Notes From Dr. Sam

Good Day,

I hope this note finds you well.

Well, I am now a month into retirement and I am regularly confronted by new surprises. Over the last several years I had slowly reduced my time in the office and by Thanksgiving I was only there three half-days a week. With this reduced schedule it had never occurred to me how much of my time I spent thinking about “the office”.

Technically, I didn’t think about the business of medicine because for several years I had not been involved in the financial aspects of the practice, I didn’t even go to business meetings. Even though I joked about it, I had really enjoyed the transition from paper records to electronic medical records. There was a steep learning curve but it almost immediately resulted in an improvement in care.

No, what I spent my time thinking about were the individual patients.

There is the older woman who has heart failure and crippling arthritis and is now facing end of life issues, struggling to keep her life intact. She lives alone and is determined to continue. Even though she won’t admit it, she knows there is an end and it is sooner than later.

One of the my favorite friends was a dear man whose wife of fifty years had recently died; each time I saw him it was obvious he was searching for an anchor, a point of stability. I had known this couple for thirty-seven years and had watched them grow old together; in a sense they were my heroes.

A friend, my age, has developed diabetes and hypertension; he is faced with the fact that he was no longer twenty and isn’t the least bit happy about it. But, like most good middle class problem solvers he has put his mind to it and will deal with this the same way he has all the other problems life has thrown at him.

A few months ago a young woman in her early forties who I have known since she was a teenager developed breast cancer and was scared that this was the end of her life. It was an aggressive tumor and the therapies are heroic; during the middle of her trial she thought about quitting but didn’t. She is a real hero to everyone in her world.

When I began in the practice of medicine, I was twenty-six years old, armed with science and certitude. It didn’t take long to learn that science is full of holes and for many problems it is only the starting place. All of the academic diseases with formal sounding names occur in real people with real lives. Certitude slowly eased its way out the back door.

For forty years I was privileged to move around in this world, looking for answers. I prided myself that I could leave it at the office but the truth is I didn’t. I now realize that most of my conscious and other-than-conscious time was spent thinking about patients. And, it is equally obvious that I’m still thinking about it.

Have a good journey.

Sam