We are conditioned to act swiftly. To react before contemplating. To proceed before second-guessing. To awaken at three in the morning because someone’s existence may rely on it. This is how we grasp ethics, not in lecture halls, but in hallways infused with the scent of antiseptic and coffee, beneath harsh lighting, next to stretchers bearing failing hearts.

Thus, at some point, we start to think that morality resides in the present. In urgency. In the ability to take action immediately.

However, not every type of harm barges in. Some forms of damage don’t burst through the entrance. They seep in. Silently. Over time. They embed themselves into policy. They don’t shout. They build up.

And when physicians protest, when they cease working, postpone procedures, disrupt what seems like an inviolable order, it can feel like a breach of our commitment. Not just in a professional sense, but personally. It contradicts everything we have trained for. Show up. Do not forsake. Never disappoint them.

Yet time imparts a different lesson, if you are open to it. Sometimes the larger harm lies in persisting.

We often perceive harm as something overt: the canceled operation, the rescheduled patient, the mother in the waiting area whose child’s appointment vanishes. These moments are significant. Certainly they are. But they do not encompass the entire story.

There’s also the patient who ceases to call because Medicaid consistently says no.

The resident who learns to endure mistreatment because voicing concerns could jeopardize their career.

The attending who spends almost half the day inputting data into software rather than applying their judgment.

And the unspoken truth, shared among us, that whole communities remain unhealthier than they ought to, not due to some uncommon illness, but because neglect has become the norm.

These occurrences are not standalone incidents. They are ingrained in the system. Over the years, we have come to normalize them. None of it makes news. At least not until someone disrupts it. Not until a doctor articulates, openly, what many have quietly endured.

This is not unprecedented.

In the 1960s, some physicians in New York refused to continue working under a system that compensated them so poorly they could no longer treat the underprivileged ethically. In the 1980s, doctors in Israel walked away, not out of impulse, but because conditions had worsened to the extent that remaining felt irresponsible. Then, in 2023, junior doctors in the United Kingdom faced the same tough decision. It was not about politics or protest. For many, it was about survival. Their work had been undervalued for far too long. Their compensation diminished. Their capability to continue, just to remain, had quietly vanished.

And long before any of this, even in ancient Rome, there were moments when dissent manifested differently. Senators, confronted with proceedings they could no longer endorse, arose and exited. No speeches. No chants. No theatrics. Just absence. A manner of expressing, without extravagance or noise, that they could no longer participate.

These acts were not examples of abandonment. They were acts of remembrance. A way of saying: This is not what we agreed to. This is not care.

Simone Weil once stated that to be rooted is perhaps the most crucial, and least recognized, necessity of the human spirit. She was not speaking in metaphors. She meant belonging. Dignity. The quiet assurance that one’s labor is still tied to something human, something whole.

Medicine, when distorted by cost-cutting and bureaucratic drift, gradually erodes that significance. It detaches us from the motivations for which we entered the field. And then it suggests we are burned out, as if the blame rests with us. To strike, then, is not an escape. It is acknowledgment.

Still, the struggle is authentic. I have experienced it.

To halt can seem like defeat. To continue can appear as complicity. We navigate between these two conflicts and label it professionalism. We are encouraged to persevere. To keep going. To fulfill our duties.

Yet endurance does not always equate to integrity.

Kierkegaard once remarked that life can only be understood in hindsight, but must be lived in the present. I often return to that thought. I recall the silences I permitted. The minor adjustments I made to stay afloat. The years I devoted to maneuvering around something I should have confronted directly.

I no longer think that silence signifies care. Occasionally, the ethical action, the more courageous one, is to cease. To step off the treadmill, not due to exhaustion, but because you are finally clear.

The patient in front of you is important. Indeed. But so is the patient you will never encounter. The one ten years from now. The one who may endure suffering because we continued to acquiesce to a system we no longer believed in.

There are times when taking a break is not neglect. It is a kind of remembering. To recall what medicine was intended to be. To remember that harm