When It's Time to Retire: Notes From the Afterlife

David Loxterkamp, MD


Ann Fam Med. 2018;16(2):171-174. 

In This Article

The Practice

Through my general practice I have come to know them for more than 3 decades. They are the town's teachers and ministers, garlic and dairy farmers, window makers and boat builders, fast-food cashiers and corporate climbers, home schoolers and retired military. You can find their names on the portraits of old sea captains in the local maritime museum and the rolls of our welfare recipients. They are as proud and old and white as the state of Maine, a people slow to talk and wary to welcome "folks from away." But oh, the nuggets of wisdom in the few words they would spare.

They care for my kids, service my car, bag my groceries, deliver my mail, mow the lawn, and grease the local wheels of commerce, industry, and government. In turn, I have injected, sutured, and delivered them; attended them in the hospital and called on them in their homes; exhorted, supported, and escorted them to their eternal rest. They know me by my argyle socks and straight bowties, standard lines and corny jokes. They often remind me that "I know where to find you," which is around the corner from Blood's Garage, past the blinking light on High Street, up on Salmond Street where we raised our kids and "improved" the Percy McGeorge house, its gardens and vines.

They surely saw it coming. That I was slowing down and cutting back, first giving up OB and hospital rounds a half-dozen years ago; then the nursing home and hospital call; finally, the trimming of my office hours and the closure of my patient panel. As a result, my practice narrowed to the care of old friends in gradual decline. I have had a ringside seat to the multitudinous complaints of an aging population, all variations on a theme that, for the most part, are not amenable to doctors' orders. Yet they tug at my heartstrings; I feel responsible, powerless, sad.

My patients, too, know where they're headed: deep into the uncharted waters of poly-pharmacy, specialty consultations, replacement parts, and rehabilitation. One by one, they have given up winters in Florida; swapped the rambling farmhouse for a condo in town; arranged for CPAP, meals on wheels, and home health aides; braced themselves for an intervention about the driver's license or living alone. And then one day, the sentinel event: A fall. An involuntary drop in weight. Blood on the tissue. And in the blink of an eye, their lives are transformed by the doctor's schedule and treatment plan.