Last February I began announcing to my patients that I would be retiring in August. A few weeks later, March 2020, the regional health network of which my rural family practice is a small cog decided to curtail face-to-face visits to protect all of us, patients and providers, from exposure to SARS-CoV-2. Today I’m saying goodbye to my patients of 39 years via telehealth.
For several years now, especially after my older partner retired but no doubt because they also noticed my own grey temples, my patients have been asking me, “Are you next?” Or demanded, “Don’t you retire, too!” Or more than one: “You can’t quit practicing until I die!” So I’ve had plenty of time to ponder how I would say my goodbyes. Give fair warning: “But I’ll still be here to see you back for your next 3-month follow up.” Add a bit of boilerplate in the After Visit Summary including my younger colleagues’ names and the assurance, “You’ll be in good hands.” The obligatory form letter to my entire panel, its wording vetted by the compliance office.
The actual farewells, though, have been more intense than I anticipated. I predicted pretty well which grey-haired women (my age!) would ask for a final hug but I never expected the man whose chronic pain I had barely held at bay through the years to tear up and clasp me like a brother. Now it’s May and many more adieu’s yet to come. Currently I’m saying goodbye on the phone or via video link. Patients are asking, “Will I ever see you again in person?”
Will they? Well, it’s a small town. We might raise a hand passing at Food Lion, separated by six feet, although masked we might not recognize each other. What they really mean is will we ever again share together that sacred space, the exam room. Sacred, from Latin sacrare, to set apart: when the door closes the chamber becomes a place for telling and hearing secrets. It is the domain of eye contact and subtle body language. For the healer who can resist the impulse to leap into every hesitation it may become a realm of powerful silences. I am proud of my skills at juggling meds, managing a dozen co-morbidities, recognizing the occasional obscure syndrome, but my highest aspiration has been to master that quarter hour in the presence of one fellow human creature.
My patients are missing a final personal encounter. I am missing hundreds; just one more pale hue in the infinite spectrum of pain this coronavirus is causing. By the time I walk away will we have re-opened our doors? Will our state ever have adequate community-wide testing and surveillance or universal contact tracing? I am in the demographic that is one errant sneeze away from the ICU and a ventilator. Would I be willing to sit down tomorrow twenty-four inches from my next patient and peer at them from behind an ear-loop mask? One sneeze. I am afraid.
I don’t really care that the pandemic has robbed me of going out with the bang of vigorous full daily schedules and stuck me with a whimper. I’m already over the fact that my last few paychecks will be perceptibly slimmer. My deeper sense of loss is like arriving at the dock to wave at the ship that has already cast off its moorings. Can I call it back to harbor? Four decades as a small town family doc teaches a very peculiar sort of generosity – the ability to conceal from your patients your level of personal woe. But this is not the annoyance of another interrupted family meal nor the aggravation of a few hours of lost sleep. This month or the next we will begin to lift some physical distancing restrictions. Will I be generous enough to expand my schedule, to risk my patient’s virus so that we can experience face to face the completion of our long journey together? For whom would I be willing to make that sacrifice? For my patients? Or for me?
. . . . . . .
Care
She opens the jeweled box of care
and unfolds first one
then another – fragile,
painful, frayed.
She falters then lets me touch them:
melancholy scent of longing,
golden afternoon interrupted forever
by thunder,
stained silk of loss;
this shared hour sighs away
past recapture
but the air about her flickers
with some rare new color –
she repacks her box to leave,
each wisp grown a shade lighter
and I carry a pastel weight.
The Geriatrician Ages
They don’t fly up at him, all these names,
no confusion of pigeons’ wings
in the parking lot; they don’t lock arms
to block him entering
the next exam room;
maybe they awaken him near dawn
but not by shaking. More like
the powdery flutter
of a moth disturbed in daylight,
the mute gray snowfall
of ash from burning newsprint.
Many he can’t recall, but all of them
he recognizes when dry lips
whisper their presence
from the other side –
not accusations (their ease of passing
one more benediction
of his calling), not really thanks
though most are grateful,
mostly just an airy I . . . I
in his cluttered bag of memories.
So many, so often now, more and more.
Each murmur a spirit body bowed
into a wheelchair, curled mantis-like
in bed, pushing against a walker,
each of them pushing, pushing
against what held them here
and what let them go.
Some days he can’t remember
if he last saw them on evening rounds
or in a dream, and any moment
he expects the office door to open:
one will enter, speak
his name, one he had thought
was gone.
