Navigating burnout and disability leave

Welcome, dear reader! I know I don’t have all the answers and my experience is limited, but I hope sharing this provides comfort, reassurance, and guidance to anyone who might be going through the same thing and anyone who wants to start this journey but doesn’t know where to start. Feel free to skip around, or read the whole thing — after all, I’m just here to support.

A timeline of events

October 2019: I start therapy, thinking my burnout is something I can just “work through” by talking about it.

November 2019: I realize I need actual time off. I ask for unpaid leave of absence, but am too overwhelmed to deal with the logistics, so I drop my request.

February 2021: My therapist finally convinces me to seek medical help for my physical symptoms, depression, and anxiety. I learn that I have access to paid medical leave under California’s FMLA law through coworkers I had opened up to about burnout and who had gone through the leave process previously.

March 2021: I finally get a doctor’s note and start conversations with HR (with the support of my manager). A leave administrator is assigned to my case. I stop working at the end of March.

April 2021: I work with my leave admin on the paperwork to get my medical leave claim approved.

May 2021: My leave is officially approved for 6 months, retroactively starting in March and ending September 2021.

September 2021: I work with my manager, HR, the leave admin and PCP on setting up a reduced work schedule of 3 days/week. My company approves the schedule for three months and I am paid through CA’s short-term disability insurance (SDI).

January 2022: I go through another round of approvals to get work on a reduced schedule for an additional three months.

March 2022: My short-term disability benefits end. Since I cannot return to work full-time in my condition, I am transferred to long-term disability (LTD) insurance so that I can be paid.

June 2022: I quit so I can stop half-assing my recovery and my job. My LTD claim is also finally approved.

Where I’m at now (Dec 2022)

Personal health

I’m a year-and-a-half into recovery. I still feel like I’m at 60% of where “normal” should be, and I have to remind myself constantly that it’s okay, these things take time.

Physically, it’s still super easy for me to regress to pre-quitting, stress-induced symptoms like stomachaches, headaches, heart palpitations, sleeplessness, and full-body fatigue. I still struggle to get more than 6 good hours of sleep, even though I’m in bed for 10 hours. My health team has explained it this way: my body is stuck in survival mode and has, essentially, forgotten how to return to homeostasis. I’ve also learned that sleeping 6 hours is the bare minimum you need for your body to perform its basic functions (like digestion), and we need 8–9 hours to be healthy enough to expand into states like ambition, fulfillment, joy.

Mentally, I still struggle with intense brain fog. It took me a year to pick up a book and another 6 months to finish it during this period — not because I couldn’t find time or lacked the will, but my brain just gets overwhelmed really quickly. (The sleep debt isn’t helping).

Emotionally, I’m still trying to find the right balance between being an engaged and present partner and friend while protecting my emotional bandwidth.

Current care

Therapy: weekly for about two years now.

Psychiatry: monthly to assess my progress and my medications.

Primary Care: monthly for a more holistic assessment of where I’m at physically, mentally, and emotionally.

Physical Therapy: 2–3x/week chiropractic (but transitioning to weekly physical therapy starting 2023) and weekly acupuncture sessions for pain management.

Burnout and depression (TW: suicidal ideation)

I think it’s culturally accepted at this point that we live in a society of toxic productivity. That our inherent value as human beings and to the world is rooted in constant, blind, self-sacrifice of our wellness and happiness. Even in grade school, I can recall all of us striving to out-compete another in how hard we worked, how late we stayed up, and how much we achieved. To pull an all-nighter was a badge of honor and continues to be one we proudly wear to the office workplace as adults.

Alongside these societal expectations were equally toxic ones I internalized from my parents, who never stopped working and took pride in that fact. I recall fainting once in the 6th grade on the way to class because I was sent to school in spite of a 100-degree fever. I remember simply getting up a minute later to finish the school day. Even stomach flues weren’t a reason to stay home; it took a day or two before the teacher realized how sick I was and sent me home. Tests needed to be taken, homework needed to be turned in.

These experiences taught me to ignore what I was feeling in my body. If I wasn’t dead or dying, then there was no reason to stop.

Fast-forward to 2020, my stress was at a fever pitch. A cascade of tight deadlines, big projects, and changing management. To survive this, I trapped myself in a vicious cycle of overworking, not getting enough done because I was too tired to function, stressing out about not doing enough fast enough, and overworking to catch-up.

