Good to the Last — Ad Astra per Aspera

I left clinical medicine on November 30.

In the months leading up to that date, I wondered what the last day would be like - would I be happy or sad? anxious or excited? exhausted or energized? Would the patient interactions on that day feel different than those of the previous 20 years? And what would life feel like the day AFTER the last day?

There was a long runway - I told my team and patients in January of the upcoming change. I have a small patient panel and got to say goodbye in person to almost everyone. Some of those goodbyes started in June (“You are doing great! Your next visit will be in December, so let’s talk about who you want to see.”), and I gained experience at emotional switching between patients. My visit preparation began to include the question and answer sequence “Will I get to see this person again? Yes - ah good, business as usual, no stress! Not likely - be ready for unexpected emotion when you say goodbye.” Those last-time visits held some of my favorite moments: patients recalling how they picked me as a doctor, what they thought when they met me for the first time, memories of our partnership over the years and particular events that stood out. In a nod to continuity, during the last month I saw some of the same patients who established care my first week in practice.

I felt the date grow closer with each future order we created. At first only the one-year reminders (mammograms, stable labs) would be resulted after the end of November. When the six-month and then three-month orders began to be due in December, the plans felt much more real. In the last weeks when virtually every recommendation made - treatment changes, short-interval lab follow ups, return appointments for acute problems - would require someone else to pick up the thread and continue with next steps, the intensity of emotion rose. And it was a good emotion - a beautiful tension between feeling ready to enjoy the flexibility of not being responsible for the day-to-day health of a group of patients and, at the same time, knowing I would very much miss those people, our relationships, and the intimate privilege of sitting together in an exam room and making a plan for better health.

Since that last day, I do feel a sense of loss - like something is missing and I’m not sure what. For a week or two, I would have sudden panic mid-afternoon: “I haven’t checked my inbox!” (What if there were patients waiting for a portal message or phone call back from my team? There could be abnormal labs, resulted but not yet addressed!) When I calendared for the week, it took a while before I stopped looking for the block of time each day I would reserve to round on inpatients. I miss the feeling of satisfaction when our team wrapped up a really busy day with everything done. And I really miss text messages from my nurse - gentle prompts with a touch of sass on days I wasn’t in the office, letting me know I needed to take care of something for a patient that she knew shouldn’t wait until the end of the day.

My last day of patients was deliciously ordinary: a wonderful blend of routine follow ups, a few appointments with active partnering for improvement on a particular chronic condition, some well visits, and even a same-day add-on visit for an acute symptom. It was one of those blissful days when I didn’t feel rushed and seemed to have enough time with each person on my schedule. My inbox stayed caught up, and I had the opportunity to chat between patients and enjoy the day with my team. The day wasn’t so very much different than all the other days in the last 20 years.

It was good to the last.