Discovery

I needed to retire when I did. Especially with the discovery I made afterward.

My medical practice had been exciting, challenging, and satisfying. I cared for an immense number of people, with a great range of age, race or ethnicity, language, life experience, and culture. Some were rich and some poor, some educated, some illiterate. I learned from all of them, and I cared about them. My memories are of emergency rooms, hospitals, and offices, but also dark stairwells, cluttered apartments, field stations in tents. I loved my colleagues and had faith in them and appreciated team care with nurse practitioners, physician assistants, physical therapists, and social workers, all working to the same end. Acute situations called for rapid thinking and bold action, but many situations called for cool analysis, self-awareness, empathy, calm reflection, and total honesty. I never stopped trying to improve the way care is organized, and I loved research and service in medical care organization, quality improvement, administration, and teaching.

Of course, I disappointed myself, too. When I was young—and for a good many years after—I expected that I would do work in underserved and underdeveloped regions, do something pioneering and bold, maybe a little dangerous. Partly, such a life was not compatible with the kind of family life I also cherished. Partly, I doubt I really was made of that kind of fiber.

But …

But the workload never stopped ballooning as my panel of patients aged and became sicker; the well ones moved on and the complicated ones stayed. There was no way to cut back unless I was prepared to tell many people who had followed me for years that I wanted them to go elsewhere, while still continuing with others. Cutting down on paid session time without cutting back on the population needing to see me would only result in unacceptable waits for attention, or in sandwiching those visits between paid sessions. Of course I would do the latter: same workload, less pay.

Medical practice was changing in America, and not for the better: more documentation for billing, insurance forms, justifications in writing to be sent to insurance administrators and gatekeepers who knew nothing of the patients and little of the disorders or treatments, more certifying to third parties, letters, forms, and overrides. This was coming directly out of the time I had to spend talking with patients about their concerns, helping them with decisions, hearing about their personal lives, comforting them. I was not willing to compromise this point as much as the pressures demanded. So, I was working longer and longer hours, with many evening phone calls and paperwork keeping me up long after my wife went to bed, and getting me up before dawn to finish the computer work.

Besides, the practice of adult primary-care medicine was being emptied of stimulating intellectual content, and becoming more and more a checklist. Most of my training was being wasted as “hospitalists” took over hospitalized patients and referral specialists took over more cases. These were long-term trends in American medical practice driven by insurance and financing, billing, liability concerns, and patient expectations. Today’s primary care clinician should probably be a non-physician.

The fun parts of practice were being inundated by the drudgery. The parts for the mind and the parts for the heart were replaced with forms and checklists.

And …

And there had to be more to life: long-deferred interests in the outdoors, in becoming an artist, in enjoying music, writing, gardening, and political action, in a new round of serious study, in doing more with my wife and friends, in doing those things before the lights went out. A friend died suddenly. And another died slowly. A person very dear to me appeared certain to die but defied the odds. Others dear to me suffered from disabilities and could never get to do things they had deferred.

I had no desire to die before I had tasted more of life.

It was time to move on.

It was no small thing to make a decision likely to be a one-way valve, to leave what had been my most tangible self-identity, to send back my license, quit my academic and staff positions, and leave my patients and my colleagues.

Do I look back to my career with longing at times? Of course. I believe “once a doctor, always a doctor.” It pulls at me sometimes, especially when I pass a place where I practiced, or run into a past colleague or patient, or explain something medical to friend or family. But I know that it’s over.

“Retirement” is a horrible word. Beaten armies retire from the field. But for me, it was a new beginning, a shift in gears. It was a chance to discover and to play—and to grow.

My wife gets the credit for talking me into joining HILR with her.

Certainly HILR is not the entire package that I want for myself in retirement. I need more solitude, a chance to write, do oil paintings and photography, “journey into myself,” maybe write poetry. And certainly our social life outside HILR, our gardening, our travel, our lives as grandparents are all important to us.

But it is amazing how much of what I need now is to be found at HILR: academic challenge, exciting reading, lectures, debates, roundtables, films, and clubs (HILR has a hiking club, writing club, travel groups, play-reading and acting clubs, political and contemporary-affairs clubs, language clubs, poetry club). I love having a new world of peers, many more highly educated and far more conversant than I on many topics. To know them is to learn. The seminars are all peer taught, and the classes full of great discussions with insightful people (as well as others less sharp of course; well, life isn’t perfect). In contrast with the classes I attended 50 years ago as I started college, my classmates are mostly attentive, mature, do the homework, and don’t have any reason to obsess about grades. Most are clearer about who they are now. A perfect seminar trifecta of great reading, great teaching, and great classmates is perhaps uncommon, but two of these three is usual, and at least one of the three highly likely.

The opportunity to research something and then to lead a seminar before really sharp people is exciting and fun, if a little scary. But I’ve done it twice, and my wife has done it once. I’m doing the research right now to lead another group along with a colleague. And I wouldn’t miss it for the world.

And then there is being a valued part of Harvard University with all that is there open to us, and we enjoy the support of a dean and are led by an assistant dean. The Harvard Gazette is chock full of events, and the library system is staggering. The campus is gorgeous.

I always wanted to go back to school, I mean to a campus, with exciting courses but with more than classes, with campus life. I feel that I have that at HILR, except that I won’t be kicked out after four years.

And then there are the friends. Most are older than I, and I admit to coming in with some age bias. This quickly fell away as I discovered that they are really very exciting people, rich in experience and knowledge. Enough of them are friendly to me to give me a sense of family. They return year after year, and we have informal times together in the lunchroom. Some of them now see my wife and me socially in their homes, in restaurants, and theaters. They are my new peer group, and we are likely to have friends from HILR for many years, maybe till death.

Stunning, really. It has redefined who I think I am. I am one of them.

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