The Question that Changed Everything

After almost 10 years of accumulating pressures, seeded doubts and diminishing joy while working (see the previous post, “The seeds of retirement”, Dec 11, 2018), I had become pessimistic that things could somehow improve–and increasingly disillusioned with my medical Faustian bargain.  Younger physicians had cemented my impressions with their similar clinical experiences in training, epitomized by a recent Facebook post by a fresh medical graduate, on the “Humans of New York” page (December 14, 2018):

“I just finished medical school. Now I’m heading to residency, which is supposed to be even tougher. I’ve been working sixteen-hour days. Then I’m expected to study every night when I get home. Some of my classmates only sleep three hours per night. I tried that for a few months during my surgery rotation, but I ended up getting really depressed. I felt completely depersonalized. Everything seemed like a dream. To make matters worse, a lot of the instructors are jerks. I think they went through hell when they were students, so they feel like they should put us through hell. On the first day of rotations, my attending physician told me: ‘I’m an asshole, but I’ll make you a better doctor.’ He made fun of me in front of other students. He put me down in front of patients. He’d threaten to kick me out every day. I guess they’re trying to weed people out and make strong doctors. But they’re just traumatizing people. They’re making us apathetic. I got into medicine because I really wanted to make a difference in people’s lives. But after going through hell, I just don’t care anymore.”

Although I had almost forgotten these frustrations in my own training, it has long been self-evident that young doctors have to be thick-skinned to survive the process, and it doesn’t get much better after, given that the chronic sleep deprivation, extreme performance demands and criticisms remain common throughout a career.  Most physicians do find a way to inoculate themselves from the worst of the abuse, in order to salvage a career and maintain a livelihood, but they often pay a personal price for long-term survival. 

But I digress. Knowing that the indoctrination process had not changed much in the decades since I had graduated solidified my skeptical perceptions for the future; and now, in the face of developing personal health problems in my 50’s, the reasons for wanting to leave my career had become clear and defensible. 

Guilt

Yes, defensible.  As I ruminated over what would eventually be the biggest career decision of my life, curiously, it became suddenly vital to be able to defend my argument to leave my medical career–whether to my friends and family, my colleagues and support staff, or even to my patients.  Most likely, I sensed a necessity to overcome a sense of guilt over even thinking about such a decision–after all, is primary care medicine not an honorable, well-paid profession, with a central role in the delivery of a community’s health care? Does it not demand years of arduous training, along with considerable financial investment and support from governments, medical schools, communities, and families?  Well, yes. But there is room for more than one perspective here–am I to remain community-obligated and duty-bound forever?

First, I would have to challenge my own assumptions.  Since most doctors do not appear to be struggling, is it really all that bad?  Was it really just some more regular time off, a change in scenery, or a slightly different role that I needed? Was I really turning away from my obligation to my community (which already had a doctor shortage), and from the training program that provided me this unique opportunity? Am I going to just walk away from the most reliable income stream I have ever had? Would I miss working with my colleagues and support staff? Am I going to regret this decision within a short period of time, knowing that returning to the fold can be very difficult?  Am I just being selfish? Although I would have to make a lasting peace with each of these questions, the answers to all eventually became pretty clear, no matter how many times I reviewed them.

Avoiding pain, seeking pleasure.

Although I was first preoccupied with ending negative or painful experiences, I did eventually allow myself to consider some of the upsides of retiring. Yes, allow: you see, most physicians, including me, have had extensive training and experience in extended hours on call, making it easy to feel chronically duty-bound to put others’ needs ahead of our own–always, always, and forever.  But, in a shameless moment of daring, I found the courage to think outside the box, by asking myself this question: Outside of medicine, are there things I want to do before I die, and, if so, when was I planning to get around to them?  Although I did not really have much of a list at the time, I knew that my best lived life would not just be defined by a medical career; the question of how I wanted to ultimately define myself would be the most personally relevant exploration I needed to pursue.

Who am I?

This introspection sent me down a few rabbit holes.  Since time is a non-renewable resource, I first needed to confirm–and now, promptly– that I had a direction, an identity outside of my medical career, or at least, an inclination to build one, otherwise I may as well work as a doc until I drop. Or would I be lost without the M.D. rubric?   

This was initially quite difficult.  The last time I was not medically inclined was more than 30 years ago, and back then I struggled with any confidence in any direction.  Back then, I loved sports and the outdoors, education, and traveling, and I had some occasional hobbies. But I would have to go deeper.

Over time, it was evident that I strongly identified with health, with helping people, with constantly learning, with supporting my community–could I find other ways to satisfy these inclinations? Did I have other basic characteristics that were not germaine to the role of physician, but nonetheless needing some outlet or recognition? Were there other skills or experiences that I wanted to explore once medicine was behind me? These questions were much more fun to contemplate, and over time, the answers went from a trickle to a torrent.  I fantasized over writing a book, blogging on health (and the process of retirement!), learning a second or even a third language, traveling and living in Europe, becoming an entrepreneur, developing my cardiovascular fitness, becoming a bodybuilder, learning to kiteboard, volunteering in a third world country, developing my woodworking and landscaping skills, going back to university, improving my IT skills, resuming piano or guitar lessons, improving my culinary skills, reading classic books for pleasure, joining a volunteer organization in my community, doing health workshops for schools or businesses….and so on.  Clearly, in finding many worthwhile pursuits, without needing to pick just one, I had my first look at a retirement “smorgasbord”. This would keep me happily busy for quite a long time–so, would I have to let some of these ideas go?

A new found urgency.

Since I was approaching 60 years old, I cannot expect my health to remain trouble-free indefinitely, so what would be a reasonable time frame to count on for good health to get some of those bucket list items done?  Since my clinical career has offered me a unique vantage point, to see how health problems develop over time, it was pretty easy to come up with the following synopsis: If I continue to take reasonably good care of myself– regular exercise, a healthy diet, good sleep, etc–I could reasonably expect to make it to age 80 with close to full functionality, before the odds start stacking against me.  Dementia, Parkinson’s Disease, diabetes, stroke, heart disease, joint problems–all in evidence in my family tree–would all be good bets by then, and maybe even before.  And I haven’t factored in cancer risk or accidents.

7000 days.

So, from 60 to 80–that is 20 good years, to get done everything I want to get done to feel I have lived a life well lived.  It seems like lots of time, until you translate that to about 7300 days.  And when you ask, “Of this time period, which are likely to be your healthiest 5 years?  The answer, obviously: the next five years.  And as there are many pursuits on my list that will require being both physically and mentally fit, I really need to get on with things–and the sooner the better.  And when I framed it this way, the decision to retire ASAP was very easy.  And, like getting married, I probably should have done it even sooner than I did.

Have you thought about who you are, or what you would be if you were not a doctor? It is not enough to have reasons to get away from medicine–you need to be drawn toward something as well. To pull you toward retirement, or even just a change to a non-clinical career, you may need to answer this question clearly, since we have all heard of people who have retired for a few months to play golf before they get bored and return to some kind of work.