Ch-ch-ch-ch-changes

That was the first line of my 1985 medical school application essay. It’s seared into my memory and a pillar of my core beliefs. It isn’t surprising that when I contemplated retirement at 59, I realized my primary definition of myself since I walked through the doors of University of Pennsylvania School of Medicine in 1986 has been in medicine: a student, intern, resident, fellow, dermatologist, dermatologic surgeon, and cosmetic dermatologist. I wondered, “who will I be if I’m not a practicing physician?”

Non-medical friends say it is a strange question. My life is full of dear friends and family. In addition to work travel, I have interesting adventures around the world. I love wine, cultural history, photography and a variety of crafts. But whenever I introduce myself to someone new, the opening is aesthetic dermatology and the conversation gets stuck there. Even talking about my crafting harkens back to work – I talk about sewing fabric as I would skin, with running, locked and mattress sutures, dog ears and advancement flaps. Sun protective gear and spotless skin mean I’m never in cognito.

My daily life has revolved around medicine. Unlike friends in other professional fields, I couldn’t just ‘shuffle’ things and have a workday lunch. End of day was an estimate at best – all it took was one patient who needed more time or a post-procedure emergency. Patient hours are booked out months in advance and meeting dates, years in advance, so spur of the moment vacations didn’t work. I ran through airports, hurled myself up stairs, zig zagged in crowds while repeating ‘pardon’ ‘scuzzi’ ‘sorry’, and apologizing to avoid missing a connection and having to reschedule patients. While away for work or fun, I wanted to hear about patient issues in real time. As my mentor, Stuart Salasche MD, once told me, ‘If you never go to sleep worried about a patient, you aren’t a real doctor.’

I’m not the only one with this mindset. Other physicians were shocked at my decision. Their first concern was whether I was ill (I’m not). After congratulations, some told me the decision was ‘brave’. Others, that I’d be bored. One longtime friend about a decade younger who I regularly see as we lecture and consult internationally, got visibly upset. When we discussed it the next day, he said he realized it made him face his own ‘mortality’. It’s an interesting word – I’m not dying, but for those of us who spend so much of our life steeped in doing, thinking, writing, and teaching, the end of our medical career can seem like a type of death.

Some of this is generational. I was born on the cusp of Boomers and GenX with the associated work ethic. I used to joke that when I retired in my 70’s, it would still be well before my dad, a dermatologist from the Silent Generation, whose heroes “died with their boots on.” Family and staff imagined him ultimately passing slumped over a punch biopsy in his 90’s. In fact, our original partnership contract addressed the possibility of my taking sabbatical, leaving to practice elsewhere, retiring, or dying, but none for him. He didn’t see any as likely. His retirement at age 80 after 50 years of practice was ‘early retirement’ for him. Yet at 87, despite world travel, collecting historic documents, and numerous other interests, he still identifies as a “retired dermatologist.”

Some of this is also practicing at an admittedly intense level. I was brought up being told, you can do anything you want, just do it the best you can. This insight came from a recent article in the New York Times about retiring Olympic Champion surfer Carissa Moore. She discusses facing the fear of “Who am I if I don’t do this anymore?” What made her story particularly interesting to me is her not needing to retire – she is still in top form, thrives on competition and admits the easiest thing would be to continue in the ‘warm cocoon’ of her sport. However, she wants to be challenged in other ways and redefine herself.

I’m not an Olympic athlete, but I’ve accomplished my clinical and academic goals in medicine. As the author states about Moore, ‘this is about what she wants, not what she did. It is about the eternal, universal search for something more—more challenges, more unknowns, more meaning’. Moore states, “I’m excited to see what else there is, outside the jersey.’ As for me, I’m excited to see what else there is, outside the scrubs. I’ll continue to write, teach and consult in aesthetics as long as it percolates my brain and I have something meaningful to contribute. Most of all, as I end almost three decades of clinical practice, I have a sense of calm about my next chapter.