I spiraled into insecurity about my skills and intelligence. I became afraid to ask for help and of contributing my ideas and solutions because they weren’t 100% airtight and perfect like I thought all my colleagues were. Even the thought of submitting my code for review would give me mild anxiety attacks. I would re-write a message to a teammate several times before sending it. I started communicating less and less, which meant people didn’t know how my projects were progressing and if we could meet our deadlines. It negatively impacted my work performance.

I started to have nightly nightmares of being fired. Every day, I’d go into work expecting to see a pink slip and my desk cleared out. I felt a rush of pins and needles throughout my body every time someone spoke to me or messaged me because I was so sure I was only going to hear criticism.

In terms of physical health, I couldn’t sleep for more than 1–3 hours due to my anxiety. There were many days where I didn’t fall asleep until 6am: sleeping two hours before my alarm went off so I could make my first meeting at 9am. I’d wake up with pounding headaches, and I’d go to bed with them. My stomach was hurting constantly, which meant that I was spending hours of the workday in the bathroom (and thus feeling even more stressed about not getting enough done). The heart palpitations would come in clusters — several in a minute, a few dozen by the hour. I couldn’t workout as much anymore because I’d get chest pain and felt like I was never getting enough air. I lived with the hairs on my neck constantly raised; the slightest movement or sound I perceived as alarming would send shockwaves of panic.

I was in a lot of pain, and I ignored it for two years. Every time I got a new symptom, I’d shrug it off with some silly reason — “oh you’re not sleeping well because it’s just an insomniac episode. you’ve had those before”; “oh headaches just run in your family”…etc. I wasn’t dead or dying (yet), so there was nothing to worry about.

It took me until the summer of 2021 to be able to say to myself, “oh I think I’m really depressed” and “I’m tired of feeling bad”. At this point, I almost never left the couch and binged shows for hours in a total haze. If I laughed, it was only to stop myself from crying in front of people. There was this void of sound, sight, and touch where I felt like I was trying to access the rest of the world while stuck in a doorless and windowless room. My heart ached constantly of loneliness and sadness, even as I was finally reunited with my partner after 7-years of long distance (we’re married now!). I often fantasized about scenarios like stepping off a curb a bit too early or too late, and a car or bus would kill me instantly. Maybe a knife would slip, maybe I’d fall down the stairs, or I’d slip off a bluff and into the ocean while hiking.

I wanted to be consumed by the bagel (Everything, Everywhere, All At Once reference — if you haven’t seen it, DO IT NOW). I felt that I was ready to go if death found its way to me.

I waited way longer than I should have to get help.

Applying for medical leave and disability benefits and the cost of healthcare

My journey has been privileged with a lot of resources that I know aren’t available to many of us. I had a high-paying job at an incredible workplace filled with smart, compassionate, and supportive people. I also had a loving network of friends and family; my partner is my pillar through the darkest of times. By the time I quit, I had managed to accrue enough savings to support myself for at least 6 months.

My leave of absence options

As noted in the timeline of events, I wasn’t aware that paid medical leave was an option to me at all when I first approached my manager in 2019 about taking extended time-off. My company had unlimited PTO, so I tried to request to take three weeks of vacation. That was denied since anything more than two consecutive weeks of vacation was considered a leave of absence. So then I started looking into my company’s leave of absence policies. I didn’t think I qualified for paid leave of absence when I first started my research because it required medical reasons, and in my head, there was nothing medically wrong with me. I had acclimated to all my bodily pains at this point, and it was just normal stuff I was going through.

It sounded like unpaid leave of absence was the way to go. I actually avoided actively pursuing this option until 2021 because I didn’t have enough savings and there are no job protections when taking an unpaid leave of absence. I would also lose my company benefits, which meant I would have no health insurance. My team was also growing fast and I was afraid of being replaced or cut.

When I switched managers in early 2020, I made it a point to be completely transparent with them on where I was. That I was doing my best at work but felt like I was drowning: not thriving. They knew about my intention to take a leave of absence and were so supportive of it — I’m truly forever grateful. I started to open up more to my team and others in the company that I worked with. Eventually, people opened up to me about their experience with burnout; many told me they were able to get approved for medical leave.

That reopened a door that I thought was closed to me. It was a huge relief to know that others who struggled through the same things had successfully gotten approved. There was a way I could come back to a job, have health insurance, and also continue to get paid while I recover.

How to prepare for applying for paid medical leave

Paid leave of absence is a company-specific benefit offered to employees at my company. My company approved paid leaves of absence for employees who meet the criteria defined in the FMLA (Family and Medical Leave Act). Per the act, “eligible employees are entitled to 12 workweeks of leave in a 12-month period for: … a serious health condition that makes the employee unable to perform the essential functions of his or her job”.

