Tag Archives: retirement

(Almost) Free at Last!

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I’m now semi-retired.

Even though I feel like I’m in my thirties mentally, I feel like a dinosaur next to physicians that are my kids’ ages. (Aaron would probably say, “Yeah, a T. rex!”). After 36 years, delivering babies is like riding a bicycle, but I started riding that bike when obstetrics was a Schwinn 5-speed I bought in high school. Now that bike is made from exotic materials costing thousands of dollars and requires an engineering degree to operate, even though the destination hasn’t changed.

I was ambivalent about leaving hospital practice when I started writing this, but I’ve gotten used to the idea of maybe never delivering another baby. Letting go has been easier for me than it would be for those whose identities are inextricably tied to their professions. I’ve become increasingly skeptical about the direction health care has taken; I’m more than happy to pass the baton to the next generation and wish them luck. They’re going to need it.

However, I am not just sitting around watching Matlock or yelling at kids to get off my lawn. I’ve been doing health assessments for seniors for the past two weeks and it’s been a fine experience. If nothing else, I’ve gained an appreciation for seniors and insight into what is to come.

Fifty years ago, we didn’t see people in their eighties or nineties. The seniors I knew as a kid were grey, wrinkled and tired.  Most people, especially those who did manual labor their entire careers, retired at sixty-five and had a few good years before dropping dead from a massive heart attack or a stroke. I was shocked to discover LBJ was only 55 when he became President and died at 64, my current age.

But by 2020, the percentage of people over 65 will have doubled since 1950, from 8% to almost 17%.  Ten years ago, people 80 and over were the fastest growing population segment. More people are working well into their 70’s and 80s, often out of necessity but sometimes by choice.

So, I’ve been driving around the Heartland making house calls. I have a rolling case with the equipment I need: a scale; an automatic blood pressure cuff; an ophthalmoscope; a pulse oximeter; a reflex hammer and a penlight; gloves; a 10g monofilament diabetic neuropathy tester; and company paperwork.

The people I’ve seen so far have all been warm and welcoming. They seem genuinely happy to talk with me and are far more relaxed than they would be in the intimidating confines of a physician’s office or a hospital room. The evaluation takes about an hour, longer than the fifteen to twenty minutes allotted to primary care visits. Several have remarked “This is the most thorough exam I’ve ever had!” I can only see six to seven people in a day and no practice would be able to survive at that rate, so it’s a nice service to provide.

While I’ve seen a few people my age, most of them are mid-seventies to early 90s.  Despite chronic illnesses and the infirmities of age, they don’t complain. Yeah, the back hurts and getting around is tough, but any day one wakes up above ground is a good day.

One of my clients on the first day lived in an assisted living facility. I passed a group of women around a table in the hall on my way to his apartment. One of them noticed my white coat and asked in a loud whisper, “Is that a doctor?”  The gentleman was a 93 year old veteran who still drove his own car and liked to play games on his computer. He’d been retired for 27 years, lived by himself, and still had more energy than I do some days.

An 89-year-old man learned keyboards when he retired at 62 and now plays for community events. I asked him what kind of music: “Swing, country, jazz, blues…”  He pointed to his keyboard and microphone, sitting next to his treadmill. He gave me hope that I might be more than a mediocre piano player before I die.

A couple of the men were still running their own businesses. A man in his mid-70s needed a new computer monitor and snagged a 43” UHD TV for four hundred bucks just before I met with him. Another man, 80, had rental properties to check on later the afternoon I visited him. I called a few days later to make sure he’d gotten his blood pressure rechecked and he recognized my voice.

“My blood pressure was much better. Thanks for calling me!”

I saw a couple for my last visit of the day near the end of the second week:  A 99-year-old man and his 92-year-old wife, who both looked like they were in their seventies. They were still relatively active; they’d been waiting for better weather so they could start working in their garden.

The husband went first. I confirmed his identity, entered his medications into the record, and then started with a long list of standard health history questions, which includes asking about past alcohol use.

He became a little defensive and said, “I never drank that much. When you’re Italian, there’s always wine on the table.” 

Sensing his unease, I replied, “My late father-in-law, Mike, was from the South Side of Chicago. After the war, he and his buddies used to crash Italian wedding receptions because the food was great, and the women loved to dance.”

He brightened up and replied, “We used to get trash can lids and bang them together in the middle of the night. People would throw money at us to get us to go away. They never threw quarters, though, only nickels and pennies.”

The conversation became a little more somber when I talked about Mike’s war experience.

