Purpose as Avoidance?

A colleague’s influence, the cost of mattering, and the reckoning I did not choose

Photo by Luke Jones on Unsplash

A friend and colleague of mine, Dr. Heather Paulson, published a piece this week that I have been carrying around in my chest ever since.

Why I had to leave myself behind

She tells the story of closing her oncology practice, leaving the country, and slowly learning that the practice itself had been a trauma response — a way of returning to the scene of her father’s death every single day under the guise of helping other people not suffer the way he did. She opens with a line from Blake Mycoskie that I keep coming back to: “purpose doesn’t heal the wound you refuse to look at.” I let her words move through me. Allowed her sentences to bump against the parts of me that have been refusing to be seen and heard. The light from her words landed on a handful of my blind spots — the ones I had become very practiced at walking around for the better part of three decades.

Dr. Heather and I were never close. Pleasant, collegial, the way you are with someone whose work you respect from across the room at conferences. But when she went quiet — when she packed up her practice and disappeared into the mountains of Peru and the murmurs started, the did you hear what Heather did, the is she okay, the what a waste — something in me knew. I remember it physically. I felt in every cell that she had not lost her mind. She had found her soul. She had stopped pouring, and the people watching her stop were uncomfortable because most of us had not stopped, and the only way to keep going was to tell ourselves that what she was doing was the wrong move instead of the brave one. I celebrated her, quietly, in a way I doubt she ever knew.

I am writing this now because reading her piece this week was the first time I let myself sit with the parallel. And with everything that is not parallel.

Dr. Heather chose to walk away.

I did not.

My ending came differently. Abruptly. With extreme resistance on my part. With dysregulation I am still untangling, betrayals I am still naming, and hard truths landing one after another like body blows — the kind where you do not even have time to breathe before the next one hits. I did not get the dignity of a sabbatical. I did not get the romance of a one-way ticket to a foreign country. I got a forced ending and a phone that stopped ringing and a long list of words I am no longer allowed to say out loud in certain contexts. I got a silence I had not asked for. I got to learn the hard way that the world I had spent over 30 years building — the platforms, the audiences, the institutions, the offers, the relationships, the network — could be peeled off me by other people’s hands.

So when Dr. Heather wrote that her practice was a trauma response, that her external success was the mask over an open wound, that she was reopening it every time she walked into clinic — I felt the wind go out of me. Because of course it was. And of course mine was too.

— — —

What was I running from? I am still figuring that out. Thirty years is a long time to not look at something. I have my guesses. The early losses that I metabolized into mission. The deep need to be the person in the room who knew what to do when the body was failing, because I had been the body that was failing once, at nineteen, written off, and no one had known what to do. The pull to be useful, indispensable, the lighthouse on the rocks for other people, because being the lighthouse meant I never had to be the boat. There is a particular kind of person who becomes very good at holding other people’s lives in their hands. Some of us are very good at it because we are gifted. Some of us are very good at it because we are bleeding and have decided that movement is better than stillness. Most of us, if we are honest, are both.

I built a career on Test, Assess, Address, Don’t Guess. I tested everyone else’s terrain. I have also been testing my own — religiously, since 1996, analyzing my own labs and biomarkers and patterns with the same fervor I have applied to anyone else’s, pivoting in response to what I find, refusing to outsource the inquiry. What I did not permit, until quite recently, was the other kind of testing. The interior kind. The terrain underneath the terrain. The questions that do not show up in blood work. The kind of inquiry that asks not what is happening in my cells but what is happening underneath the reason I keep checking them.

And so I poured. And I poured. And when the cup ran dry, I poured from somewhere deeper — from the qi, from the essence, from the bone-marrow reserves the body keeps locked away for the last hour of the last day. I did not know I was doing it. I thought I was just tired. I thought tired was the price of mattering.

The bone-dry cup is not a metaphor I am inventing for the sake of a Substack. In Chinese medicine, jing — essence — is the deepest constitutional reserve a body has. You are born with a finite amount. You spend a small amount each day just being alive. You spend more when you are stressed, sick, sleep-deprived, grieving, performing, defending, proving. When yours runs out, the body does not whisper. The body collapses. I have watched this happen to patients for nearly thirty years. I have, in retrospect, watched it happen in myself for the last five and called it dedication.

In Dr. Heather’s piece, a mentor catches her at dinner in Peru and asks her, with the particular bluntness mentors are allowed, why she had closed her business when she could have done it remotely. Her answer — which I have now read more times than I can count — was this:

“I realized my business and practice were a trauma response. And I just couldn’t keep holding space while reinjuring myself every day.” — Dr. Heather Paulson

The reinjuring. That is the part. The work itself — the work she loved, the work she was extraordinary at — being the very thing that kept the wound open. Because that is the part I had not let myself name about my own life. The patients I walked alongside through diagnosis. The stages I stepped onto. The chapters I wrote. The interviews, the podcasts, the late-night emails to someone in another time zone who needed an answer before their oncology appointment in the morning. I was helping. And I was, in some inverted way, bleeding into the help. The cup was already empty. I was making the offering from the wrong well.

To clarify, this work — walking alongside people through the most disorienting moment of their lives, helping them rewrite endings that everyone else had already written for them — is still my work. It is still, without flinching, the thing I am best at on this planet. I am not writing this to apologize for any of it, and I am not writing this to walk away from it. I am, in fact, already back to client consulting in a new form — not as the doctor on the chart, but as a bird’s-eye-view ally drawing on three decades of practice and the influence of my mentors, in service of a different narrative and a better outcome. The work is real. The patients are real. The outcomes are real, and I intend to keep contributing to outcomes for as long as I am here to contribute to them. This is not a piece about regret. It is a piece about the difference between offering from a full vessel and offering from a depleted one, and how the second kind is impossible to sustain even when the offering itself is good. You can do beautiful work from a depleted vessel. You cannot do it forever. The body, eventually, sends the bill.

