156. Boundary Rituals: How to Keep Work from Following You Home

Ever walk out of a shift and feel like the hospital came home with you? In medicine, the mental residue can cling long after the work day is done. One way to address this is boundary rituals, deliberate actions designed to process the day and allow you to leave work at work, be more present when you get home, and possibly even sleep better. As a bonus, the ability to disengage from work is one of the strongest predictors of reduced burnout.

In this episode, Mohamed Hagahmed, MD, shares how he creates this boundary—through small rituals of gratitude, stillness, and reflection. From growing up as a refugee to serving as a sideline physician for the Pittsburgh Steelers, Dr. Hagahmed’s path has been shaped by resilience, culture, and care. He explains how he learned to stop carrying unfixable wounds home, why kindness is clinical armor, and how tiny acts of self-compassion can protect meaning in medicine.

Guest Bio:  Mohamed Hagahmed, MD a Clinical Assistant Professor of Emergency Medicine at the University of Pittsburgh, Associate Medical Director at the Center for Emergency Medicine, and EMS Medical Director for several systems in Western Pennsylvania. On top of that, he works in high-acuity emergency departments across the region. He’s a graduate of Johns Hopkins Bloomberg School of Public Health, passionate about resuscitation, critical care, and toxicology education. And he’s the creator and host of EMERGE in EM, a podcast focused on emergency medicine education and global health empowerment.

We Discuss:

From Refugee to Resuscitation

• Dr. Hagahmed was born in Sudan, fled with his family due to political persecution, and later lived in the UAE, Germany, and the United States.
• Before entering medicine, he played professional football in NFL Europe, using sports as a means to support his education.
• His diverse cultural background and refugee experience have given him a unique perspective that informs his empathy and drive in medicine.
• Today, he serves as a sideline physician for the Pittsburgh Steelers, completing a remarkable arc from athlete to physician. His path demonstrates how resilience and adaptability can transform adversity into professional purpose.

The Unfixable Wounds of Emergency Medicine

• Emergency medicine appealed to Hagahmed because of its wide clinical scope and the foundational knowledge it provides across disciplines.
• But it also brings deep frustration, seeing patients repeatedly return to the ED due to societal failures that cannot be addressed within clinical care.
• This sense of helplessness in the face of structural inequality has been a persistent stressor in his career. Over time, he recognized this as moral injury, which took a toll on both his mental health and professional satisfaction.

The Guesthouse Approach to Trauma

• After many years, Hagahmed developed a personal ritual to process emotional residue from his shifts, using emotional naming and acceptance techniques. He imagines emotions as guests that visit him after work, which he acknowledges and then gently releases.
• Each shift ends with a moment of gratitude toward colleagues, which helps him transition emotionally before beginning his reflection practice.
• He uses silence, deep breathing, and memory recall to focus on positive events from the day instead of fixating on negative outcomes. This routine helps him avoid carrying unresolved tension into his personal life and allows him to be more emotionally present at home.

Healing Through Stillness and Self-Awareness

• Hagahmed realized that his tendency to internalize stress was harming his relationships and distancing him from those he cared about. 
• One practice he developed was changing clothes before leaving the hospital, which symbolically and mentally separates work from personal life. Feeling the air outside the hospital became a sensory anchor for reorienting himself to the world beyond the emergency department.
• He has learned to recognize and appreciate even small positive events during shifts, like a successful discharge or a kind interaction with a teammate. His goal now is to not only acknowledge these moments privately but to express appreciation publicly to his team.

Self-Compassion Isn’t Soft—It’s Required

• Hagahmed once believed that expressing emotions was a sign of weakness and tried to emulate the stoic physicians he saw in training. Therapy and emotional education helped him understand that avoiding emotion can create long-term relational damage.
• He now actively models emotional openness and checks in on medical students and colleagues who witness traumatic events.
• For new attendings, he recommends setting emotional boundaries and allowing for grace when mistakes happen or when things feel overwhelming.
• Self-compassion is not instinctive for most high-achieving physicians but is a skill that can be cultivated with effort.

The Ritual of Letting Go

• After each shift, he engages in a deliberate transition ritual that includes gratitude, reflection, and physical separation from his work identity.
• Listening to music and doing light exercises before work puts him in the right mindset to engage with high-intensity environments.
• Bringing coffee or snacks for his team is not just generous. It’s part of his emotional strategy to build positive energy.
• These small acts of kindness and personal preparation help set a tone of collaboration and reduce emotional friction during stressful shifts.
• He believes that rituals, both entering and exiting work, are crucial for maintaining long-term emotional health in medicine.

From Frustration to Advocacy

• After burning out from repeatedly witnessing preventable suffering, Hagahmed decided to pursue systemic change through advocacy. Earning an MPH allowed him to better understand the public health landscape and strategize solutions beyond individual patient care.
• His current advocacy focuses on improving immigrant trust in healthcare, particularly in emergency and pre-hospital settings. His vision includes legislative action, cultural training for EMS, and global conversations on equity and access.

Advice for New Attendings: Protect the Threshold

• The transition between hospital and home should be treated as sacred and protected, not rushed or dismissed.
• He encourages attendings to build rituals that mentally and physically separate clinical and personal spheres.
• Perfection is not only unattainable; it’s a damaging standard that prevents necessary reflection and growth.
• Early in his career, he would obsessively review patient charts after shifts, which eroded his peace and strained his relationships. Allowing yourself grace and letting go of the need to rework every decision is essential for sustainable practice.