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Navigating Burnout and Disability Leave
Some of you may already know this about me and have seen my posts about this long and ongoing journey to full recovery. Regardless, 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.
Table of Contents
- Where I'm at now (2023)
- A timeline of events
- Facing burnout and depression
- Applying for medical leave and disability benefits, and total costs of healthcare
- Leave of absence
- How to prepare for applying for medical leave
- Return to work on a reduced schedule and filing for SDI (Short-term Disability)
- Applying to LTD (Long-term Disability)
- Total costs of healthcare
- Reflections on the process
Where I'm at now (2023)
When I first wrote this post on my old website it was December 2022. At that point, I was still only feeling at 60% of where "normal" should be. I was feeling frustrated with how slow my recovery was going and constantly questioning whether I was doing something wrong because I was a year-and-a-half into burnout recovery but still feeling like shit all the time. Now that it's June 2023 and I'm two years into recovery, I feel like I see the light at the end of the tunnel finally. I feel like socializing again, have more mental capacity to engage in things like reading and writing and even a wee bit of coding, and my bodily pains are still present but maybe 70% of what they were when I was working.
It wasn't until the past couple of months that I truly, finally stopped getting heart palpitations for good. Same with the headaches and unrelenting fatigue. My sleep problems are still out of my control, and I still get work or school nightmares at least 2-3x a week, but it feels more manageable now that everything else is slowly calming down. I've also learned through this process that I store a lot of stress in my stomach and hips, so any sort of stress just throws my GI system into disarray and my IBS goes haywire. But I feel a lot more in tune with my body and I think I'm getting better at taking care of it.
I'm also finally at a point where I'm not spending $2-3k/month on psychiatrists, therapists, physical therapy, and other specialist care. I'm still somewhere around $1-2k but I finally get to start saving a bit more money!
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.
Facing burnout and depression
TL;DR I waited way longer than I should have to get help.
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 bodily pain. If someone didn't forcibly hospitalize me, I would just keep going.
Starting in 2019, I could no longer 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. I developed pretty bad IBS and my stomach cramps were unrelenting, which meant that I was spending hours of the workday in the bathroom (and thus feeling even more stressed about not getting enough done at work). The heart palpitations came 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 constantly had shortness of breath. 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 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.
By mid-2020, my pain 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 in too much pain 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 to contribute ideas and solutions in meetings because I felt like they needed to be 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.
Every time I got a new pain symptom, I'd shrug it off thinking, "well you're not dead yet".
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 wanted to just stop feeling.
Therapy didn't and hasn't "fixed" my depression, nightmares, and habitual, negative self talk. But it's given me a lot of tools and resources to learn from it and ground myself. I have grown so much with the help of my therapists and am so lucky to have found a wonderful care team with doctors I trust. Being able to talk to all my doctors and therapists, and get started on anti-depressants and sleep medication saved my life. I also have a phenomenally supportive partner and feel blessed every day to have someone who accepts me, even with all the baggage.
Applying for medical leave and disability benefits, and total costs of healthcare
I fully acknowledge that my journey has been privileged with a lot of resources that aren't available to everyone. I had a good 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 "serious medical conditions", and in my head, I didn't think anything I was dealing with was that serious.
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. 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 under California's Paid Family and Medical Leave Act (FMLA).
That reopened a door for 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 not have to rely on my emergency slush fund while recovering.
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 (read more here). 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".
- 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.
- 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.
- At my company, HR puts you into contact with a leave specialist contracted by the company to process leave of absence claims.
- When your claim is opened, you must submit substantial evidence of a serious health condition. For me, this meant:
- all records from my therapy sessions;
- evaluations and medical records from my health care team (my PCP, psychiatrist, and a cardiologist);
- third-party psychiatric and medical evaluations by a nurse practitioner contracted by the leave company;
- 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.
- Comprehensive calls with your leave specialist on the cause of your condition and your current, physical and mental state.
- 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.