How it works:

1. You need to have a doctor’s note explicitly stating that you are unable to do your job due to your health condition. The doctor’s note must state the date on which you must immediately stop working.
2. Once you have a note, you submit it to your manager and your HR contact to start the process of filing for approval of medical leave.
3. At my company, HR puts you into contact with a leave specialist contracted by the company to process leave of absence claims.
4. When your claim is opened, you must submit substantial evidence of a serious health condition. For me, this meant:
5. the past 1.5 years of therapy notes;
6. evaluations and medical records from my health care team (my PCP, psychiatrist, and a cardiologist);
7. third-party psychiatric and medical evaluations by a nurse practitioner contracted by the leave company;
8. an official diagnosis from my main health care provider (PCP in this case) that is considered an “eligible” health condition for medical leave, i.e. major depressive disorder for me.
9. Comprehensive calls with your leave specialist on the cause of your condition and your current, physical and mental state.
10. Filing out stacks of forms such as certifying my disability, applying for CA short-term disability insurance, claims for disability benefits…to name a few.
11. Getting company/HR approval based on your physician’s statement certifying your disability.

Not all companies have the same paid leave of absence policies; I was lucky in that my company had a generous policy where they would pay us for the full, 12 weeks entitled under FMLA. N.B. FMLA does not require companies to pay you during your leave, only that you are entitled to 12 weeks and that your job and standing at the company will be protected.

My recommendation is to talk to coworkers who’ve had experience with taking a leave of absence at your company or reaching out to HR regarding your company’s policies to get a sense of your options. Also make sure you’re mentally prepared to spend hours of your days for weeks calling doctors’ offices, labs, your leave specialist, your health insurance, and generally playing a broker. This work extends past your approval of your medical leave claim because on a fortnightly to monthly-basis, you are required by the leave company to provide re-certification that you are still disabled, the degree of your disability, and progress reports from all your doctors. Perhaps you have doctors’ offices who can handle this sort of paperwork on a regular basis in a streamlined way, but none of my doctors’ offices could, so for at least two weeks of every month of my leave, I was calling back and forth between my leave specialist and doctors’ office (internally screaming) “did you get it? no?” and “can you resend it? again?”.

Full disclosure: while I am so grateful I was paid during my 6 months of medical leave, I did not find it restful. Constantly fielding calls and paperwork and submitting insurance claims…not relaxing. By the end of my six months of leave, I wasn’t where I wanted to be. The palpitations still came several times in the week; the headaches were present for more than half the week; the stomachaches and fatigued unchanged. However, I was up from 1–3 hours of sleep to 3–5 hours with the help of prescription sleep medication…so yay.

Returning to work on a reduced schedule and filing for SDI

At the end of six months, your FMLA benefits run out. My options were to go on unpaid leave of absence under my company benefits, which meant my job was no longer protected but that I could continue to be 100% off work, or work on a reduced schedule. I chose to work a reduced schedule of 3 days/week because I felt bad and wanted to show my company that I was a “team player”. My HR contact approved the schedule for 3 months. I worked with my leave specialist on getting paid through the California Short-Term Disability Insurance plan (SDI) — all CA workers pay into this program via taxes. Under this contract, my company would pay me for the hours that I worked and SDI would fill in for the days I didn’t.

I barely managed on the reduced schedule; I had a rotating door of healthcare appointments and continued to manage all that paperwork proving I’m still disabled and delivered projects for my team. The stomachaches and chronic fatigue still took me out for hours of the work day. Some days I ended up working 10 hours because I was afraid of not doing enough.

Three months came to an end. I’m still so appreciative of my managers and the incredible HR team at my company, because they approved me for another three months of reduced schedule, which is really generous and uncommon.

Applying to Long-term Disability

Your SDI benefits end after 180 days. Since I was still medically considered disabled and unable to return to work full-time, I was required to apply to long-term disability if I wanted to continued to be paid while working on a reduced schedule. The long-term disability insurance plan is a company-specific benefit available to you as an employee. Your company may pay for all of it or you may have to contribute a portion of your paycheck into it. In either case, this is often a benefit you choose to enroll in during the yearly benefits-election period.

Applying to long-term disability (LTD) is like applying for medical leave on steroids. If you read through this and thought that what I had to do for medical leave was painful, the LTD approval process and maintaining your LTD benefits is worse.

