Why Physicians Sit in the Car After a Shift

For a season of her life, one ER physician coach would come home from a shift and sit in her car in the driveway. Not for five minutes. Sometimes for two hours.

She could make decisions, care for patients, manage chaos, and stay calm. But once home, she couldn't make herself go inside. At the time, she had no good explanation, and part of her wondered, what is wrong with me?

What Medical School Teaches, and What It Doesn't

Medical school covers autonomic physiology in detail: sympathetic, parasympathetic, and the exam that tests them. What it rarely teaches is how to recognize those same dynamics playing out inside your own body after years of practice. No one names what chest tightness, bracing, emotional shutdown, an inability to relax, or dread before a shift actually mean.

Many physicians quietly conclude they're weak, broken, or not cut out for this. That's not what's happening.

A Framework: Polyvagal Theory

Polyvagal theory, developed by psychologist Stephen Porges, is a framework for understanding how the autonomic nervous system responds to cues of safety and threat. It's worth noting that it remains a debated model among some researchers, so it's best treated as a useful lens rather than settled physiology. As a lens, though, it clarifies a lot.

When the nervous system detects safety, there's access to connection, flexible thinking, curiosity, and presence. This is the state where a physician can engage fully with a patient, think through a complicated differential, and come home and be a human being. Porges calls this the ventral vagal state.

When it detects threat, it shifts into protection. For physicians, the fight-or-flight end of that spectrum tends to look like urgency, irritability, constant scanning for the next problem, and an inability to stop. Medicine often rewards exactly this and calls it being dependable or a team player. What's often being described, though, is a nervous system under chronic threat.

Functioning Isn't the Same as Being Regulated

It's possible to perform at a high level and be significantly dysregulated at the same time: caring for patients, leading, teaching, and parenting, all while the body signals something not yet learned to be heard.

When sustained mobilization continues long enough without recovery, the system can shift in the other direction, toward shutdown. In Porges's framework, this is the dorsal vagal state: numbness, disconnection, heaviness, and an inability to make one more decision. That's what sitting in the car looked like. At home, it can look like getting through the door with nothing left, scrolling, isolating, snapping, or staring at the wall.

A Better Question

The usual internal question, "what is wrong with me?", has no useful answer. A more productive one: what has my body been carrying?

Many physicians have run for years on chronic threat physiology: the threat of missing something, of harming someone, of being sued, of disappointing patients, families, administrators, and people at home, all inside a system that treats human need as an inconvenience. The body adapts by learning to brace, override, perform, and disconnect. And because functioning continues, it's easy to conclude everything is fine.

It isn't that the person was fine. It's that they were adapted, and adaptation deserves a clinical response, not shame.

Two Percent Safer

This framework offers a different pair of questions: what state am I in right now? and what would help my system feel even 2% safer?

Not perfectly calm. Not magically healed. Two percent. That might look like:

• Feeling both feet on the floor and noticing the room
• Unclenching the jaw
• Lengthening the exhale
• Stepping outside and letting the eyes settle on something in the distance
• Humming or singing along to something loud on the drive home
• Simply naming it: this is shutdown, and I am not broken

For many physicians trained to override the body, this can feel counterintuitive. The invitation is to do something different: listen to it instead.

The Bottom Line

If you've ever sat in your car because you couldn't yet go inside, that's very common among doctors, and it makes sense given what the day demanded. The body wasn't failing. It was protecting. Often, a little awareness of what's happening is most of what's needed to begin recovering.

FAQ

Why do some physicians feel unable to go inside after a long shift? Hours of sustained alertness and urgency can leave the nervous system depleted rather than settled when the shift ends. The sense of being unable to move or engage is a common sign of shutdown after prolonged mobilization, not a character flaw.

What is polyvagal theory? It's a framework developed by psychologist Stephen Porges describing how the autonomic nervous system responds to cues of safety and threat, including states of connection (ventral vagal), mobilization (fight or flight), and shutdown (dorsal vagal). It is debated among researchers, so it's best used as a helpful lens rather than a settled model.

What does "feeling 2% safer" mean in practice? It means aiming for small, achievable shifts toward safety rather than perfect calm: grounding through the feet, unclenching the jaw, lengthening the exhale, orienting to the room, or naming the state out loud.

Is functioning well at work a sign my nervous system is regulated? Not necessarily. It's possible to perform at a high level while being significantly dysregulated, which is why chronic threat physiology can go unnoticed for years in people who are still highly capable.

When should someone seek additional support? If shutdown, numbness, or exhaustion is persistent or interfering with daily life, talking with a therapist or other qualified professional is a worthwhile next step.