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Retirement blog

Dr Liz Archer has retired from general practice in December 2011 and writes with insight and humour on life after retirement.

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An end and a beginning

Today I did something momentous.  I surrendered my medical licence to practice.  I’ve had the GMC form on my desk for weeks, but couldn’t quite bring myself to sign it.  Until now, that is. This week, the GMC kindly sent me some further paperwork about revalidation, and that made my mind up.  I have no intention of doing any clinical work again – ever - so there is no logical reason for me to hang on to my licence.  But there is something terribly final about requesting “voluntary erasure” from the medical register.  I have so far shied away from that final act of surrender, but reading the latest update on the revalidation process did it for me.  I was left paralysed with ennui, and signed the form there and then.

So, I am no longer a ‘proper’ doctor.  One valuable outcome is that it will save me a tidy sum in GMC fees, which I am sure I can spend more usefully.  Preferably on something entirely flippant.



Coming up for air

It’s done!  All the building work is finished and order has been restored!  The builders have gone, and I’m now full of admiration for the job they’ve done.  The smell of fresh paint is beginning to fade and I can breathe once more. I have taken the opportunity to have a huge clear-out of stuff - numerous black bags of papers and journals, several pieces of furniture, a stack of pictures, and a quantity of storage boxes.  I’ve sorted out the stuff I’ve decided to store, and that seems in some way to have cleared my head, too. Now, perhaps, I can begin my retirement?  Ah, but there’s Christmas to negotiate first. There was a time when I eagerly anticipated Christmas.  It was a special time of year, filled with celebration and the joy of giving and receiving.  The problem now is that it always seems to turn up when I’d rather be doing something else - like starting my retirement.  Then there’s that course I’m teaching after New Year. Oh, and the talk I promised to do in February, and then I’m helping to organize that conference at Easter…..  Oh dear.

 I have a sense that my retirement is endlessly being deferred.  It does occur to me, of course, that this feeling might be an issue I need to address.  What if all this ‘other’ activity actually is my retirement?  I think it’s time to make some decisions about prioritizing my activities.  Just like I used to do when I was at work.  Funny that.  Now where did I put my diary?



When did I find time to go to work?

A truism about retirement is that, after a certain period of adjustment, retirees start wondering how they ever found time to go to work.  Well, I can now tell you that this is absolutely true. 

I feel like my feet haven’t touched the floor since I got home from Devon.  Ever since the builders moved in and began “renovating” my house, that is.  I know I asked them to do it, but it still feels like a huge intrusion.  I move my furniture and possessions from room to room, and watch helplessly as an ever-thickening layer of brick dust settles around me.  In desperation I have retreated into my bedroom with the cat, since that’s the only room in the house, which doesn’t feel like an overly cluttered attic.  I peer into the gaping hole in the sitting room floor where the hearth should be and wonder if I will ever get my home back.  So much for my plans for leisurely morning strolls along the seafront, tango classes, and quiet evenings in with a good book.  My days are taken up with making tea for the chaps and attempting to keep the worst of the domestic chaos at bay. By 9 o’clock I’m exhausted and can only think of bed. I’m sure it will all be fine in the end, but this is not quite what I had in mind for the first weeks of my new life.  Hey ho.



Devon Magic

I’ve been away at a retreat centre.  I was longing to ‘drop out’ for a few days, in the full expectation that I would finally be able to let go of work and slide into retirement properly - no email, no phones, and no schedules.  Only the slow, daily rhythm of sleeping, eating, and walking on the land.  Indeed, I slumbered deep and long in my candle-lit yurt, lulled by the wind and the crackling warmth of the woodburner.  I could have done without the chilly midnight walks to the composting toilet, though, but any such grumbles disappeared at the sight of the deep, star-studded Devon sky, and the screeching of tawny owls in the woods.  I was enfolded by the valley’s soft and magical darkness, and felt glad to be alive.  The healing properties of nature and the land are truly miraculous.