- 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 that my company had a generous policy where they would pay us for the full, 12 weeks entitled under FMLA. FMLA does not require companies to pay you during your leave; it only states that you are entitled to 12 weeks of leave, and protects your job and standing at the company (which is already huge!).
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 you are required by the leave company to provide re-certification that you are still disabled, the degree of your disability, and submit progress reports from all your doctors on a fortnightly to monthly basis. 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?".
In all honesty, 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 meant I had no time to relax. By the end of my six months of leave, I barely felt recovered. The palpitations still came several times in the week; the headaches were present for more than half the week; the stomachaches and fatigued unchanged. I was able to increase my hours of sleep from 1-3/night to 3-5 hours with the help of prescription sleep medication so at least I made some progress there!
Return to work on a reduced schedule and filing for SDI (Short-term Disability)
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), which we all pay into through taxes as employees in CA. 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 deal with the monthly burden of submitting health documents and forms while delivering 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.
The three months quickly passed. 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.
Applying to LTD (Long-term Disability)
Your SDI benefits end after 180 days. I was still medically disabled and unable to return to work full-time by the end of the six months of working a reduced schedule. As a result, 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 already been contributing 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:
- 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".
- Expect to wait a long time for a decision. It was almost 3 months before I learned I was approved.
- 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 was sending me snail mail. Each letter came with an ultimatum to "respond by [some] date otherwise my claim will be delayed or denied" even though, I'd often get the letters over a week after the ultimatum date to submit updated documents. Their specialists all worked in a different timezone from mine, so my waking hours are offset from theirs just enough that we end up playing voicemail tennis for weeks.
- LTD requires to submit every sort of medical document you've ever received or had recorded, from lab tests to notes from every single doctors' visit from every single doctor you're seeing, among many others. This meant I had to spend weeks playing telephone with all my doctors' offices all over again, on top of coordinating with the LTD specialists on my case.
- You are also required to send updated medical records and progress reports every few weeks like FMLA and STD.
- 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 total costs of healthcare
If you live in the US, this is a familiar narrative for you: healthcare is really fucking expensive here. Millions cannot afford a trip to the doctor. I've never spent as much money in my life as I have in the past two years on my health. 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. My health insurance at work was pretty good, but now I'm on a high-deductible plan where I have to pay out-of-pocket for pretty much everything.
It was actually really difficult for me to stay in-network because most of the doctors in-network with my health insurance didn't have very good reviews. A lot of good providers are 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 medical 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.
The US healthcare system is honestly just super fucked because of for-profit health insurance and healthcare. 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.
Summary of care:
- Primary care: in-network, $30 copay/visit; totaled about $60/month
- Cardiologist: in-network, $60 copay/visit; totaled about $180 for the first two months of medical leave
- Psychiatrist: out-of-network, $300/visit; totaled $600/month
- Acupuncture: out-of-network, $100/visit; totaled $400-600/month depending on intensity of chronic pain
- Chiropractic: out-of-network, $70/visit; totaled $840/month
- Therapy: out-of-network, $200/visit; totaled $800/month
Total costs from 2021 - 2022: est. $24,000.
Total out-of-pocket costs: est. $22,000.
Yes, you're seeing those numbers correctly. Only about $2000 of my healthcare costs were covered by insurance.
Reflections on the 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 just finding the mental and physical capacity to sit down and write blog posts like these two years into recovery.
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 2 years now and it's been life changing. I feel like, for the first time in my life, I'm more like the person I've always wanted to be: present, engaged with the world, and less afraid. The depression fog has lifted finally and the incessant screams of anxiety are less audible, though they're still present. 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.
Waves of guilt and fear of falling behind still come a few times a week. I worry about finding a job in a very unforgiving market full of layoffs. But I know this time is necessary and I remind myself every day that a job and some job will always be available. But I need a functioning, healthy body to get that job and the support my dreams for the rest of my life.
Be safe, be healthy, and be well, friends. If you have questions or need words of encouragement, I'm happy to help (comment box and other engagement features coming soon!).