I will not be anonymous because I am one of the physicians who left and I am no longer afraid. Prior to my leaving in 2016, I spent 13 years at Queen’s Medical Center, first as a hospitalist and later as a member of its Liver Center.

In May 2016, as I watched my children perform at Kawaiahao Church as part of a halau, I gave in to a thought that I had been resisting for a long time: I have found my purpose in life. It is to take care of patients with liver disease in Hawaii. As I watched my children dance to the ancient Hawaiian melody, I felt at peace with having given in to my purpose in life and a strengthening resolve to do my best to fulfill it.

It did not last. Shortly after that memorable performance, problems arose at the Queen’s Liver Center due to the change in management. At first it only affected the support staff, leading to tearful conversations in my office and resignations. It progressed to the mid-level providers and shortly after, to the physicians. By the end of summer 2016, the level of stress was intolerable and led me to resign.

After an extensive search for job opportunities in hepatology, I was offered a position as the Liver Program Director at UCSF Fresno. I sold my home where my children were born, uprooted them from their beloved Sacred Hearts Academy, their grandparents (biological and hanai) and left Hawaii in anger. I promised myself to never again give in to the inner thoughts of discovering my purpose in life. I was just going to have a job.

I was welcomed by UCSF Fresno with opened arms. Hepatology providers are far and few between in the California Central Valley and I was busy from Day One. In addition to clinical practice, I was encouraged to teach gastrointestinal fellows and internal medicine residents, recruit and conduct clinical trials, do as much community outreach work as I could possibly fit into my schedule. I spent the first year waiting for the second shoe to drop — certainly things couldn’t be that radically different from my previous employment. I figured I’d enjoy the ride while it lasted.

Two years later I continue to receive remarkable support from the organization at all levels. I continue to teach, bring large research grants to the institution and frequent the local news station as an expert on liver disease. I am involved in the leadership of this physician-run organization. I am no longer waiting for the second shoe to drop. I am respected for my contributions to the organization and not for the amount of money that I bring it through billing.

Despite a promise that I made to myself before leaving Hawaii, I am dangerously close to, again, finding my purpose in life: to teach future generations of hepatologists, to advance the field of liver disease through research, to care for the patient population in need. This is not very different from my original purpose; only location has changed.

I share my experience with the readers in Hawaii to show that the art and business of medicine can and should be done differently. UCSF Fresno is not without problems, but most problems can be solved by collaboration and without threats or fear-mongering. I am happy to have had the opportunity to experience this environment and I will stay here. But in a weak moment, especially when I hear from my old patients, I allow myself to think of how amazing it would have been to do it all in Hawaii, in a place that I considered home for most of my life.

Marina Roytman, M.D., F.A.C.P., is the liver program director and a clinical professor of medicine at UCSF (Unversity of California San Francisco) in Fresno.