. . . . . . .
Care was first published in Mobius, Vol. 2, Nr. 20, Fall-Winter, 2006
The Geriatrician Ages originally appeared in Journal of the American Medical Association, Vol. 304, No. 16, October 27, 2010, and is also featured in my March 17, 2012 post
Both of these poems are collected in Crossing the River, Main Street Rag Publishing, © 2017
. . . . . . .
. . . . . . .
You cared for me all my life and I chose you to care for my two children for the past 13 years! You are a wonderful physician and we will miss you terribly! Best wishes in your retirement!
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Thanks! I’ll be around to hear all your family’s updates and progress in coming years.
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This made me cry. Thank you for sharing your thoughts and feelings so beautifully, Bill. I will share with friends in the healing professions.
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Thanks for sharing that, Debra. So many big and little obstacles confront us all these days.
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The doctor is not in. All are missing him, and he is missing them. Praise for this “final” hymn, and for new beginnings.
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Thanks. I’ll trust in many new beginnings and hope to see Earl and Priscilla along new paths and old.
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Your humanity enriches us all, Bill. Your patients have been lucky to know you. I have as well.
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Thanks, Becky — I still feel a great connection to Barton, hope to walk those grounds again.
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It’s been a few years since we shared a few years working together. You will forever hold a special place in my heart for many reasons, but most of all, because you took time out of your own busy life to attend my wedding, and take pictures that I will have for as long as I live.
First hand experience, your patients LOVE you and hold you on a pedestal. You’re caring and laughter will ring in the halls of JFMC for as long as they stand. All it takes to become a physician is an education, but It takes much more to become a good doctor. Many years of thought, continual research and actually listening to and caring about your patients. As i have worked in the field for many years now, I have come to realize these qualities aren’t always found in the newer generations of physicians.
Always remember, you are not just a good doctor, but a wonderful physician.
I wish you a peaceful retirement full of relaxing hikes and bird watching. You deserve it.
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Kelly, thanks for such kind and generous words, and believe me I was honored to attend your wedding. I’ll never forget that day along the creek at Stone Mountain! Keep on laughing, hon.
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Bill, your “goodbye ” is a poem to your practice, your profession and your patients. I am moved by your beautiful and tender words. What fortunate people you cared for all these years. I can imagine how unfortunate they feel now that you’re retiring.
But you’re not going away and that’s a blessing for all in Elkin.
And promise me you’ll keep the fine poems, meditations and photographs coming.
Now go and enjoy your well earned retirement.
Love, Diana P.
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Diana, thank you for your kind words. I’ll meditate on the phrase . . . “not going away.” Love, Bill
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I have known you since the day JFMC opened, You were with me when my daughter was born, and I have worked with you so many years at Hugh Chatham from the time I became a nurse,and a friend also. You are a great physician and helped so many people in our blended communities, So yes, you will be missed greatly. I hope you get to enjoy your newly slower scale of living for you as you enter the world of the retired, you deserve it so.
Karen Southard, RN, BSN
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Thank you, Karen, for years as co-worker and colleague and patient and friend. Thinking of your family makes me smile. — BILL
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Congratulations, Bill! This is a masterful and emotional farewell. I wish you many long walks, many joyful bird songs, and many, many more poems.
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Thanks, Kevin, and thank you for all the writing you and Press 53 continue to inspire.
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Oh Bill! Your words are so beautifully moving and so filled with love. Thank you, as always, for sharing so openly your heart, your wisdom, your compassion, and your youness! You speak so eloquently from the soul… you will always be a practitioner of the healing arts whether with stethoscope or pen in hand. Keep on sharing your wonder, Poet Pal, and know that you are so deeply loved by so many!
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Thanks, friend. hearing from you is always like sun through the clouds.
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Bill, my Brother Poet, your tender, pained words move me. I’m seeing my cooped-up students now by Zoom. I can only imagine what it would be like to retire from academic therapy and inform my troubled students only virtually. The memories of your in-person care will be vivid for each of your patients and those memories will outlast this strange time.
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Thanks, Joan, your compassion for your students glows.
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Thanks for extending your tender farewell to those of us not right nearby. But I guess we’re all saying things (goodbyes, hellos, and everything in between) from a distance these days. Wishing you well as you move on to what’s next.
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Thank you, Celisa. I did think as I looked at the title about our friend who could not visit her husband most of the time he was in the ICU his final days. And our granddaughter leaving playschool every day who always had to run back in for one more hug. All levels of goodbyes.
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