A Retired Psychiatrist on Retirement: Rejoicing Jubilatio

Introduction

Well into my own retirement, I conclude discussing retirement is not easy. While there are numerous publications, books, programs, diverse opinions, and a body of commonality, each retirement is unique. I hope to offer a unique perspective to physicians at all stages of their careers.

I retired reluctantly after many years of private psychiatry practice, part-time in the Veterans Administration medical system, and the United States Air Force Reserves.

I had to retire due to the illness of a family member that required my complete attention. I was 77. My last 26 years were devoted to care of U.S. military veterans. I had many patients that I followed for years and we shared common experiences. I am a veteran of the Gulf War (8/1990–2/1991) serving in a combat theater. This created a special bond with my military patients. We had a close relationship; we worked in groups; we were like a family. I honed my psychiatric skills learning the special stressors on service members and their families during and after wars.

Perceptions

Retiring was difficult for me. I enjoyed my patients and my practice. I have asked colleagues, some retired, some considering retirement, about their experiences. Some of my colleagues were still quite young, yet couldn’t wait to retire. They planned to devote their “free” time to travel, to developing new hobbies, and enjoy life more. Many of these physicians planning early retirement were on the ‘burned-out’ end of the spectrum, did not derive much pleasure or kinship from their practice, or had other interests. Others were on my end of the spectrum enjoying medicine and interacting with patients. Those already retired with this positive mindset, missed being a physician.

Here are some of these physicians’ enlightening comments regarding their sundry experiences:

• “I am really happy now. The first six months were hard, but now I am taking courses at a university, I am in contact with friends and family locally and abroad, which is the advantage of using Zoom. I am not isolated.”

• “I play golf every day, and I can travel and go to the best places. I am active all the time.”

• “I hate slowing down due to age! I can’t work as before. Now I practice just a couple of days per week. I hate getting old!”

• “I can’t do many of the things I used to love to do, like riding my motorcycle, skiing, and much more.”

• “I was active doing research, mountain climbing, and flying. Now the only thing I can do is write books. I can’t hear well. I am losing my muscles, and it is hard to exercise. Yes, old age is hard.”

• “Now I can read books that I didn’t have time to read, I can learn another language, I can develop a hobby, photography, work in the garden, paint, play golf as long as I can, etc. Now I am free.”

Others found that devoting more time to attend church and/or serving as volunteers allowed them to create a vocation of service which gave meaning to their lives.

Definitions

The word “retirement” in Spanish is “jubilacion,” related to jubilo (joy). “Jubilar,” the verb, means “to retire” but also means to be fired or dismissed. “Jubilatio,” in Latin means retirement, gladness, rejoicing. Retirement in Latin also has another word “decedo” (depart, retire, cease to be, die). Decessus means retirement, death, vanish, decline, passing. There are more combinations and cross definitions, but all seem embody two main points:

1. The joy of being free.

2. Coming to terms with dying.

Decessus also means death, to vanish. It means the end of one’s productive life, In our professional life, people and families need us and depend on our decisions that affect their survival, their very lives. The next day after retirement, we are removed from treating patients in crucial moments where death, pain, happiness, and sometimes cures, can depend on us. Suddenly we are spectators; we are deprived of our professional duties; we may begin to feel irrelevant and not needed.

This new retired status shows us that our life has limitations as one chapter finishes, we open a new one and consequently closer to the end of the book of life. Marcus Aurelius reminded us: “Remember that man lives only in the present, in this fleeting instant…This mortal life is a little thing, lived in a little corner of the earth…”¹ Retirement embodies these two contradictory extremes.

Effects

Retirement is a time of reflection, a review of our physician career, assessment of our remaining life goals, achievements, failures, mistakes, relationships with family and friends, and how to utilize our remaining time and freedom.

A timeless consideration, Cicero in Laelius wrote of old age:

“The course of life is fixed, and nature admits of it being run but in one way, and only once; and to each part of our life there is something especially seasonable; so that the feebleness of children, as well as the high spirit of youth, the soberness of maturer years, and the ripe wisdom of old age—all have a certain natural advantage which should be secured in its proper season.”²

“… men, of course, who have no resources in themselves for securing a good and happy life find every age burdensome. But those who look for all happiness from within can never think anything bad which nature makes inevitable. In that category before anything else comes old age, to which all wish to attain, and at which all grumble when attained.” ²

Cicero reminds us that getting old is not a reason to remain inactive, or disengage from what life asks of us. Cicero’s comments are as old as antiquity but hold true today, and likely for all time.