But I was also restless.  I found it hard to slow down and be fully present to the place, and seemed always to have something on my mind.  A vague anxiety hung about, nagging at me.  What’s in my diary that I should be attending to?  I’m sure there’s something I ought to be doing at the moment.  What about all the emails, phone messages and post piling up and awaiting my return? What about….?  These thoughts became intrusive and insistent, and undermined my enjoyment of these precious few days in Devon.  I realize I have a very long way to go before I can claim to have finished with ‘work’!  I might have left my office physically, but mentally I am still there.  This insight is unwelcome.



A great send off

Well, the day has arrived ;my last day at the practice and the end of my career as a GP. 

I have been given a wonderful send-off, with a series of perfect gifts and a great night out in Brighton with all the team.  Then this morning I arrived to find a magnificent flowering orchid on my desk with a couple of celebratory balloons wishing me a happy retirement!  My last surgery session felt unreal, and I’m glad that I didn’t have to deal with any very serious problems – my mind was not really on the task.  There was something solemn and terribly final about handing in my prescription pad, ID card and keys, and then emptying all the drugs out of my bag.  It was like being stripped of an identity.  I cleared out the last of my personal bits of pieces, and said my final goodbyes.  The practice manager burst into tears as she hugged me, and that finally set me off I - I had remained remarkably calm until that point.  I cried most of the way home.

How do I feel?  Relief, sadness, elation, restlessness, uncertainty…. A tumult of emotions and thoughts.  It is hard to describe, so I won’t try.  I can only let the feelings sit with me, and observe.  I know I will miss my colleagues a lot – they are a fantastic team, and it has been a joy to work with them.  And I will miss the patients, including the ‘difficult’ ones who have been my greatest teachers. 

It will take time for me to adjust to letting go my structured week, though I have no anxieties about not having enough to do.  I just don’t know how my life will reshape itself.  I can only try to remain open to what comes in to fill the space. 

What an adventure! 

 



Time to say goodbye

I have been really moved by the patients’ response to the news that I am leaving. 

So many of them have thanked me and wished me well, and now the cards and gifts are arriving – everything from a bottle of champagne to a bag of windfalls from the apple tree in the garden.  I know that the sentiments they express are heartfelt and genuine, and I feel deeply touched. 

One letter in particular, from a patient I have not seen for some years, made me stop in my tracks.  She wrote about my visit to see her after her husband’s sudden death, and how the words I spoke had really helped her through that difficult time.  The point is, I can’t remember what I said or did, and I suddenly felt humbled.  How often I have failed to honour the healing power of simple empathy, or to recognize the extent to which my little ‘routine’ kindnesses make a difference? 

The staff have told me that they are putting together an album of all the messages that patients have left with them at reception.  I’m not sure that I will be able to bear reading it.

 



Stop and stare

I was brought up with books, but I find that I am less and less inclined to read them.

I once devoured fiction with gusto, from the classics to the most challenging of modern literature.  I used be enthusiastic about expanding my clinical knowledge and skills, and then began to educate myself about the pressing demands of the ‘real world’ outside medicine.  I have studied everything from Buddhist philosophy through climate science to the new economics, and for a while I found it thrilling and challenging stuff.

Now I just feel wearied by the relentlessness tide of unanswered questions I am left with.  I realize that, at this stage of my life, the most important learning will arise from within myself rather than from ‘out there’.  It really is time for me to ‘stop and stare’, and to allow myself to be touched by the simple wonders of ordinary life and the natural world



The myth of perfection

I am beginning to clear out my consulting room, and look in bewilderment at the mass of papers, journals, books and other stuff I have accumulated over the last few years. 

It’s strangely reassuring to know that all the information I might ever need is in here somewhere - if only I could lay my hands on it.  Ah, the fantasy that somehow all that knowledge will become absorbed by my mind through physical proximity alone.  If I just sit amongst it I will become blessed with perfect knowledge!  The truth is that I have generally relied on a couple of well-thumbed pocket guides and Google to tell me whatever I need to know.

So why have I been gathering all this paper together?  How many murdered trees do this stack of abandoned literature represent?  As I pile it into boxes for recycling, I suddenly feel rather foolish.  Why has it taken me this long to be so honest to myself?

