Third phase

From the day I stepped into kindergarten to the day I was handed my M.D. degree was 22 years.  I started to get a small paycheck for six years I spent in training, so nearly 3 decades  passed before I was ripe enough to be trusted with real patients and to begin to teach others what I knew.  That effectively ended 2 Decembers ago, although the U paid me to tie up loose ends and clean up my office for the six months they finished putting me through the meat grinder.  Figure 34 years there, three more decades.  As my birth mother is 88 and only starting to slow down while her mother made it past 100, I’m hoping I’ve got the genes for 3 more decades.  My financial advisor says my money’s not likely to run out.

Except for socking money away, I never really “planned for retirement”.  Medicine is a harsh mistress, although she offers ample rewards, not just monetary.  My joy was always in joyfully doing what I had to do.  After that there often wasn’t much time or energy for anything else.  In med school, I learned to take pleasure in the mundane chores of everyday life: cooking, eating, drinking, laundry, cleaning, exercise, maintaining an old car, and chasing women (rarely mundane, but surely one of life’s necessities).  25 years ago, I began brewing my own beer, probably the closest I ever got to a “hobby”.  Great use of all that chemistry and biology I had to study.  I stopped once the craft beer revolution got far enough along you could go out and easily buy some pretty tasty stuff someone else had made for you.  Sure, I enjoyed sports, particularly my Wolverines, followed politics, listened to all kinds of music, and liked to go places with my dear wife, who shared so many of my interests.  We were avid bicyclists, owning 6 bicycles of various types between us, but that all stopped abruptly when I had a bad accident in Chile 6 years ago.

So what does a retired doctor do?  I thought I would miss clinical medicine much more: the daily challenge of figuring things out, the gift of having to give of yourself to others, the variety of people with whom you come in contact, the gratitude from the occasional patient you’ve actually helped, the satisfaction of seeing a trainee finally “get” something you’ve been trying to teach them, your colleagues and co-workers (well, some of them), and the opportunity to publish on something new you yourself have figured out.  All of that is gone, well except maybe for the very last item.  But what’s also gone is having to listen to people tell you about their aches and pains all day while expecting you to do something about it.  Can’t say I miss that at all.  I still have an active license, and now and then someone will ask for some free advice and I give them their money’s worth.  Every so often, I put on my white coat, yellow tag I.D., and scrubs and go into the Medical Procedures Unit to watch a young protégé begin to master a biopsy technique I’d been doing for all those 34 years which some of my ex-colleagues decided maybe they missed after all.  I was worried during the first wave of COVID I’d be pressed into action, but other than a batch e-mail from my Chair seeking volunteers to staff the new medical services, nobody asked me, at least not nice enough for me to consider the offer seriously.  Whew.  That’s a lot of war stories I’ll never get to tell, but I appreciate being spared. With conferences and faculty meetings virtual, it’s easy to participate in them when they look interesting.  I’ve been asked to deliver one myself next week.  One of my former fellows asked me to participate in the combined Beaumont/Wayne State/Henry Ford journal club.  I envisioned myself being the crusty old fart in the back of the room, grumbling that this stuff isn’t new; we’d figured that out a long time ago.  A role I’d been preparing for all my life.  Unfortunately, I came away from my first experience 2 nights ago with a sense of relief that I don’t have to know that stuff anymore.  I’ll still give them another try. I haven’t yet uttered my first grumble.