The Meaning of Life

Retirement will inevitably mean a deeper and more persistent musing on the meaning of life. The importance of finding meaning in our future is stressed by Seligman who states that a “fixed point in the future” allows one to overcome “that sense of emptiness and meaninglessness which so often affects the unemployed.”³

Viktor Frankl describes the effects of not working.⁴ He discussed the physician’s condition: “The medical profession merely provides a framework wherein the doctor finds continual opportunities to fulfill himself through the personal exercise of professional skill. The meaning of the doctor’s work lies in what he does beyond his purely medical duties; it is what he brings to his work as a personality, as a human being, which gives the doctor his peculiar role.”

Not working deprives some physicians of a meaningful life, and in certain cases it manifests as “apathy and emptiness.” Thus, retirement may be more difficult for physicians than other professions and occupations.

The Universals of a Fulfilling Retirement

Cicero, in Old Age, has Cato tell us that life continues post retirement and we should remain busy, and physically and mentally active.¹ These again are timeless concepts and concepts proven by time.

Seligman³ discusses the “Happiness Theory.” He posits to be happy is to have “a meaningful life” that consists in belonging and serving others and devotion to causes larger than the self. Examples of these might include: religion, service organizations, political causes, or volunteering at schools, hospitals, retirement centers, conservation, and clean-up groups. The goals are to increase positive emotions, engagement, meaning, satisfying human relationships, and accomplishment.

Acceptance

Our inner peace and happiness flourish when we accept the changes that our retirement life will experience. Ingmar Bergman in Wild Strawberries describes⁴ the process wherein a retired physician that is traveling to accept an honorary degree “is forced to face his past, come to terms with his faults, and make peace with the inevitability of his approaching death.”

The film presents a clear, uncompromising, and compassionate description of the process of reviewing a physician’s life devoted to work, reviewing his errors, and missed opportunities for time with family and others. Ultimately the physician must learn to accept the past and open the heart to the present. All physicians, especially on retirement must learn acceptance. Acceptance is to open ourselves to reality, as is. Acceptance is to develop the ability to see our life, our history, our family, friends, and colleagues, and glean satisfaction and significance from same.

Love

In retirement we must embrace, enjoy, and enhance love of our friends and families. We must develop joyful projects with our new freedom. We must strengthen our old friendships and develop new ones.

My Rejoicing Jubilation

After retirement I was busy taking care of my family, so I did not have too much time to think on past events. I realized that my life had changed, and now that my responsibilities were different, I felt some emptiness, missed my patients, my work, and at times I felt that I had abandoned them. It was difficult to accept that their care was not my responsibility anymore.

This journey into medicine started very early in my life, as a child, I used to play in the food elevators of a new hospital that was opened earlier to care for victims of an earthquake. I still can’t believe I did that!

Our sixth grade teacher, Ms. Dalmolin, shared and discussed after classes books with us, e.g. Shannon’s Way by A.J. Cronin, Microbe Hunters by Paul De Kruif, and others dealing with medicine and science. She aroused our interest in science and kindled an avocation to be physicians. Years later in a hospital, I again met Ms. Dalmolin. She was then a medical student. God bless her soul!

An important part of being retired is to have time to review our life, all aspects of it. One of the reflective dangers is to be too critical and to aggrandize our errors and to waste time dealing with things that are past. We look at the past as a large and long collage of events and human figures, where some events appear and invite us to reflect. Gradually this narrative takes form and traces a trajectory of our professional and personal life. Hopefully, other physicians will find their narrative as satisfying and fulfilling as mine has been.

Retirement and aging tend to focus our thoughts on the existential questions of life. What have I learned thus far? How can I be a better person in the time I have remaining? How can I enrich, educate, and improve my family, my friends, and the causes I believe in? I have more time to devote to our children and grandchildren and have the privilege to be part of their projects, dreams, their maturing in life, and to share my knowledge and experience. I am there to help, to share experiences, to discuss carefully current events, and to listen to their ideas and dreams. I have rediscovered that above all things love is indispensable to understand and relate to others.

I agree with the “Fox” teaching the Little Prince: “One sees clearly only with the heart. Anything essential is invisible to the eyes.”⁶

We Are All Going to Die

The other aspect of retirement is death. We know that inevitably we must depart this life on earth. Our death changes from a remote concept to a looming reality. I witnessed friends, colleagues, and family members die. I know one day it will be my time. I attended to the necessity of estate planning and discussed with my family. With a friend I went to Jefferson Barracks and asked, if possible, for a burial site facing the Mississippi River.

These retirement years can be wonderful. Now I live every hour, doing my best, to be good to my family, colleagues and friends. It is not always easy to be free from old ideas, memories, and feelings, but is wonderful to see every new day as children live them, fresh, no hard feelings from yesterday, just smiling, and grateful that still I am able to argue.