 

We doctors are perfectionists, by definition, and the idea of just ‘getting by’ with imperfect knowledge is anathema.  We are, after all, required to be paragons at all times – at least, that’s the myth that drives us, and which some of our patients also buy into.  I have decided that I am going to make friends with my healthy imperfection, and that I am not just going to acknowledge my ‘normality’ but celebrate it.  I think I’m really beginning to get that it’s OK to have off days, make mistakes, get tired and irritable, and sometimes even to let other people take care of me.

 



Why can' it always be like this?

It’s strange how the mind plays tricks on us.  Nothing actually changes, but subtly everything changes. 

I notice how, as the date of my retirement approaches, I am progressively letting go of my concerns about meeting QOF targets and other self-serving bureaucratic requirements.  And as I do so, I find myself relaxing and becoming more present to my patients.  Surgery sessions seem to expand, and I find myself more alert and attentive to people’s needs. 

I am being reminded of why I went into medicine in the first place, and how precious – even sacred – the intimacy of the consulting room can be.  I am touched by the trust and kindness of these people, and by how much I care about what happens to them.  We have a history together that retirement will not erase.  In short, I am beginning to enjoy the work again.

Why can’t general practice always be like this?



Subversion

The most subtle tactic for achieving unorthodoxy as a pensioner is, I would suggest, to cultivate subversive thoughts.  No-one can actually see what you’re thinking, and it’s amazing how letting the imagination loose within the privacy of one’s own head can shift one’s perception of reality.  I’ve tried it, and the results can be very ‘interesting’ (as in the apocryphal Chinese proverb).  Naturally, subversive thinking tends to subvert one’s behaviour, and I suspect that this is when the fun really starts. 

 

Every change in life begins with an idea, thought or image which, when invested with energy, begins to take form in the outer world.  Someone once said “Be careful what you wish for!”, so I need to remain mindful that being subversive will only be fruitful (and fun!) if it also takes me where I really want to go.    

The more I think about it, the more I realize that it is actually my own mind that most needs to be sabotaged.  I mean all those habits of thinking that set me up for a fall.  For example, when I get up in the morning I often start running through all the tasks that I want to get done, and needless to say, I set an expectation for myself that I will get them all done that day.  I don’t stop to ask if I want to do them, or even whether I need to do them.  So, when I fail to accomplish my self-imposed – and often completely unnecessary – roster of duties, I feel like I’ve wasted the day.  How wrong can you be! 

 I once overheard a conversation between two elderly brothers-in-law.  They were discussion the little wooden sculptures that one of them was making as a hobby.  The woodworking brother-in-law explained just how long it took to complete the various stages of production for each piece. The other brother-in-law, who had been a businessman all his life, then started to make helpful suggestions about how the woodworker could save time by putting the first coat of varnish on one piece, and while waiting for that one to dry he could put the first coat of varnish on the second piece, and while that one was drying he could…  But the woodworking brother-in-law interrupted him.  “Why would I want to do that?” he asked. “The one thing I have plenty of is time!”  The businessman brother-in-law suddenly saw the foolishness of his efficiency suggestions, and they both laughed uproariously. 

 


 



Crossing the bridge

I had an interesting afternoon with a friend this week.  We were talking about retirement, and she was expressing astonishment at how quickly the first year of hers had passed.  Our regular meetings over afternoon tea have produced some deep explorations of how we bridge the transformation from working professional to retiree. Indeed, I look to her as an invaluable repository of useful tips for my own metamorphosis.  On this occasion we got onto the question of how I might best help myself cross that bridge, and we came to the conclusion that I definitely need to have lots more fun. 

 However, I realize that having fun is not as simple as it might first appear.  The initial step is to shed responsibility, or at least to shed the air of sobriety that accompanies being a responsible person.  I think I can probably manage that one OK.  The second step is to learn to relish the freedom that follows on from not having a mortgage, not having to work to feed myself, and – best of all – not having to please anyone to ensure that I go on getting paid.  This is abundance indeed. 

