At 32, Karma Hill was doing everything she thought she was supposed to be doing.
She had finished her bachelor’s degree at Georgia State University and was studying for the LSAT. She was married, working and raising three children while pregnant with her fourth. Her kids played football and basketball, ran track and danced. Hill was a room mom for all three of them.
And then there was everyone else.
Her mother had multiple sclerosis. So did an aunt who needed significant support. Her grandmother was getting older. Her grandfather, who had been like a father to her, had recently died. There were siblings, nieces, nephews, extended family and friends.
Hill was the person people could call.
She liked being that person.
“I genuinely believed that if I was capable of doing something, I should do it,” she says.
There was nothing particularly alarming about the life she was living, at least from the outside.
The family owned a home. They traveled. They entertained friends. Hill exercised and ate well. She even did the things we’re taught to call self-care: massages, manicures, time set aside for herself.
But she remembers lying on a massage table with her body completely still while her mind continued working, coordinating what needed to happen next.
Some nights she would close her laptop and essentially pass out from exhaustion.
She didn’t think something was wrong.
She thought this was life.
When capable becomes a way of living
There is a particular kind of exhaustion that can hide behind competence.
The work gets done. The children get where they’re supposed to go. The meeting happens. The deadline gets met. Dinner gets figured out. Somebody remembers the appointment, the medication, the birthday and the thing everyone else forgot.
From the outside, everything works.
What people couldn’t see in Hill’s life was how little room remained inside of it for her.
“I was available to everyone, but I was not really available to myself,” she says.
Hill doesn’t describe her younger self as abandoned or unsupported. That’s an important distinction. She had people around her who loved her.
The problem was deeper than whether anyone was willing to help.
Being capable had become part of who she was.
Her grandmother had modeled service and generosity. Hill watched her care for children, grandchildren, extended family, church members and relatives who became ill.
The lesson Hill took from that wasn’t that women should destroy themselves for everyone around them.
It was simpler.
When you love people, you show up.
Hill showed up.
Again and again.
“At that point in my life, being a strong woman meant that if you woke up, had breath in your body, could move your limbs and had the mental capacity to continue, you continued.”
Until her body began telling her something different.
“Something is wrong with me.”
During her fourth pregnancy, Hill started experiencing symptoms she couldn’t explain away.
There were headaches and significant fatigue. By about five months, walking from the parking garage to her office could leave her so short of breath that she had to sit near the entrance before going upstairs.
Sometimes she sat in her car before she could drive home.
At the grocery store, she leaned against the cart to catch her breath.
Her body began swelling significantly.
Hill had already been through three pregnancies. She knew this one felt different.
She sought additional medical care and remembers telling her doctors plainly:
“I’m not worried about the baby. I’m worried about me. Something is wrong with me.”
She says she was repeatedly reassured that the baby was doing well and that her tests appeared normal.
Eventually, that reassurance began doing something dangerous: it made Hill question what she knew about her own body.
Maybe she was overreacting.
Maybe she was complaining.
Her daughter was born May 5, 2009.
About a week later, Hill was home preparing to feed her newborn when she felt an intense burning in the center of her chest. She became hot and short of breath.
A thought crossed her mind.
Am I having a heart attack?
Then she began checking herself against what she thought a heart attack was supposed to look like. No pain in her left arm. No pain in her jaw.
So she started doing what she had always done.
Managing.
There was a newborn. There were other children. Going to the hospital would require arrangements. Was this really serious enough to disrupt everything?
The pain eventually diminished, although it never fully disappeared.
The next day, her newborn daughter’s own health concerns led to the baby being admitted to the NICU.
While Hill was there, the severe chest pain returned. The following day, she experienced another episode while showering at the hospital, this time accompanied by vomiting.
She would later learn she had experienced three heart attacks.
A NICU nurse finally saw Hill, asked what was happening and insisted she be evaluated. The nurse found a wheelchair and took her to be checked.
Bloodwork showed elevated troponin levels, indicating injury to the heart. An echocardiogram suggested damage.
One physician pushed for further investigation rather than sending the 32-year-old mother home with medication and follow-up care.
A cardiac catheterization revealed the severity of what had happened.
Hill says doctors diagnosed her with spontaneous coronary artery dissection, or SCAD, a condition in which a tear forms within the wall of a coronary artery and can restrict blood flow to the heart.
There was significant damage.
Her family was called to the hospital.
Hill was told she might not survive.
Survival wasn’t the transformation
This is usually where stories like Hill’s become tidy.
The person nearly dies. She awakens with perfect clarity. Everything that mattered before suddenly doesn’t. A new life begins.
That’s not what happened.
Hill remembers thinking about her four children, including the newborn who might grow up without really knowing her.
She thought about tiny details. Would somebody remember their favorite things?
