The Cost of Earning a Paycheck: Reflections a Year After Returning to Work

"Congratulations,” my neurologist said when I first told him I was returning to work. At first, I thought he was being sarcastic. But he wasn’t . Congratulations were actually in order. Throughout my rehab, I heard story after story about stroke survivors who never regained certain abilities. How few ever return to their previous careers fully functional. Only 3–6% of strokes are like mine: A hemorrhagic stroke in the basal ganglia. Of those, nearly half don’t survive the first year. The odds have so far been in my favor. When it comes to work, only about 20% of stroke survivors return within the first year. For hemorrhagic stroke survivors, fewer than 10% make it back at full capacity. 

It’s now been a year since I returned to work. This has been the hardest season of my career. And truthfully, it would be even without the added layer of stroke recovery.

I went back to work eight months after my stroke because on the surface it felt like the next logical step. At first, it was a gradual re-entry, easing back in, building my hours over time. But while my schedule increased slowly, the stress and responsibility didn’t. They came back all at once. 12- weeks later, I was working full-time hours again.

At the time, I believed that returning to work was a sign that I was getting better. I felt relatively well, rested enough, with decent energy, able to move my body and keep some rhythm to my days. But what I couldn’t see then was that this version of “well” only existed because for 8 months, recovery was my full-time focus. Rest was built into everything. Stress was minimal. My entire life was structured around healing.

I returned to work partly because months of reduced income had taken their toll, and the financial strain was real. Bills don’t stop simply because your body does. There was also the quiet but persistent commentary; questions and assumptions that are hard to ignore. "If you can do X, why can’t you go back to work? " And always, "you look good"  - as if outward appearance is an accurate measure of readiness. From the outside, I looked fine. And for most people, that was enough to conclude that I WAS fine.

Underneath that, things were off in ways that are much harder to explain.

Cognitive overload doesn’t announce itself the way physical symptoms do. It doesn’t demand attention. It’s quieter than that, and somehow heavier. It lives in the space between thoughts, in the moments where something simple should happen but doesn’t. Before my stroke, thinking was effortless. Now everything arrives at once: Conversations, background noise, light, movement, the pressure to respond, the awareness that I’m already getting tired. My brain tries to carry all of it, and sometimes it just can’t. It feels like drowning in air. The immense ongoing effort it takes just to keep up, to stay present, to hold things together goes unseen.

Undoubtedly, work gets the best of me. It gets my peak energy, my clearest hours, the version of me that can still perform and present as okay. What no one sees is what happens after; the crash at the end of the day, when everything shuts down. By the end of each workday, there is nothing left. Not for therapy, not for meaningful rest, not for the kind of recovery that actually requires time and space. 

By the time I get home, even the simplest things feel out of reach. Making dinner, tidying up, basic chores, things that used to be automatic now require energy I just don’t have. So they wait. And they pile up. Or they don’t happen at all. And even more than that, what really doesn’t get seen is the cumulative effect of those days, repeated over and over. It builds in ways that are hard to notice at first, but impossible to ignore over time.

Weekends stop being a time for living and slowly turn into a time just to recover enough to do it all over again.

There’s also a feedback loop that’s hard to see from the outside. The stress and mental load from work lead to neurological fatigue, which intensifies the physical symptoms. That physical strain creates more fatigue, more depletion, and in turn, more mental stress. It feeds itself. Each layer amplifying the next until everything feels heavier than it should.

Plans with friends and family become tentative at best, and more often than not, cancelled. Not because I don’t want to be there, but because there is simply nothing left to give. And with that comes the quiet exhaustion of having to explain it over and over again: Why I can’t come. Why I need to rest. Why something that seems small feels like too much.

Slowly, almost quietly, my recovery has stalled. Not in a dramatic or obvious way, but in that subtle, frustrating way where progress slowed, plateaued, and even began to slip. During the week, I’m not just working, I’m using everything I have to appear okay.

Returning to work didn’t mean I was ready. It didn’t mean I was done healing. It meant I was trying to fit recovery into the leftover spaces of my life, while the world assumed I was already whole.

And if I’m honest, knowing what I know now, I would have given myself more time.