How do I handle the heavy load that comes with hard-won autonomy?

You can manage the most complex patients, the ones others send onward, and you fought hard for the autonomy to do it your way. Now you are feeling the other side of that freedom: the load. Autonomy and weight came in the same package, and being caught between them is the honest position of someone who got what they wanted and found it heavier than expected. The thing to see is that autonomy was never meant to mean alone. You fought to make your own calls, not to carry every one of them by yourself. Somewhere the two got tangled, and independence started feeling like isolation. You can hold your hard-won authority and still share the load. Those are not opposites. Look for where you are carrying weight that does not actually require your autonomy, tasks you could delegate, decisions you could share, support you have not asked for out of pride or habit. Hand one thing off this month without feeling you have surrendered anything. The freedom you fought for is worth keeping. The loneliness attached to it is not, and you can set that part down.