 The third element seems to involve doing something that might at first sight be completely out of character.  Being an unorthodox pensioner is not only safe (remember, no-one can sack you) but is also de rigueur for the modern retiree.  Nevertheless, it is clear to me that abandoning orthodoxy will be sustainable only if I opt for some activity that I’ve secretly hankered after doing for years.  Certain people might opt for the dramatic gesture, such as getting a facial tattoo or dying their hair pink (pretty well guaranteed to shock family and friends into appalled disbelief).  But for me it could be as straightforward as enrolling in a red nose clowning group, or walking the Camino de Santiago.  Well, when I say simple, I don’t actually mean simple, if you get my drift.

 



Facing the Future


One of life’s great luxuries (for men and women alike these days) is having a facial.  The other day I submitted to the ministrations of the wonderful Louise, and slept like a baby while the facemask worked its magic.  Now this is what I call healthcare!  Afterwards, I rummaged through my diary for a suitable date to book in for my next session, and fixed on an evening at the end of September.  Then I realized that this date was my last day as a GP.  My last day of clinical work – ever. 

I can’t think of a more appropriate way to mark my departure from medicine.  Surrendering to a ritual cleansing and exfoliation, then stepping out feeling like a new woman.

 



The Work Ethic

I was listening to a programme on the radio today, about youth unemployment.  It made me think about how attitudes have changed since I was emerging into the job market in the mid 1970s.  A man who runs a discussion group for NEETs* was being interviewed and he commented that many of his group seemed to expect that their ideal job would magically drop into their lap if they just sat there and waited for long enough.  He reported that group members habitually turned down real job offers, complaining that they were not interesting enough, or didn’t pay enough, or involved too much hard work, or required them to get up too early. 

I admit that I was a tad work-shy as a newly qualified doctor, but what scared me off was not that the job didn’t meet my expectations, but that is met them too well.  I was terrified by the level of responsibility I was expected to carry – definitely not congruent with my level of skill and experience - and the punishingly long hours involved.  But it never occurred to me that life shouldn’t be like that, or that in some way I deserved something better.  I never questioned the need to learn the job by diving right in and doing it, intensively and for a long time - and often for lousy pay. 

But that stage of my life has passed and I’ve done my time.  I’ve learned a lot, forgotten even more, and gave up working unsocial hours a long time ago.  Looking at my impending retirement, I am struck by the possibility of reversing that ‘diving in’ of 35 years ago.  I now picture myself climbing out again, towelling down, and then stretching out on a lounger with a cool drink in my hand.  Bliss! 

 



The patient experience

 

The politicians’ talk about patient choice and ‘improving the patient experience’, but my impression is that the NHS tends to create the exact opposite.  This is worrying, especially since I am approaching seniority, with its increased likelihood of close personal encounters with healthcare professionals.

My mother is 91. She remains remarkably well and active for her age, but she struggles when it comes to the NHS.  She’s on a number of medications, which are delivered, in neatly blistered packs every month, but she has little idea what they are or why she’s taking them.  When she needs to see her doctor she always seems to be at the wrong end of the telephone queue for the day’s available appointments.  And if she asks for a phone consultation she’s likely to miss the doctor’s call back either because she can’t hear the phone or because can’t get to it quickly enough.  My mother is of a generation that is stoical, self sufficient, and doesn’t like to make a fuss.  She feels that she is being poorly served by both primary and secondary care, and she is right. 

I contemplate migrating from one side of the healthcare divide to the other with some trepidation.  As a working GP, I struggle to fulfil my task of smoothing over the gaps in service for my patients, but the prospect of being at the receiving end of my own GP’s customer relations skills presents an altogether different challenge.  I expect I will be able to maintain my equanimity so long as I’m feeling reasonably well, but I could end up getting pretty tetchy if I’m not.  I have no intention of following my mother’s example, and I fully expect to make a fuss.  Even if I risk being labelled “difficult”.



