Just over a month has elapsed since my retirement from patient care. I’ve been to one grand rounds at my prior medical center, encountering a smattering of old friends, some preceding me to retirement, others in active discussions with their financial advisers and others a mixed multitude of residents and students assigned to the secondary campus that month looking upon us geezers in the small video access conference room with amalgam of awe and envy but no apparent desire to tap our wisdom or experience in any way. They offered coffee that 8 a.m. none of the mostly unhealthy breakfast goodies that I used to seek out from the table when I worked there eight years previously.
My name was no longer on the roster for CME credit, part of the reason for exiting my house that early in the morning, but I signed underneath, leaving a printed name, address, email, and home phone so there would be no ambiguity about who should get that hour’s credit. Pleasantries on arrival, but silent abrupt departure at the conclusion, as the majority of those in the room then had to move along quickly to their daily tasks, mostly clinical.
For the most part, my “medical mind” for the last month has laid fallow. I submitted two essays, one of which I have a contractual obligation to produce and the other for a very good friend who is developing a consulting business which needs a pipeline of science writing. One essay written a few months before appeared in print, so I read it and added the author’s response to the readers’ comments, of which there were quite a few. And I read the table of contents of my two subscription journals though none of the articles in either. Some medical journal summaries come to me passively when I open my daily email or Facebook. I paid much less attention than I would have as an active physician. Agriculturally, though, fields lie fallow for renewal, mandated as far back as the Old Testament where cultivation is suspended every seven years to allow the farmers to rest and focus on returning for the next cycle.
Now the fall months are here. For me personally, September has always afforded me a reset button. Some people use the calendar year as demarcation, others try to coincide with nature where rebirth and replanting come in the spring. Medicine perhaps distorts nature’s cycle of time with residencies or new jobs traditionally having a July 1 start date. This inner clock probably begins with the first third-year student rotation, years of summer vacation beginning with pre-school and concluding with Step 1 and clinical obligations spanning most young American’s lifetimes to that point. For me, though, while my personal semi-annual goals run Jan-June and July-December, my de facto pursuits start around Labor Day. A new school year begins.
While I no longer attend, my wife has enrolled in the state university branch of the Academy of Lifelong Learning, designed for retirees to keep their minds engaged. We can sift through the divided opinion as to whether the Jewish calendar starts a few weeks prior to Passover with the Torah’s specified first month or the more practical demarcation of Rosh Hashanah and a series of designated festivals that comprise much its month. But certainly attendance at most synagogues peaks with the fall Holy Days and tails off to its summer nadir. The World Series climax of baseball gives way to college football with my teams on TV most weekends and the NFL where my team will mostly let me down — until I need pallbearers to let me down one final time.
Medicine has its own autumnal set points. The preclinical years begin. The residents have just enough experience to make them accountable for their decisions. The noon conferences intended for enrichment, suspended for the summer to provide new house staff core lectures partly devoted to critical things they need to know for patient safety and partly to buzzwords that they need in their notes as their introduction to external intrusion that will follow them indefinitely, those noon conferences as daily seminars in clinical medicine presented in rotation by senior faculty who are already familiar with intricate medical disorders become part of the weekday professional obligation that we all have to advance our proficiency. Medical care and medical professionalism return to the established groove, continuing to the next summer, when the classes and faculty again turn over one to another.
And while the cycles of nature are immutable, and the cycles of school, the calendar, sports, and medical training are set mostly culturally, they have a life of their own that has acquired expectation and predictability. Physicians have their cycles too, mostly long but predictable landmarks. We have our acceptance letter, diploma, board certificate, a series of practice settings or jobs, an annual reconciliation with the IRS and the IRA to see how we did and then an exit. But as people like me depart, people like my two children or my many residents extract some legacy from their elders, perpetuate some of what my generation tried to impart, then implement their own renewal as the medical generations turn over one to another. My two offspring visited recently, each at the final stages of training at highly regarded university medical centers that took a lot of time and talent over many generations to excel as institutions. As I chatted with the fellow retirees at grand rounds, I also made sure to introduce a brand new third-year student to several of these physician masters of years past, including some notable achievement of each that becomes part of these students’ professional inheritance.
Whether nature, calendar, or people, there are always starting points, renewals and eventually legacies but never total oblivion.
Richard Plotzker is an endocrinologist who blogs at Consult Maven.
Image credit: Shutterstock.com