But there’s another part of Medicine that remains active: publishing.  Early in the lockdown one of those “predatory” journals asked if I’d write something for their special issue on arthroscopy.  Flattered, I did.   “Predatory” journals take advantage of the “open access” concept.  Regular journals won’t allow access to their articles without a subscription.  In academia, the medical library pays those fees, so the doc seeking an article never has a problem.  Others outside the institution can pay for a single article rather than a full subscription, but the charges can be steep.  In “open access”, the author pays the fee in return for having his work always available for free.   Most legit journals now offer this as an option and some have gone to complete open access.  Occasionally, the author’s institution or professional society will cover this fee, but authors with research grants just include these fees as part of their research costs.  A cottage industry has sprung up of journals reaping open access fees from authors they’ve solicited with flattering e-mails. I get them every day. In my case, one of my co-authors, Ken, had a little slush fund he agreed to dip into and off we went (1).  What we ended up with looked so good, I decided to buff it up and flesh it out and try to get it into the premier journal of my specialty: Rheumatology (Oxford).  Yes, that Oxford.  Lo and behold, that got in (2)!  I next wrote a commentary on joint washout for knee osteoarthritis, which I had done and had written about for many years but had fallen out of favor.  Incorrectly, I argued.  And that got in (3)!  I have 2 other completed manuscripts ready to go.  The longer one has been kicked back by 2 European journals, but I’ve got some guy in Sydney interested.  The shorter one was sparked by another request from a “predatory” journal, but came out so good we’re going to try the waters of the legit literature.  A couple months back, I was contacted by one of my heroes, Roy, about joining him and 4 other guys trying to buff up their paper on hyaluronic acid in knee osteoarthritis, something I’m done research on, written about, and done enthusiastically for many years.  I should be working on that right now instead of typing this.  Once these 3 get in, there’s more!  I keep putting more and more things into my paper that will be a guide on how to publish in the rheumatology literature.  In various stages of development are papers on salivary gland biopsy, assessing competence in arthrocentesis, muscle biopsy, and making something out a book of cartoons my New Jersey friend Angel drew about arthroscopy while still in Cuba.  Oh, and the editor of the journal Arthroscopy wants me to write him a letter describing my Rheumatology (Oxford) paper and how to access it.  Kicker is I have to get Oxford Press to waive or substantially reduce the $4225 open access fee so Arthroscopy’s readers, almost all orthopedists, can get at it.  I wrote that e-mail last week and have yet to hear back.

Writing for WordPress is much simpler.  No editors, no reviewers, and no fees beyond the modest, and well worth it, annual.  I’ve probably had more than 100 posts since I first started in mid January.  COVID has inspired many posts, but I have other stuff to write about, like this one.

Back when I was practicing, some of my old guys would say something, commenting on retirement, like “I don’t know how I got anything done when I was working”.  I used to wonder what that was all about.  But I got it pretty quick once I retired myself.  Work and its pressures keep a lid on so many things you’d like to do but can’t, or can’t do much, and on things maybe you never thought about doing in the first place.  My late dad, who put in 31 years at Fisher Body (G.M.) before happily retiring at 51, one of the first salaried “30-and-outs”, and spending 2 more years retired than he’d spent working, used to say that “GM” stood for “Great Monopoly”, as in a “Great Monopoly” on a person’s time.  I understand that now, too.  Maybe UM is the “Ultimate Monopoly”.  Anyway, I’m happy to be out from under.  Now there’s time for shopping, cooking, hiking, decluttering and organization, music, reading, travel, connecting with my high school classmates (VHS ’70, 50 years out!), spending time with my dear wife, whose virtual teaching keeps her right by me in the living room, and of course writing.  And I can be what William Shatner told me to be 4 Januarys ago: open to new possibilities.  Now I’ve got the time.

  1. Ike RW, Arnold WJ, Kalunian KC.  Arthroscopy in rheumatology: a reminiscence.  J Surg Surg Technol 2020;2(1):27-35.

Published by rike52

I retired from the Rheumatology division of Michigan Medicine end of June '19 after 36 years there. Upon hitting Ann Arbor for the second time (I went to school here) it took me almost 8 months to meet Kathy, 17 months to buy her a house (on Harbal, where we still live), and 37 months to marry her. Kids never came, but we've been blessed with a crowd of colleagues, friends, neighbors and family that continues to grow. Lots of them are going to show up in this log eventually. Stay tuned.

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