Rhetoric and reality

I sometimes wonder if the NHS is completely mad or whether I am. Maybe I’ve missed some vital insight along the way, but I keep asking myself this same question; what is the NHS actually for?  I’ve been working in it now for over 35 years but I still can’t come up with a satisfactory answer.

To quote Vicky Pollard, it “does me ‘ed in” when I try to reconcile the preoccupations of my patients with the rhetoric of politicians and healthcare pundits.  These two groups appear to occupy different planets.  This may simply reflect how long I’ve been in the job, but I thought medicine was supposed to be about relieving suffering, with the added bonus of occasionally curing a disease or two.  And public health certainly played a big part in the story.  But the modern healthcare discourse seems to be all about ‘cost effectiveness’ and ‘evidence based practice’, and about giving the public (read ‘Exchequer’) value for money.  The very word ‘healthcare’ is a neologism, and its precise definition remains opaque.

I am perturbed by the gap that seems to be opening up between healthcare rhetoric and the real problems that my patients bring into the surgery. Things like work stress, relationship difficulties, debt, obesity and other lifestyle issues, the misuse of a variety of substances, and old age - with or without dementia.  Not only are we in the NHS (and society at large) failing to address the causes of this rising tide of human misery, but we are also failing to respond to it appropriately.  Focussing on improving the delivery of disease management programmes is simply not going to hit the spot.  And as for ‘nudging’- well! I rest my case.



Dreaming of Tornadoes

 

I think I’ve just worked out what the tornado dream was about, and it’s nothing to do with angst about losing my identity at all.  I’m just plain angry.  Angry about the years spent putting up with scruffy residences, dreadful hospital food, and obscenely long hours on duty; angry about clinical teaching in the form of ritual humiliation at the bedside, and the condescension of uninterested seniors; angry about the hours spent struggling to meeting pointless bureaucratic targets and chasing irrelevant bits of QOF data….I could go on. 

 

One of the interesting by-products of giving up the day job is that I no longer have to submit to the pretence that everything is just fine, and that all I have to do is keep my head down and make it through to the end of the week.  So long as I have to go on working, I have to keep the lid firmly on my stronger emotions.  Otherwise I am likely simply to displace them into impotent rants against “the system”, or weeping quietly into my lasagne. 

 

Fortunately, I weaned myself off my more dysfunctional coping mechanisms some time ago, such as mindlessly browsing You Tube or reaching for the gin bottle.  Instead, I have discovered a much less harmful way of dispersing the tornado of rage - the well-placed expletive.  It’s quite safe so long as I remember to do it in private.

 

 



Getting rid of stuff

I have also felt a strong need to get rid of "stuff".  My study is floor is usually covered with piles of paper, and what isn’t on the floor is squirreled away in a row of archive boxes along the wall.  Collecting ‘interesting’ articles is a persistent and irritating habit of mine - another example, I fear, of the ‘just in case’ mentality. 

 

These bits of paper, once collected, rarely get looked at again and even more rarely prove useful.  They also make hoovering the study a bit of a nightmare.  No matter how much I try to sort, file, or otherwise organise them, they drift like autumn leaves into new piles on the floor – or onto my desk, burying essential documents like credit card bills. And when I do manage to have a clear out, I scan each article and can’t imagine why I kept it in the first place.  Whatever significance it had at the time has long since passed me by.   Sometimes I start to worry that I have forgotten something essential, that some critical insight about my work has become irretrievably lost.  I'm only too well aware that the volume of information that I have forgotten now far outweighs what I currently think I know. And aren’t we all acutely conscious of the fact that we start shedding brain cells remorselessly from middle age on? These thoughts provoke disquiet.

 

I comfort myself with the observation that the electronic information revolution is suffering from a similar problem, even if all those terabytes of data are tidily hidden away somewhere on the Web.  There is just far too much of it - more than any one person can even begin to get their head round.  Let’s face it, most of us can’t even keep up with the deluge of research, guidelines and bureaucratic directives that land on our (actual or virtual) desktops every day.  We all end up relying on user-friendly websites when we need a “digest” to guide us about the ‘clinical problem’ who is sitting in front of us in surgery.  This scares me.  Gone are the days when everything I needed to know about ENT could be found in one slim volume.  I mourn the passing of that ease and simplicity of access to ‘knowledge’.  I also mourn the passing of the old-fashioned general physician and general surgeon, whose years of experience had matured into humanity and wisdom rather than into a technology upgrade. 

