Point: Retirement and the Myth of Sisyphus
Editor’s Note: To read another perspective on retirement, read “Counterpoint: Just Walk Away.” Recently, we received a letter in response to the Point and Counterpoint articles from Peter W. Carmel, MD, D. Med Sci. Click here to read the letter.
Just walk away? It makes no sense. A neurosurgeon will typically spend four ye
“It happens that the stage sets collapse. Rising, streetcar, four hours in the office or the factory, meal, streetcar, four hours of work, meal, sleep, and Monday Tuesday Wednesday Thursday Friday and Saturday according to the same rhythm – this path is easily followed most of the time. But one day the ‘why’ arises and everything begins in that weariness tinged with amazement.”
-Albert Camus, The Myth of Sisyphus
I was an academic neurosurgeon for 34 years — five years at the University of Texas Medical Branch (Galveston), five years in private practice with a University appointment at the State University of New York (Buffalo), nine years at the Mayo Clinic and 15 years at New York University (NYU) School of Medicine. I worked with good people and had good practices in all four of these institutions.
But, I was never a “politician.” I was just a doctor who mostly took out brain tumors — admittedly not a very “happy” way to make a living.
During my 15-year tenure as chairman of neurosurgery at NYU, we went through three deans. Many academic neurosurgical colleagues at other institutions had problems dealing with their deans — I did not. Frankly, I liked all three of them: 82-year-old Saul J. Farber, MD, who despite his age, was still brilliant and taught me some Yiddish; Robert Glickman, MD, who struggled with an ill-fated hospital merger; and now Robert I. Grossman, MD, a brilliant neuro-radiologist who will probably go down in NYU Medical Center’s history as their best dean ever.
The Last Straw
It was the mid-level administrators — holdovers from the bloated bureaucracy of previous administrations — that tried to prove that they were doing their jobs by hassling the medical staff. It was these clowns, the administrators, that made my job distasteful. It was a rare day that I did not leave work seething after an interaction with one or more of these people.
The last straw for me happened during a meeting with a young, self-important, newly-appointed chief of hospital operations, a radiologist by training and the chief medical officer, a middle-aged burnt-out internist who did not want to be a doctor anymore. They handed me a job description — a full-page list of my “duties and responsibilities as department chair,” which included monitoring and filing reports of practitioner performance, safety, quality, medication reconciliation, etc. — about 25 tasks, all totaled. Taking good care of one’s patients or ensuring that our residents would become competent surgeons was not on the list.
Of course, I could have “delegated” most of these tasks and dumped them onto others in the department. However, neurosurgery was a relatively small department. None of the neurosurgeons were being paid by the medical center, nor was the medical center helping pay their office rent, secretaries or malpractice insurance premiums. Except for three pediatric neurosurgeons, the rest of us, myself included, were in a fee-for-service — “eat what you kill” — private practice paradigm that had existed since the inception of neurosurgery at NYU; everyone from Thomas I. Hoen, MD, to Joseph Ransohoff, MD, to myself.
Handing in My Resignation Letter
My colleagues and I had nothing to gain by being the “patient safety officers” or the “quality officers” of the Department of Neurosurgery, answering to the “clinical quality officer” of the NYU Medical Center and wasting hours in meetings. What was in it for them? But then …. what was in it for me?
Nonetheless, I had to admit that the practice of medicine had changed in the 41 years that I had been a doctor. Bureaucratic aggravations were necessary for hospitals to maintain accreditation, comply with federal and state guidelines and to get paid from third-party carriers who kept changing the rules in order to avoid paying the bills. But, I was just a surgeon. Wasting my time and stressing my patience in interminable meetings was not what I wanted to do with the rest of my life. I had to face it: I no longer had what it took to be an academic department chairman circa 2008. It was time to bail and move on.
I was not rash; I thought about it for a few days as my 20-page letter of resignation trimmed down to three short paragraphs. I particularly liked the first paragraph:
“After the requisite consideration that such decisions deserve, I have decided to step down as Chairman of Neurosurgery effective as soon as practicable.”
Requisite consideration? Practicable? Hell, I don’t talk that way, but I thought that it looked good on paper so I ran with it. The new dean was an articulate, classy guy, and I thought that he’d dig it.
Reasons for quitting? That’s getting into the 20-page territory. Less said the better; short and sweet. Therefore…
Second paragraph: “My reasons are entirely personal.” (Let him guess.)
Then the grand finale: “I wish you well in your role as dean and CEO of NYU Medical Center. I am sure that you will be successful.” Why not show a bit of class and good sportsmanship on my way out?
Proud of my prose, I wanted immediate feedback so I called the dean and told him that I had to see him immediately (before I changed my mind). He sensed that something important was up and said that I could come right over to his office. He greeted me warmly and asked me to sit down, not in front of his desk, but in one of the easy chairs across from him – the type of treatment afforded to donors of the medical school. He probably thought I was going to give the medical center a pile of money or introduce him to someone who would.
“So, Pat, what’s up?” he asked in a polite tone that nevertheless indicated that he didn’t have all the time in the world.
I handed him my brilliantly crafted letter of resignation — hot off the press.
He took the piece of paper with a smile that lasted until he read the first sentence, then started crossing and uncrossing his legs and wiggling in his soft, comfortable easy chair. Then, he forced a smile.
“Why?” he asked.
I had put a lot of thought into this — over the past 14 years. Now was the time to let it all hang out. Let him have it with both barrels, but I decided not to. Brevity and BS was the way to go.