Things to know about LTD claims:

1. You are required to work for a certain number of hours per week to be eligible because you need to demonstrate an”intent to work”.
2. Expect to wait a long time for a decision. It was almost 3 months before I learned I was approved.
3. The process is slow, cumbersome, and the information you get about what exactly you need to do can be vague. The company that handles my LTD claim sends me snail mail, which means that their demands for me to “respond by XXX date otherwise my claim will be delayed or denied” are totally unreasonable. E.g. I will get a letter postmarked June 10, receive it on June 28, and read in the letter that they were due information on June 26. They’re also based in a different timezone, so my waking hours are offset from theirs just enough that we end up playing voicemail tennis for weeks.
4. You end up redoing all the work you did for medical leave because the transferred records from FMLA weren’t enough. So you end up playing the doctors’ offices telephone game all over again.
5. Much like medical leave, you will be asked to send any updated medical records and progress reports every few weeks.
6. Depending on your company’s LTD insurance plan, your coverage may end when your employment ends (unless you’re fired). Fortunately for me, my LTD benefits cover me for one year, even after employment ends.

I didn’t know about #6 until after I had quit. I simply assumed that my benefits ended when I left my job, so it was a nice surprise to learn that I was covered for another year.

The cost of healthcare

If you live in the US, this is a familiar narrative for you: healthcare is real, fucking expensive here. Millions cannot afford a trip to the doctor. I’ve never spent so much money in my life on just one aspect of it. Depending on your health insurance, you may have an amazing, low-deductible plan that covers most medical services; or, you may have a shitty plan with a high-deductible and with very few services covered. I was on the former last year, and am currently on an awful plan where I’m essentially paying out-of-pocket all the time.

Obviously, the best case scenario is that you can find doctors you like in-network and have a lower cost for care. The issue I ran into is that finding a good provider in-network was the exception, not the rule. A lot of good providers tend to be out-of-network because insurance doesn’t pay them equal to the amount of their services. E.g. an acupuncturist who charges $100/visit will only get paid $10 through insurance. I’ve had traumatizing experiences with bad providers, so I was willing and financially ready to pay the out-of-network costs for people I really liked and trusted.

It’s not fair to patients like us, and it’s not fair to providers who’ve invested decades in school and training to treat us. It’s always the insurance company who wins. (Side bar: we really gotta lock down this universal healthcare shit).

Summary of care:

• Primary care: in-network, copay; fortnightly to monthly (current) visits
• Cardiologist: in-network, copay; fortnightly for the first two months of medical leave
• Psychiatrist: out-of-network, $260 — $300 per visit; fortnightly to monthly (current) visits
• Acupuncture: out-of-network, $100 per visit; weekly for pain management
• Chiropractic: out-of-network, $100 per visit; 3x/week for pain management — transitioning to physical therapy in 2023, which will be in-network (!!)
• Therapy: out-of-network, $200 per visit; 2x/week to once a week (current)

Total cost from 2021–2022: ~$24,000.

Total out-of-pocket costs: $22,000.

Being alive is expensive!

Reflections on the whole process

I think anyone who is struggling should look into their leave options. Take advantage of whatever is available to you at your company. Even if they only offer unpaid leave, if you can afford to support yourself and your dependents for even just a few weeks or a month, I think it’ll do so many wonders for your health and well-being.

Pretty much the entirety of my year 2021–2022 was spent in clinics, on the phone with insurance, in doctors’ offices, and my claims. It was 200% an absolute pain in the ass and I cannot in good faith say that I felt like I was getting the rest I needed until I finally quit my job. I’ve had this vision of what my rest period would look like — running in the meadows, catching butterflies, petting strangers’ dogs, writing more, painting…etc. — and it has not been like that AT ALL. It’s been a shit ton of hard work. I’m still working towards that vision and getting to a place where I have the capacity to do things that fulfill me.

Nevertheless, working through the process of getting leave was the forcing function for me to finally get treated and put my health first. I’ve been on Lexapro for 1.5 years now and I feel like I’m finally becoming more of the person I want to be. The depression fog has been lifting and the incessant screams of anxiety are less audible; I’m also better at not listening to them. When I returned on a reduced work schedule, I had more courage to block off sections of my calendar for doctors’ appointments that I needed, rather than pushing them off so I could get all the work I was “missing out” on done. It also allowed me to keep my health insurance and continue getting paid, which helped me build up the savings I needed to quit without worrying about finances and debt.

I still feel a lot of guilt. I still struggle with feeling like I’m falling behind my peers. I worry about finding a job when I’m finally ready. But I know this time is necessary and I remind myself every day that some job will always be out there, but I need a functioning, healthy body that will support my dreams for the next several decades.

Be safe, be healthy, and be well, friends ✌️. If you have questions or need words of encouragement, drop a comment below. I’m happy to help.