Yes, it really is time for me to retire from clinical practice.

 



Letting go

As part of my pre-retirement financial planning I went through the startlingly long list of my memberships of professional organizations.  This was an interesting exercise.  I found myself wondering why I had bothered to join some of them in the first place (with the possible exception of the GMC), but was curious to find myself hesitant to let them go.  This is despite the fact that I have made a very definite and non-negotiable decision to stop doing all clinical work after I retire.  It’s pretty clear that I am not yet fully at ease with the idea of relinquishing the role of “proper” doctor.  Well, well, here comes that old fear again, urging me to play safe.  Just in case.  But just in case of what? 

 

When I was newly qualified I felt immensely reassured by the sight of my official memberships and qualifications.  In some way it made me feel like I was doing medicine for real, and not just playing at being a doctor.  Each new qualification, along with its smart certificate, contributed to my growing sense of authenticity. Now I am putting that process into reverse, and suddenly I feel vulnerable.  

 

Perhaps the trick is to cultivate the right attitude, something along the lines of "is my glass half full or half empty"?  I can choose to see the shedding of professional memberships (and authenticity) as a loss - rather like losing my handbag - or I can reframe it as simply letting go of what no longer serves me.  A rather less lofty consideration is, of course, that canceling my subscriptions will save me an awful lot of money.

 

I am beginning to get a taste of what it means to shed the trappings of one life in order to move freely into another.  At worst it feels a bit sad, but at best it’s about liberation from the constraints of my own - and other people's expectations of what I should be. Now that has to be a good thing!

 



Dreaming

“We must be willing to let go of the life we have planned, so as to accept the life that is waiting for us.”  Joseph Campbell
I had curious dream the other night, about huge tornadoes rampaging through my locality. The atmosphere was apocalyptic and threatening.  I don't often remember my dreams these days, but when I do it is usually because someone (ie my unconscious mind) is trying to tell me something. I can only assume that there are tumultuous goings on in the depths of my psyche.  Is this, by any chance, to do with my impending retirement?

 

I have a curious relationship with my dreams. There was a time when I used to record them in meticulous detail every morning, and I still have a couple of overstuffed files to prove it.  When I first started doing this, my dreams often took the form of long and intricate narratives, rich with drama and intrigue. As time went by, though, the dreams became shorter and more to the point. By the time I stopped writing them down they had dwindled to a few punchy images. It was as though my unconscious had developed a language of simple metaphors in order to communicate.  The significance of a dream is generally immediately apparent to me these days, with the proffered images nudging me to pay attention.  But tornadoes? That's a new one. Perhaps the old stock of images is inadequate for my present situation?  After all, I’ve never retired before, and maybe tidal waves and volcanoes don’t quite hit the spot any more.

 

Not so long ago a friend of mine came to stay, and being the good friend that she is, asked why I always take my handbag up to bed with me at night. This habit is connected with my dreams. My handbag is a powerful symbol of both my identity and my ability to function in the world, and if (in a dream) it is lost or stolen, I am left powerless and panic struck.  That makes sense, really, since a woman’s handbag contains not just the kitchen sink but everything else that she needs to survive, such as keys, money, driving license, specs, lipstick, spare shopping bag, and Kleenex.  The need to keep my real handbag close by probably points to some deep anxiety about losing my integrity and safety.  Does the tornado represent a scaled up version of losing my handbag?  I need to ponder this one.



Why Medicine?