Then another surgical possibility emerged. A surgeon who performed a relatively new robotic coronary artery bypass procedure was still in Atlanta and agreed to meet with her.
There were no guarantees.
While Hill prepared information her family might need if she died, she remembers an internal question coming to her:
Do you want to die?
She didn’t immediately answer.
The question came again.
And again.
Then something shifted.
“Wait,” she remembers thinking. “I get to choose this.”
Her answer was no.
She wanted to live.
Hill survived the surgery.
But surviving and changing were two different things.
“The deeper transformation took years,” she says.
She remained ambitious. She eventually earned her doctorate. She built businesses, became an executive coach, wrote and continued pursuing work she considered meaningful.
What changed wasn’t whether she wanted more from her life.
It was what she was willing to pay for it.
“Before, there was an element of ‘at whatever cost,'” Hill says. “Today, ambition does not get to cost me my health, peace or well-being.”
She began reconsidering some of the qualities she had always considered strengths.
“Responsibility is a strength, but responsibility without boundaries can become martyrdom,” she says.
“Independence is a strength, but taken too far it becomes hyper-independence.”
And perhaps the hardest one:
“Being dependable is a strength, but I also need to be dependable to myself.”
Rest isn’t always resting
Hill’s experience eventually informed the work she does today as a business psychologist and executive coach, as well as her book, Sacred Pause: Reclaiming Your Energy, Your Voice, and Your Rhythm.
Her REST framework stands for Resilience, Emotional Intelligence, Self-Care and Trust.
But underneath the terminology is a lesson she had to learn personally: stopping and resting aren’t necessarily the same thing.
She had been taking breaks before her heart attacks.
Remember the massage table.
Her body was lying down. Her mind was still running the household.
“A Sacred Pause is intentional,” Hill says. “It is a deliberate interruption of a pattern so that you can restore yourself, reconnect with what is happening internally and consciously choose your next aligned step.”
That distinction matters especially for people whose exhaustion doesn’t look like collapse.
Burnout can still answer emails.
It can make the meeting.
It can hit the deadline.
It can take the children to practice and remember what’s needed tomorrow.
“We often ask how someone is doing by looking at what they are producing,” Hill says. “If the work is getting done, we assume the person is okay.”
Those are not the same measurement.
Hill also places responsibility on the organizations that benefit from people who keep carrying more.
An employer cannot create excessive workloads, reward overfunctioning, normalize constant urgency and depend disproportionately on a handful of people, she argues, then solve the problem by telling employees to practice self-care.
“Self-care cannot compensate for a system that repeatedly depletes people.”
She still gets it wrong
Hill doesn’t present herself as someone who mastered rest after nearly dying.
She still overextends.
She still gets immersed in meaningful work and realizes she’s taken on too much.
She still has the instinct to raise her hand because she knows she can handle something.
“The first person who often crosses my boundaries is me,” she says.
The difference is that she recognizes it sooner now.
She notices when she starts working harder in response to stress. She notices when the practices that keep her grounded begin disappearing. She notices when she’s saying yes because she can rather than because she should.
And she has learned something else that would have been difficult for the 32-year-old version of herself to accept:
Sometimes helping means not helping.
“When I overfunction, I may actually take away their opportunity to grow.”
If Hill could sit beside that younger woman now, she wouldn’t tell her to stop dreaming.
She wouldn’t tell her to become less ambitious.
She’d tell her to slow down.
“You will get just as far,” Hill says, “and you will actually get to enjoy getting there.”
And then she’d tell her something the younger Karma Hill had already tried to do, months before anyone discovered what was happening inside her heart.
Trust yourself.
Trust what you feel.
Trust what your body is telling you.
You do not have to be everything for everybody.
And you don’t have to wait until everything stops working to give yourself permission to stop carrying it all.
Resources
Learn more about Dr. Karma Hill
Dr. Karma Hill, ACC, is a positive psychologist, executive coach and author of Sacred Pause: Reclaiming Your Energy, Your Voice, and Your Rhythm. Learn more about her work and the REST™ Framework at Konversations with Karma.
Spontaneous Coronary Artery Dissection (SCAD)
Learn more about SCAD, its symptoms, diagnosis and treatment from the American Heart Association.
Women and Heart Disease
The CDC’s Women and Heart Disease guide provides information about heart disease risk and symptoms in women.
Recognize the Signs of a Heart Attack
Learn the warning signs and what to do if you or someone around you may be experiencing a heart attack through the CDC’s Heart Attack guide.
SCAD Research and Support
SCAD Research, Inc. provides education about spontaneous coronary artery dissection, information about research and resources for people affected by SCAD.
If you think you may be experiencing a heart attack, call 911 immediately. Symptoms can vary and may include chest pain or discomfort, shortness of breath, nausea or vomiting, unusual fatigue, dizziness, and discomfort in the back, neck, jaw, shoulders or arms.
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