— — —

So here I am. Barely two months past the formal end of this chapter of my professional life — though the chapter itself had been writing its own ending for far longer than that. Sitting in the quiet that I did not choose but that I am beginning, very tentatively, to make peace with. The forced silence has done something I would not have done on my own. It has made me sit down. It has made me unhook my identity from my output. It has made me ask, in the small hours of the morning when no one is watching, who I am if I am not the doctor on the stage, not the author on the book jacket, not the voice in the podcast, not the network in the network. The answer is not yet fully formed. But the question is being asked, and the question being asked is more than I gave myself in three decades of running.

What is emerging looks something like this. I am still going to do the work. I still have something to give, and I do not believe the giving was the problem. The pouring from empty was the problem. So I am rebuilding on different terms. The work I take on now is small in volume and deep in depth. Highly motivated, well-resourced, already-bought-in people who are ready to do their own interior work and not outsource it to me. People who do not need me to be their lighthouse because they have lit their own. People who are looking for an ally, not a savior. People who, in working with me, are quietly mentoring me back into a healthier version of myself without ever knowing they are doing it.

I am also going to write. I am going to write a lot. I am going to talk into a microphone. I am going to walk on a beach with my dogs in the morning before the world wakes up. I am going to refuse calls before ten and after six and on Mondays and Fridays and weekends, not because I learned to set boundaries from a book but because I have learned in my bones what happens when you don’t. I am going to keep the cup full. I am going to be a person before I am a practitioner. I am going to model, for the people I work with, what living from a regulated nervous system actually looks like — because the do-as-I-say-not-as-I-do version of being a healer and a leader is the version that got me here, and I refuse to send anyone else down that road. The do-as-I-do version is harder. It is also the only one I have any business teaching from now on.

And I am launching a podcast. Soon. It is, in a way, this Substack on repeat — but with other people’s voices. Conversations with the writers, teachers, farmers, healers, builders, founders, artists, and clinicians whose book or stage or company or contribution almost robbed them of the very soul that built it.

Conversations about the identity that fell away. Conversations about the new brilliance that emerged in its place — or, in some cases, the new quiet that turned out to be the brilliance. Dr. Heather is one of the people who was in my mind when this idea first came through. So is more than one woman I cannot yet name. I suspect we are a larger tribe than the surface of this industry would have us believe.

— — —

There is one more thing I want to say, and it is about Dr. Heather, and it is about what we owe each other — and it is also about what is currently being said about me.

When she went quiet, the colleagues around her did not, on the whole, celebrate her. They worried. They speculated. They lowered their voices when her name came up. The doing-business-as-usual machine has very strong opinions about people who stop doing business as usual. The system that profits from busy healers is not going to throw a parade when one of them puts the cup down.

I am learning this in real time. The murmurings about Dr. Heather were polite compared to the narratives currently in circulation about me. Stories I will not dignify by repeating. Stories that are, honestly, fucking mind-boggling in how far they have drifted from anything resembling the truth. There is a particular quality of wildness that fiction acquires when it travels through an industry that has decided it needs you to be a certain kind of villain or a certain kind of casualty so that it can keep doing what it was already doing. I do not have the energy to chase the stories. And I have realized, slowly, that I also do not have the need. Let the narratives run their course. The people whose opinion I actually want are the ones who will wait — for the truth, for the writing, for the work, for me — to land on its own time, in its own way.

But some of us — quiet, in our own rooms, while everyone else was murmuring — knew. We knew exactly what she was doing. We knew it because some piece of us wanted to do it too and did not know how. And what she did, by going first, was open a door. She made it real. She made it possible. She made it survivable. I would like to think I am paying that forward now — not by going second, because I am learning there were many I never saw who went quietly long before either of us, but by going loud where some of them had to go quiet.

I did not walk through that door the way she did. The door I walked through was kicked open from the outside while I was still bracing against it. But I am through it now. And I see her on the other side. And I see, increasingly, a handful of other people I deeply respect on the other side too — women and men both, more of them than the surface of this industry would suggest. The other side is not exile. It is the field. The actual field. The terrain none of us were tending while we were so busy teaching everyone else how to tend theirs.

So I am tending the soil of my own soul now. Slowly. Without an audience-size target. Without a curriculum to deliver. The things that are coming — a podcast, an eBook, a new questionnaire, a return to client work in a form that feeds me as much as it feeds the people I sit with — are arriving on a rhythm I am setting from the inside instead of having one set for me from the outside. Because I have learned that you cannot give what you do not have, and the pretending-to-have-it version of giving is, in the end, worse than the not-giving.

Photo by Alfred Schrock on Unsplash

Dr. Heather, if you read this — thank you. Thank you for going first. Thank you for going quiet. Thank you for coming back out the other side as the beautiful mariposa you are, and writing about it so the rest of us could see the path.

And to whoever is reading this who has felt themselves running on fumes and calling it purpose — please. Put the cup down. Look at the wound. The work will still be there. You will be better at it on the other side. And you will, possibly for the first time in your personal and professional life, be able to do it without bleeding into it.

I will see you in the field.

From the soil up,

Dr. Nasha