Presence Isn’t a Luxury — It’s Medicine Part 1

You can feel it before you name it.

That moment in the middle of a shift when everything feels just a little farther away.

When your brain feels foggy even though you slept.

When you’re listening to a patient but also slightly… watching yourself listen.

When you’re technically functioning, but not fully there.

Physicians call it “being off.”

Neuroscience calls it a prefrontal shutdown.

I call it what it is:

A nervous system that’s been running too hot for too long.

Presence isn’t a soft skill.

It’s a physiology.

And when burnout hits, presence is often the first thing to disappear.

The Myth: Presence Is About Trying Harder

Medicine trains you to push through anything:

• fatigue
• emotional weight
• alarms
• disruption
• stacked crises

You show up no matter what—until showing up starts to feel like moving through water.

Most physicians respond to this by trying harder:

• focus more
• be more mindful
• be more patient
• power through the fog

But you can’t grit your way into presence.

Because presence isn’t discipline.

Presence is neurobiology.

When the nervous system is dysregulated, your mind and body move into survival mode.

And survival mode is incompatible with presence.

What Burnout Actually Does to the Brain

Chronic stress doesn’t just affect mood.

It reshapes cognition.

A 2024 review in Neuroscience Letters found that prolonged stress disrupts the brain’s ability to regulate the prefrontal cortex — the area responsible for:

• executive function
• attention
• emotional regulation
• empathy
• accurate decision-making
• working memory

When the prefrontal cortex goes offline, two things happen:

1. The limbic system takes over
2. Presence becomes impossible

This is why physicians describe:

• feeling foggy
• losing patience for small things
• zoning out in conversations
• missing details they would normally catch
• feeling emotionally distant or disconnected
• acting efficient but not feeling present

It's not a moral failing.

It’s a brain doing exactly what it was trained to do in crisis situations — shift into survival mode.

The problem is that medicine asks your brain to live there.

Hyperfocus Isn’t Presence

Here’s the part physicians rarely say out loud:

Sometimes the less present you feel,

the more productive you become.

Hyperfocus is a survival adaptation.

It looks like competence.

It feels like numb clarity.

It works — until it doesn’t.

Hyperfocus is useful during codes.

It’s destructive when chronic.

Because it bypasses presence entirely.

Your mind sharpens while your body disconnects.

Your empathy goes quiet.

Your internal signals go offline.

Your nervous system stays locked in readiness.

Presence can’t coexist with a survival state.

Not because you aren’t trying —

but because your biology won’t let you.

Why Physicians Lose Presence Before They Notice Burnout

Physicians override internal signals better than almost any profession.

You’re rewarded for ignoring:

• thirst
• hunger
• pain
• bathroom needs
• grief
• fear
• moral distress
• limits

Your training literally taught your body:

“Don’t register what you feel.”

So when burnout begins, you don’t feel the early warning signs.

You feel:

• fuzzy
• detached
• sped up
• slowed down
• emotionally thin
• like you’re watching your life from two feet behind you

These aren’t personality issues.

They’re neurobiological symptoms.

Your nervous system is telling the truth

long before your mind can name it.

Presence Requires Regulation, Not Willpower

Here’s the turning point:

Presence is only available when the nervous system feels safe enough to downshift.

Safety isn’t a thought.

It’s a physiological state.

You cannot think your way into presence.

You have to process your way back into it.

This is where many physicians get stuck:

• You understand why you’re burned out.
• You understand the system problems.
• You understand the workload, the moral injury, the chronic stress.

But insight doesn’t create presence.

Presence emerges only after the body completes the stress cycles it never had time to finish.

How EMDR Restores Presence

EMDR (Eye Movement Desensitization and Reprocessing) is often described as a trauma therapy — but for physicians, it's more accurately a neurobiological recalibration.

Here’s what the research shows:

• EMDR downshifts the limbic system
• It reactivates prefrontal functioning
• It allows the body to complete unfinished stress responses
• It improves attention, clarity, and emotional regulation

In one Neuroscience Letters study (2024), EMDR was associated with increased prefrontal activation and improved attentional control — exactly the markers that go offline during burnout.

For physicians, this translates to:

• Your mind feels clear again
• You can stay with the moment
• You feel emotionally present even under pressure
• You stop rehearsing or bracing internally
• You feel in your body instead of hovering above it

Presence returns because your nervous system finally learns:

The danger is over. You can stand down.

Why EMDR Intensives Are Ideal for Physicians

Weekly therapy often fails physicians not because the therapy is wrong —

but because the format is incompatible with your nervous system and your schedule.

EMDR Intensives solve that:

• 3–5 half-day sessions
• No weekly reactivation
• No insurance trail
• No rescheduling around call
• No stopping just when you were finally getting somewhere

The nervous system can complete the work in days, not months.

And when the system settles, presence returns.

Not because you tried harder —

but because your biology finally had space to reset.

Presence Isn’t a Luxury — It’s Medicine

Patients feel the difference when you’re present.

But more importantly:

You feel the difference.

Work stops feeling two inches removed.

Home feels like home again.

Your breath deepens.

Your patience returns.

Your clarity comes back online.

You feel like yourself again.

Presence isn’t an extra.

It’s the foundation of safe, skillful, sustainable practice.

But you don’t regain presence through effort.

You regain it through regulation.

If you’ve been feeling foggy, disconnected, or “not yourself,” please know this:

Nothing is wrong with your character.

Nothing is wrong with your resilience.

Nothing is wrong with your heart.

Your nervous system just needs support.

And it can learn safety again.

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Citations

• Neuroscience Letters (2024). Prefrontal activation changes following EMDR and stress reduction interventions.
• American Psychological Association. Clinical Practice Guideline for the Treatment of PTSD in Adults (2024).
• Tarquinio, C. et al. (2023). EMDR for Healthcare Workers: A Systematic Review. Frontiers in Psychology, 14, 1168452.
• Shanafelt, T.D. et al. (2024). Predictors of burnout in U.S. physicians. Mayo Clinic Proceedings.