Change is the essence of remaining who you are14 September 2021
Dr. Friedberg :
For over forty years, Dr. Freed was a family doctor in a local community. He was, in his way, straight out of Norman Rockwell. He made house calls. He knew the children of parents he'd treated as children. Most of his records were on hand-written charts, stored in green metal upright cabinets in an office adjacent to his house. You'd see the lights on, sometimes, late at night when somebody had an emergency. He was there for his patients in every sense.
But he was over 80 now, and his life had taken a turn. No more bustling about. He was laid up in a wheelchair after a nasty fall, which triggered a depression from persistent postsurgical pain. He came to see me to explore what he termed his "uncertain future." The problem, as he explained it, was that it was hard to examine patients if he could hardly move. "They end up asking how I feel, which is crazy. It makes me feel old."
Dr. Freed continued to keep up with the latest research, and he was mentally sharp. "But I wonder what it says to patients if I don't look the way they remember I looked." He feared they would attribute to him the wish not to let go despite an obvious decline. "Maybe they'd think I was taking advantage. One even asked me to get her a second opinion." It's demoralizing to a doctor to fear that patients could lose confidence in him. He thought maybe it was time to retire.
Besides, COVID was raging in the community, and it was risky to keep practicing - even younger guys were retiring. There didn't seem to be many options.
What we had to discuss, therefore, was the effect that retirement might have on Dr. Freed. "Medicine is my life. If I give it up, what's left?" On top of his fear that patients might stop trusting him was the equal and opposite fear that leaving the profession would leave him bereft. It was like he felt that he'd hit a wall, that no matter what he did he was in for a tough, deflating time. My concern was to help him, even at this later stage of life, to navigate what felt like an existential crisis. If he were to remain happy, and adjusted to his newly troubling situation, then he would have to grow beyond it. He would have to find ways to feel alive and kicking, even though he could barely walk.
The key, I thought, was to continue to see himself as a vital part of his family and the community, however his function might change. Thus, if he ceased to practice medicine, he'd have to feel that he was still helping the people whom he'd served over two (sometimes three) generations. What kept him going was service on an unusually intimate scale, i.e., giving back to people whom he actually knew and who made him feel valued.
As we began to confront his retirement, it seemed crucial-for his peace of mind if not sanity-that he remain involved with people who needed the comfort of a reassuring presence. Presence was what made him tick. In a sense, he stood in opposition to the human condition insofar as it is lonely, a cohort of discrete bodies detached from the support that others might provide (if they were only there and caring and able to actually be useful). It was important that Dr. Freed never disappear into Mr. Freed, somebody who was disengaged from the healing arts.
His family thought he should do something different altogether, which was not what he needed and not what would make him happy. It was a question of degree, not kind. It meant switching gears rather than taking another road. It is often the case, as we pursue happiness, that less is more, i.e., we don't have to overturn everything we love if we can just make accommodations. Of course, radical change is sometimes necessary, and we shouldn't shrink form it. But neither should we rush into it, especially when it doesn't feel right. Dr. Freed always told his patients that they best knew their own bodies. He felt the same way now. He could retire but not retire, stay engaged without pushing past his physical capacities.
It would be a challenge. But what isn't when you're in your ninth decade?
We inched towards a solution. It was surprising how it occurred. That is, it's rare for a patient to get up from his chair, or even move much during a session. For a patient like Dr. Freed, confined to a wheelchair, his swinging around toward my bookshelf was amazing. It was proof, I thought, that he'd bring every resource to bear in designing a possible future. So, dramatically, he pulled down my copy of Shakespeare's The Tempest, which-for most physicians-is an iconic text, concerned with the magic that we wish we could perform and the need to finally acknowledge that we can't. He found Prospero's famous lines about his departure: "I'll break my staff . . . And deeper than did ever plummet sound I'll drown my book." It's a stunning farewell. But how did it apply to a man, like Dr. Freed, who didn't want to leave off casting spells? He told me. "I'm going to rewrite the part about the book."
Dr. Freed said that the idea came to him while we were talking, while he sat in his chair gazing at my shelf (one of the benefits of in-person therapy as we transition to remote). He thought that if the great magician could bury his book and disappear, then lesser mortals, like himself, would have to keep writing if they were to do any good. "Maybe my role now is to pass on to the community what I've learned. Other doctors should know, and my patients." I marveled at Dr. Freed's process of association from Prospero through himself to the wider world, all of it without my prompting. I thought he'd had this notion in him all along. Maybe it was just waiting to burst out.
In fact, writing a book or, rather, a sort of memoir of his life in practice, was a terrific idea. He embodied a type of medicine that had disappeared and was probably rare even when he'd set out to practice it. Maybe the personal attention that he provided was re-emerging in concierge practices, but these were limited to wealthier patients. They were high-tech. They had nothing to do with dedication to an unwavering ideal of service. It would be good for doctors to learn about a different form of practice, if only to try to emulate elements of it when they could. It would be good for the community at large to realize that medicine is, fundamentally, about being there for someone and taking the time to listen.
It was a plan. After all, the poet/physician William Carlos Williams wrote The Doctor Stories about his years in family practice in the first half of the 20th century, when small, individual practices were far more common. Dr. Freed's memoir would be in that tradition. True, it might seem anomalous at this point in history, but in that sense it would likely be compelling. When we got down to talking about whether he'd dictate his stories or actually write them out, and whether he might need someone to help shape them into a book, it seemed like he was on his way.
So, we can learn a lot from Dr. Freed's experience in pursuing happiness through personal growth. First, of course, it's that you're never too old. Any biology text will state that growth is fundamental. It's what living things do. It's built in. The trick, however-at least in humans-is to pull it off in ways that are not entirely programmed but that fall under our deliberate control. The fascinating part of Dr. Freed's case is that while, in the end, he took control of the process (and even wrested control from an officious, fretful family), he also possessed the capacity to grow without making radical changes. He simply entered the next phase of who he was all along. In effect, he found himself, and it counted for growth.
In this new phase of his life, he remains connected to the community that he loves. Of course, Dr. Freed was a physician, with deep ties to two (even three) generations of people. But his story demonstrates that we all need to keep up such ties, one way or another, since we all believe (one way or another) that what we've done really mattered to somebody, probably to quite a few people. Remaining a vital part of our community-however we do it-is an essential objective, an element of personal growth. Dr. Freed knew what he needed, and he made it happen.
(Dr. Friedberg practices as a psychodynamic psychiatrist in Manhattan).