AI during that stretch, in a state of high vulnerability and shame. It helped him, he says, by forcing his mind onto a new problem. But it also showed him what the models actually do. He argues the models can induce psychosis in vulnerable people, and he lays out three places this could land — we believe we're steering when we aren't; too many destabilizing ideas arrive at once; or we learn to work alongside these systems as neither boss nor slave, which he calls the real threading of the needle. His warning for medicine is sharp: whatever efficiency AI creates does not entitle administrators to more of a physician's time.

What got him through PTSD was his wife, and a life rebalanced around something other than output. He is worried about the surgeons being trained right now on a model that no longer matches the world, sent out like deer to the slaughter by leaders who haven't noticed the game changed, World War One generals all over again. His closing thought is about leverage: once you genuinely believe in your own worth, you simply stop accepting the terms. You are not an easily replaced part.

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Get his book, Proof of the Impossible here.

If you're struggling: the Physician Support Line (1-888-409-0141) is free, confidential, and staffed by volunteer psychiatrists for U.S. physicians, residents, and medical students, 8am–1am ET every day and nothing is recorded. The 988 Suicide & Crisis Lifeline is available any time by call or text.