“Well, Bob, I’ve been Chair of Neurosurgery for almost 15 years, and I’ll be 67 next September. I want to check out while I’m at the top of my game.” (Where did that come from? And who said that I couldn’t think on my feet?)
He said that he could understand that, but at NYU, there are surgical chairmen who remain active until well into their 70s. I was aware of this, I told him. But, I didn’t tell him that some of these guys weren’t any good — some were actually dangerous and too senile to know it!
But then, I could see the wheels of opportunity starting to turn within the dean’s skull. I’ve never been a “team player.” I was a born-again capitalist. For this new dean, there was merit in getting a chair of neurosurgery that would be more willing to jump on board the “practice plan” bandwagon.
“But you still plan on staying at NYU and doing cases here?” He asked. Translation: the medical center is in major financial trouble, we need you to keep working, keep bringing in the money.
“Of course, I will,” I said. “In addition, I’ve got some papers in process and would like to finish my book.” I didn’t mention that the papers were being written by my residents who were mining my clinical database, and the book never went beyond the thinking stage. We’d call it a sabbatical. The official version (on the website) stated: “to more actively pursue clinical, teaching and research interests at NYU and Bellevue.”
In fact, I just wanted to disappear.
Then the dean relaxed, and we talked about who should sit on the search committee and possible internal and external candidates who we should consider as my successor. I also suggested an interim chair who would serve until the search committee selected a new chairman. So we parted on good terms. “Pat, you are an outstanding neurosurgeon,” he said, as I headed for the door. “And you, sir, are a remarkable judge of talent.” I said with a smile, and we both laughed.
If there is one thing worse than being the chairman of a department; it is not being the chairman in a department where you used to be the chairman. You are no longer the “boss,” but you are not “one of the guys” either. So I closed my practice and office on March 31, 2008. I had been a card-carrying neurosurgeon for 34 years — long enough. There were many other places on the planet I would rather be than in New York City and other things I would rather do.
I called the manager of the Hinckley Shipyard in Southwest Harbor, Maine, and told him to put my boat CYGNUS in the water, get her ready for sea and install power primary and secondary sheet winches while he was at it. That’d take some time, he said, but he’d get right on it. No problem. I was no longer in any hurry to do anything.
That was a great feeling — this was the first time in my life where I was not constrained by the anxiety of future commitments like, for example, getting back to work so that I could pay my malpractice premiums, office overhead, secretaries and other expenses that kept right on ticking whether or not I was working. Considering lost revenue, sailing my boat for a month used to cost me well into the six figures!
Sailing Around the World
While waiting for my boat to be ready, I flew down to St. Thomas, in the Virgin Islands, to help old friends bring the ROBERTA — a Hinckley SW-59 cutter — from the Virgin Islands back up to Maine. It was a raucous sail, as it usually is in April. We blew out the mainsail and had to pull into St. Georges, Bermuda on a Saturday night for repairs.
Sunday morning, I made the rounds of island sail-makers. I found most of them incapacitated — nursing big-time hangovers from Saturday night. I guess that’s the problem about living on an island where there’s little else to do but sun, fish and, most importantly, drink. “Let that be a lesson to you,” I imagined my wife saying. We repaired the sail ourselves and were gone at sunrise Monday, heading for the Gulf Stream and the ride home.
When we finally reached Mt. Desert, Maine, I moved onto CYGNUS and lived on her for most of the summer. I took a course in Marine Diesel Engine Repair at the Wooden Boat School in Brooklin, Maine. I lived on my boat and was a student again. Brain surgery was not all that complicated and now diesel engines were no longer a mystery.
Retirement, Facing New Challenges and Living Abroad
I have not regretted retiring when I did, and I have not missed neurosurgery. Nevertheless, in 2011, I went back to Danang, Vietnam, where I’d been a Navy surgeon from 1968-1969. I’m not sure what I expected to accomplish; exorcise the demons, perhaps.
I worked with my Vietnamese neurosurgical colleagues at the Danang Hospital. I was very moved by the welcome I received. I was very impressed by their technical skill and diligence. In fact, I worried that my surgical skills had slipped and that there may be a technical re-learning curve after a five-year absence. There wasn’t. I had no trouble getting back in the saddle. Neurosurgery is like riding a bicycle — you don’t forget how to do it. But, I have no regrets in not doing it anymore.
In my opinion, time (and good health) are the most precious commodities in one’s life. Time to explore, travel, meet new people, face new challenges, learn new things and develop new skills — like, for the moment, setting the injector timing on a six-cylinder, naturally aspirated, marine-diesel engine — which seems more difficult than resecting a glioma! But I’m learning.
Over the years, we accumulated properties. Not for “investment,” but just to be in, and belong to beautiful parts of the world. In addition to our home in Manhattan, we have homes in Bath, England; Deia, Mallorca; Spain, and Mt. Desert, Maine, where I keep my boat. When, after a few months in one place we get bored, or the weather changes, we simply move to one of our other homes.
I also have a classic schooner in Palma de Mallorca that I have been restoring bit by bit. Her name is HARDSHIP II. It’s a name that came with the boat. My superstitious nature prevents me from changing the name.
Do I miss neurosurgery?
Simple answer: No!
Second International Brain Mapping Course
April 26-27, 2018; New Orleans
Surgical Approaches to Skull Base
April 26-28, 2018; St. Louis, MO
2018 AANS Annual Scientific Meeting
April 28-May 2, 2018; New Orleans
Goodman Oral Board Preparation Course
May 2-4, 2018; Phoenix
2018 Advanced Endoscopic Skull Base and Pituitary Surgery
June 1-2, 2018; New York