There is a third issues I need to face up to with retirement.  Why did I take up medicine in the first place?  I think it’s probably true to say that all prospective students tell a few lies at their medical school interviews.  We all get asked why we want to become doctors, but it simply doesn’t do to tell the truth and reply “I don’t know”.  Didn’t we all invent plausible explanations to avoid sounding limp or lacking in self awareness?  I actually had no idea at that time really why I wanted to be a doctor.  I find it humbling to ponder on what I have learned since, which is that my choice to enter medicine was largely to do with my own neediness and hardly at all to do with a desire to help humanity.  But at least I do now understand that, and am able to own it.  In fact, it’s rather liberating.  No longer do I have to strive for impossible perfection, and I can acknowledge that, to paraphrase Donald Winnicott , I have been a ‘good enough’ doctor throughout my career.  Well, that’s a relief!

The time has come for the real me to step out from behind my professional persona, and find the courage just to be who or what I am.  And what’s more, I want to play! In fact, I intend to declare my ordinariness with pride.  Or as James Russell Lowell [link to Wikipedia biography] remarked

 

“Whatever you may be sure of, be sure of this: that you are dreadfully like other people.”

 

Which I take to mean that it’s actually quite alright for me sometimes not to get out of bed in the morning, and that there’s absolutely nothing wrong with being dotty about the cat.



Indentiy Crisis

Another realization I had has been finding it really difficult to describe who I am without using the word ‘doctor’.  I appear to have identified so closely with the role of ‘doctor’ that I haven’t felt the need to ask about the person who is hiding behind the professional persona.  And what is more, I have come to see that it is precisely because I (the other me, that is) was able to vanish behind the persona that I clung onto it so fervently.  This insight has opened up a real can of worms. 

 Robert Musil once wrote “One does what one is; one becomes what one does.” 

I appear to have adopted the medical persona because of who I am, but have I also grown to fit it?   I’ve expended much energy over this question in recent months, and I am pleased to report that there really is a great deal more to me than mere professional ‘facade’. But it came as quite a shock to recognize that I really haven’t had the courage fully to inhabit – or even reveal - this other side to myself.  When I did take a proper look, a host of memories came tumbling out, with all their associated “what ifs” and “if onlys”.  What if I had decided to go into the performing arts instead of medicine?  What if I had got married instead of going to Africa with the Red Cross?  Should I have taken up the offer to go into academia after completing my MSc?  Perhaps it would have been better if I had, after all, given up mainstream medicine and gone down the complementary route? 

It seems pretty unlikely that I ever really wanted to do any of these other things, otherwise I would have done them, but I still have the haunting feeling that there is an unlived life hanging around somewhere.  Maybe even several of them. 

What has come out of all this agonized self reflection is the recognition that I now have an opportunity to bring to life some of the ‘unlived’ parts of my personality.  I may not be up for classical ballet any more, but I can go and learn to tango!  And what about dropping into that clowning group that meets every Thursday morning?  I could get back to singing again, or just join a gym and get fit.  Most importantly, I will have the time to write the book that I’ve been talking about for so long.  You know, the one in which I write passionately and profoundly about all the things that are considered ‘beyond the pale’ in mainstream medicine. 

I am smiling broadly as I write.  It looks like I won’t have time for hobbies



Money Matters

I was taken aback by my emotional reaction to thinking about retirement.  My initial response was fear.  Fear of all manner of unrelated things - would I have enough money?  Would I be able to get out of bed in the morning?  Would I end up turning into a dotty old lady, infatuated with the cat?  Worst of all, would I simply cease to exist? Indeed, the very thought of retirement provoked something of a crisis of identity. 

When I began to explore the origins of these fear-filled ruminations, a number of things became clear.  The first one was that money matters.  I spent hours slaving over an Excel spreadsheet, trying to work out how much income I would need to (a) subsist, (b) live modestly, and (c) have a ball.  The arrival of a reassuring pension prediction meant I could ignore the estimate for (a), and the two sets of figures for (b) and (c) turned out to be surprisingly close.  Well, it would appear that I have learned something useful in the last thirty years.  Fortunately, I got the travel bug out of my system many years ago, so I don’t feel compelled to submit to a post-retirement Grand Tour or luxury cruise.  My requirements now are much more modest.  I’ve even got as far as imagining a Mini Tour round the UK, visiting some of the old friends that I’ve neglected in recent years.



