Sunday, December 28, 2014

Retirement, and the Goodbye Party

I have been trying for 6 months to get myself ready, and to begin to know  how to do this, how to "let go, and let God," in this part of me which always felt like the biggest part of me, and of what I was called to be and do.  And yet, Rachel said, "walk out of your role and into your life".  So there was a way to get past the feeling that I am dying-- it just was going to be hard.  I have closely watched many people approach this change, and it is not easy to do this gracefully.
I know that my children have gotten less of me than some children have gotten from their mothers, and it was always the existential question-- "did they get ENOUGH?" even though it might be less than they wanted, was it sufficient for them?  So it was even more tension, that Andy is leaving for Chile, just after the retirement party, but a great gift that he was willing to come, and hang out and just be there for me.  And Sebastian, too--- now such a grownup, and able to bring the beer, and sit on the tailgate schmoozing with Dr. Garner.
The irony is that I had invited about 100 doctor-colleagues, and only Dr. Garner actually came, and Dr. McNamara, partly because the social worker Kim brought him along.  I am so indebted to the labor nurses, who came and made merry, and were fun and strong and warm.  These women have been the backbone of my life, and in real ways, being the team in OB, have made our work possible, and gotten me through a lot of crises, and helped babies arrive safely in their mother's arms.
I have been already trying for months  to feel my way through this, saying to myself that this may be the last time I do this, and this may be the last time I see "her" face.  Last week I worked very hard stuffing envelopes with the goodbye letter.  I did it until my back was hurting so badly that I had to lie down, and again I knew deeply that it is time for me to go;  and that these letters, my last attempt to give love and support to my patients, will need other hands to seal and mail them.  I have tried to keep going so that the office will keep functioning and our staff can keep working, but we are being squeezed out by larger corporate structures, and we cannot make ends meet any more.  So I am praying for each of my staff, to be able to get good jobs, and to fit into their new lives in ways even better than what they have now-- ways that God can move in their lives in mysterious ways which will strengthen all the good in them-- which I know and have loved, and have been blessed by.
I remember several other docs facing the dilemna;  and one who couldn't leave, so she stayed until 3 days before she died, walking through the hospital, trying to function, and not willing to give up this identity.
I remember Joe Anzalone, who tried about 3 different times to retire, before he actually stopped walking in to do surgery or check on the office.  I have heard that in big corporate practices you can retire at age 55 with full benefits, so there is nothing but the love of your patients to try to hold you there.  And maybe it is easier, when there is a larger staff to take over the patient care, of those patients you have loved and taken care of for a long time.  And I do know other docs who say "but I have been taking care of (her) for 30 years, it is so hard to say goodbye!".  That is how I feel about each of my patients--- we have formed a doctor-patient relationship.
There are a few patients who had such severe stress and terror, and deep vaginismus, that to get an exam and pap smear was a major achievement.  Slowly, slowly, they came to trust me, to believe I wouldn't hurt them;  and that no question they asked would be unwelcome, that I would try to answer the best I could.  And also, we who have been practicing a long time can see now, how much the real issue is FEAR--- so many questions and hesitation and blocked speech, all from the terror of "what does this mean?".   Once we are able to give a diagnosis and tell them what it means, and to put it into a context, they can bear the next step.
I am going to miss that part, and also the part of helping women to have a normal vaginal delivery--- as the c/section rates rise higher and higher, and doctors are so scared of being sued, and the protocols get more rigid--- it becomes harder to take a chance, try a different position, see if maybe we are able to make a difference in some small way, so that this baby will come down through this mom's pelvis.  I have written before about women who don't want to see us, don't want to come to the hospital, and who believe midwives will miraculously be able to do more than a doctor to help them get through a vaginal delivery.  I am glad to know some excellent midwives, but they need us for the tough cases, and they recognize the difficulties inherent in childbirth.
I am glad that all around the world, better maternal-child health is happening. Although it has gotten worse in our country, because of loss of healthcare coverage, and women working so hard;  so preterm labor has increased.  And somehow we are having this epidemic of autism, and we don't know why!  At least in the developing world, more money and training and help is happening, to get safer deliveries, and less mothers dying in childbirth, and more babies making it to childhood.
It is time for me to stop doing the 16 hour days, the nights on-call, and the need to jump out of bed and race to the hospital for someone whose baby's heartbeat suddenly isn't looking safe-- or a hemorrhage, or an ectopic pregnancy.   I know that there are superbly trained young doctors out there, and I hope they will be willing to just be kind and compassionate and gentle, as they offer technically excellent care.
I feel the feeling of fellow-docs;  that tiny unstated resentment, of abandoning them, leaving the team.  I know that subtle turning away-- "you don't belong here anymore".  No one knows how to do this when they are young, and even when you are old, it is very hard to be able to do it gracefully.  When you are young and get sick, like one of my doctor friends who got a terrible case of chronic fatigue syndrome which has been unresponsive to every thing they have triend, she feels that they write her off, look at her as a victim and sad case, not as a doc who couldn't keep doing the medical role.  I am afraid of being seen as an old fuddy-duddy, or someone who is just in the way, or "does it wrong".
I know that they are not going to come and ask my opinion, and that everyone has to learn to make their own mistakes.  These are such hard lessons.  I will keep doing the prayers, and trying to let go gracefully--- but I know so many times a day, I will have to open my hands again, and ask for help.
I feel so lucky to have the feeling God is walking this walk with me, through the valley of the shadow of death.  I say the prayer from Thomas Merton hoping that I am listening hard enough to that real voice, which is calling me, to do what is best, which conforms best to God's plans, will, desires.
It is good I have another month to practice, another month of trying to get more graceful at trying to let go!
I read this wonderful quote today from another doc I have loved and respected, Ken Hamilton, who started a group called H.O.P.E.
"In closing, I share with you this thought—my “Prime Directive”—“First, do no harm; second, do some good; third, benefit someone; and fourth, be kind to them.”( Indeed, remember Anne Herbert’s “Practice random kindness and senseless acts of beauty,”)  and work it at every conceivable opportunity… it is infectious."

my favorite prayer---
. “My Lord God, I have no idea where I am going. I do not see the road ahead of me. I cannot know for certain where it will end. Nor do I really know myself, and the fact that I think that I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you. And I hope I have that desire in all that I am doing. I hope that I will never do anything apart from that desire. And I know that if I do this you will lead me by the right road though I may know nothing about it. Therefore will I trust you always though I may seem to be lost and in the shadow of death. I will not fear, for you are ever with me, and you will never leave me to face my perils alone.”
Thomas Merton