It was 11:30 at night and everyone else in the house was asleep. I was at my desk in the home office with the laptop as the only light in the room, and I was searching.

This was late March of 2024. I'd already left the hospital job by then. I was looking for someone local who could give me a second opinion, and somewhere in the middle of that I started asking a different question, which was, what had been fueling this in the first place.

I found a free course. The page said:

Discover a systems-based approach to healthcare.

Further down it said something about how the body's systems connect, and what that does to your health.

It was free, so I started it. I finished the last module around two in the morning.

I'd spent 24 years in a job built on what medications do to the body. Whether a drug works. What else it does that nobody wanted it to do.

That expertise stops at a layer.

We look at the organ. We mostly don't look at what's happening in the cell underneath it. The nutrients a medication quietly uses up. What it does to the bacteria in your gut. What it does to the part of the cell that makes your energy. Those go on to cause problems of their own, and they land on the same pile as everything else you're already carrying.

I knew the body was connected. At 11:30 at night I was finding out how many layers down that goes, and how few of them anybody is looking at. Including me.

NONE OF THEM TALK TO EACH OTHER

In the way medicine is organized now, being a specialist is the prize. Joint problem, rheumatologist. Heart, cardiologist. Something with your brain or your nerves, neurologist. The deeper into one part you go, the higher the regard.

None of them talk to each other.

They might talk to your regular doctor. Your regular doctor has fifteen minutes and thirty other people that day, so mostly they don't talk to each other either.

Here's how that played out for me. I thought what I had was a gynecological problem. That's what it looked like and that's what everybody treated it as. What I didn't fully appreciate until that night is that sex hormones don't operate in their own silo. They run alongside your adrenal and thyroid hormones. And all of those move with how much stress you're under, what you've been eating, how you've been sleeping, and what you're standing in.

So the thing I kept handing to one specialist was being driven by four things that specialist never asked about, and wasn't supposed to.

THE ONLY MEETING WHERE EVERYBODY SHOWS UP

There's one exception and it's worth knowing about.

It's called a tumor board. Specialists from different departments sit down together around one person's case and work the whole picture at once. Oncology, surgery, radiology, pathology, sometimes a dozen people in a room.

It works. It's also reserved for people who are sick enough to qualify, or for a case so strange that nobody wants to call it alone. Nobody calls a meeting for the person who's just quietly getting worse.

The other way to get your whole picture looked at is to go and assemble it yourself, and I did try. It took three months. Finding providers, getting referrals requested and approved or paying out of pocket, then waiting for an opening on somebody's full calendar.

If you've ever been told your labs came back normal while you could barely get off the couch, you know this feeling.

WHAT I WAS ALREADY CARRYING

Here's the part I didn't see for years.

Those ten years in the job didn't land on a blank slate.

In 2013 I came back from leave with a new baby and a nine-year-old at home, and took the helm of the department in the same stretch of months. I wasn't sleeping. I was nursing. I was trying to get the weight off. I ate whatever kept the supply up and didn't think much past that.

None of it got paid back before the next thing showed up.

Then 2020 happened, and we were all there, so I'll keep it short. On top of my own job I took on another one, supporting community vaccination clinics for kids. And somewhere in those years a glass of wine at night became two glasses at night, most nights. I'd guess a fair number of people reading this did some version of that between 2020 and 2022 and have never once put it on the same page as everything else.

Put all of it on one page and here's what you get.

Biological. Cognitive. Emotional. Relational. Leadership. Environmental.

That's the Functional Resilience Framework, and every one of the six was carrying something in that same stretch of years.

What my body was doing.
What my head was holding.
What I was feeling and not saying.
Who at home could take something off me and who couldn't.
What the job asked of me as the person everything routed to.
And the place itself.

All six at once. I didn't invent the parts.
I got tired of watching people get one of them looked at in a silo.

YOUR BODY HAS BEEN ADDING IT UP

There's a term for the total. Researchers call it allostatic load, and it's the wear that accumulates from everything your body has had to keep adjusting to.

What matters is how they measure it. Not one number. A composite. They pull markers from your heart, your metabolism, your immune system and your stress hormones, and they read them together, because any one of those on its own often comes back looking fine.

I want to be careful here, because this is where people overreach. That research measures the total. It doesn't measure the six dimensions of my framework. My six are how I keep track of where the load is coming from.

The idea underneath isn't mine and it isn't in question.

Last time I told you about a colleague who described my working conditions back to me on the way out to lunch, and how it landed like new information. We stood in the same ground for about the same ten years.

She got tired. I ended up in an exam room.

For a long time I figured the difference was something about the two of us. It wasn't. She didn't have a newborn in 2013. She didn't have to be on-call for many years and her staff covered for each other. And by the time my body finally threw its tantrum, she'd been retired a few years already.

Her exposure stopped. Mine kept running.

WHAT I'D HOLD OFF ON

If you've been treating your own exhaustion as proof that something's wrong with you or the person you've become, hold off on that.

You've got all six running right now, and nobody’s probably looked at more than one of them at a time. Including you.

None of it came with time to recover before the next thing arrived. Not in what happened to me, and not what I chose.

Recovery is what I want to look at next, because I had that wrong too.

If you want all of it looked at once, start here: www.magedmangroup.com/insights