Becoming an Elder

The positive side of turning 60 is that I will have an opportunity to step up to the role of ‘elder’.  I prefer that word to the alternative term for postmenopausal women of a certain age, which is ‘crone’.  This does, of course, presuppose that I will by then have acquired the wisdom and gravitas to fulfil the role properly.  However, it occurs to me that an alternative preparation for my passage into seniority would be to take a leaf out of Jenny Joseph’s book…maybe I ought to practice a little now?
 

“When I am an old woman, I shall wear purple
with a red hat that doesn't go, and doesn't suit me.
...more
 

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The Big Transition

I am just beginning to realize that retirement truly is one of the Big Transitions in life, and negotiating it takes a lot more than just sorting out your finances and finding new hobbies to fill your day.  Like all Big Transitions, it slaps you in the face with the great questions about Life, the Universe, and everything.  Suddenly, nothing feels certain or safe any more.  And that is scary.  But, retirement is also the most fantastic opportunity.  How could it be possible that I will be given money by the State so that I can go off and do exactly what I want?  It seems too good to be true.

On the down side, I do now have to face up to the fact that I will soon be 60 years old.  I will not only transmute from being a “proper doctor” into a “retired GP”, but also will be granted the new status of Senior Citizen.  I will be able to claim my very own bus pass, but not yet my old age pension (for some reason, this will not happen until I am 62 and a half).  In short, I will become that protean creature, a “concession”, and will possibly have to face the indignity of proving my age to complete strangers.  In my youth I often struggled with looking much younger than my real age, but I hadn’t imagined that the problem might return to haunt me at this stage of my life!  Perhaps I should come out about having grey hair?  It would certainly save on hairdressing



Time to Stop

So how do I know that it’s time for me to stop? Well, that’s quite simple.  I no longer get the buzz from seeing patients that I used to.  I’ve been here before, when I seriously ‘burnt out’ some 20 years ago. Then, I began to regard patients as an intrusion into my paperwork, but this time it feels different.  Everything about modern general practice is beginning to feel like an intrusion.  I don’t resent the patients, I just feel puzzled about our consultations at the surgery.  Why are we here?  What are we trying to achieve?  I observe these encounters with detached curiosity as the processes of the NHS machine unfold.  The clinical environment is becoming more and more tightly regulated, and (to my increasing concern) we increasingly ‘hijack’ the patients’ precious consultations in pursuit of our own agenda - QOFs. LESs, DESs, or any other passing acronym you might care to mention.  We have been grappling with relentless change and “reform” in the NHS for the last 20 years, and looking at what’s to come I realize that I’ve seen it all before.  This is no longer the general practice that used to excite and invigorate me, and I know that I will never be ready for the Brave New World of evidence-based, cost-effective medicine. I no longer have the energy for it, and in the last few months my passion for the work has quietly drained away. 

Well, that’s the rational analysis.  The truth is that I’m just tired.  Perhaps you could call it a kind of compassion fatigue?  Quite simply, I’ve been doing it for long enough, and it’s now time to move on.



I am going to retire.

Just a few years ago I could not have imagined saying that about myself.  Me, retired?  I’ll never do that!  Just as I swore to myself that I would never hang my spectacles round my neck or use a shopping trolley.  I now do both. And here I am, looking forward to the prospect of retiring at the end of September.  I have started this blog as an attempt to make sense of that move into retirement, and to document how I negotiate it.  The blog is, of course, mainly for my own benefit, but my musings might be of interest to others contemplating the same thing. 

When I say that I am retiring, it is only from clinical work. I am not, as Dr Johnson might have said, retiring from Life. God forbid! Long entrenched workaholic tendencies will see to that.  But even the thought of retiring from clinical work is pretty daunting.  I am becoming painfully aware of the perks that come hand in hand with being a “proper” doctor - the self image, the special status, the affirming sense of doing an essential job – and leaving these behind will inevitably feel like a loss.  But I think the biggest surprise for me has been that I have arrived at the decision to retire in the first place.  But I know that I truly am ready to stop clinical work.  



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