“Mike was a tail gunner in a B-17.”

“Was he in Italy? If he was in a B-17, he must have been in Italy. I was the crew chief on a P-38, that fighter with the machine guns in the nose. We flew in the Ploesti raid in 1944.” The memory angered him. “Someone ratted us out; the Germans were waiting there for us.”

I was surprised to talk with someone who knew of that campaign, but I shouldn’t have been since he and Mike were born the same year.

“Mike was on that raid, too! Their plane had been hit pretty badly and they were going down. He’d been injured and his harness was shot up, so the bombardier, David Kingsley, put his own chute on Mike, dragged him to the bomb bay doors and told him ‘Put your hand on the ripcord and pull it once you’ve cleared the doors.’ He went down with the plane and Mike spent three months in a Bulgarian P.O.W. camp.”

Before I left, he showed me a large frame on the dining room wall with pictures of him and his buddies standing in front of their plane. “You know, it’s sad. We can’t get any of the younger guys to join the VFW or the American Legion. I guess it’s not that important to them.”

I started my career bringing lives into the world. Ending it by working with people on the other end is rather fitting, I think, and just as rewarding.

© Can Stock Photo / 3D_generator

Jurassic Doc

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I don’t recall the exact moment I realized I was sliding towards obsolescence, but by that time it didn’t matter because I didn’t care.

I did my residency during the early days of ultrasound; images looked more like a Rorschach inkblot than pelvic organs or babies. We all believed radiologists made shit up when they read ultrasounds. Few things were more irritating that having one emphatically identify a non-existent tubal pregnancy, committing us and the patient to an unnecessary exploration.

We used one of the first TV cameras adapted for a laparoscope, a rather bulky attachment whose picture was as atrocious as it was fascinating. The attending physician watching the monitor while the residents tied a patient’s tubes laparoscopically said, “Maybe I DON’T want to see what you are doing.”

The hospital where I did my internship bought a Computerized Axial Tomography (CAT) scanner, a great advance over simple x-rays and a fortuitous event. One of the radiology interns volunteered for the initial scan and discovered he had a brain tumor. Word got around only after people began questioning the sudden onset of baldness.

Technology’s transition from medical advance to hospital marketing tool started in the 1990s. Physicians touted “minimally invasive surgery,” which some patients interpreted as “painless and risk-free.” Magnetic Resonance Imaging (MRI) replaced CT scans and generated new revenue as outpatients sites opened. (One small town boasted five MRI machines.)

Administrators became enamored with robotic surgery in the early 2000s, buying a toy that cost $2 million and came with a $150,000 annual service contract. Initially acquired by large private and university healthcare systems, robots found their way into small community hospitals looking to attract more customers to augment declining revenues.

I’ve always been cautious; I was never the first to embrace that which was new and heaped with promise. My choices were often met with incredulity. “What? You DON’T treat warts and cervical dysplasia with a laser?” No, but thirty years ago I saw physicians willing to plunk down fifty grand for an office model, even though they had no idea how to use it. Those contraptions are likely catching dust in a closet, having been supplanted by the far simpler wire-loop cautery known as LEEP.

I never cared for doing surgery exclusively with a laparoscope. I could take out a tubal pregnancy through a small incision and be finished in the time it took to set up all the laparoscopy equipment. I didn’t get on the Laparoscopic Assisted Vaginal Hysterectomy (LAVH) bandwagon, having watched my colleagues turn a 45-minute procedure into a seven-hour ordeal. I learned “new” wasn’t necessarily “better” but was always much more expensive.

I preferred delivering babies to gynecologic surgery, and most of my subsequent jobs were for obstetric coverage. I stopped doing major gynecologic surgeries in 2007, relieved. Then earlier this year an office nurse said, “Any woman who has a big scar on her belly from an abdominal hysterectomy should sue her physician for malpractice.” I’d passed the point of no return and was on the way out.

I don’t mind being a dinosaur, partly due to the direction my profession has taken. We spend far more money than twenty years ago for very little tangible benefit. Younger physicians rely too much on lab tests and scans and too little on actually listening to and examining their patients. I don’t want to talk with a patient while typing notes into a laptop—the health care version of texting during dinner. And I don’t want to take ten minutes to generate a prescription from an electronic medical record (EMR) when I could do it with a pen in 30 seconds.

I’m looking forward to retirement and I’m happy to pass the baton onto a younger generation. My only regret is that I probably won’t be around in thirty years to witness the same realization cross their once-eager faces.