Retiring as a pediatric hematologist‐oncologist during the COVID‐19 pandemic

Congratulations! Well done! Bravo! Our compliments and best wishes! Comments from my retirement party echoed in my head as I looked up at the night sky and tried to comprehend where I was in my life, retiring in the midst of a global pandemic. Unfortunately, the cloud ceiling was low; there were no stars to be seen to add perspective to my life. I planned my retirement before "Covid-19" was in the medical lexicon. I was 65 and had experienced a wonderful career as a pediatric hematologist/oncologist, training in the United Kingdom and then working in the United States for almost 40 years. Practicing as a physician has been incredibly satisfying. It has been my identity and how I presented myself to family and friends. Having given so much of my life to clinical work, I had not spent time developing other skills anywhere near as rewarding. I acquired some hobbies: diversions from the responsibilities of helping and supporting "my" patients and colleagues, but not activities to keep my mind or body vigorous when I stopped working. My brain "ticked" on patient-related issues and did not need me to find it other stimulation. As I contemplated no longer working clinically, my first thought was for "my" patients. I knew I had excellent colleagues to hand my patients on to, but I could not escape the thought that I would be letting them down by not providing their care myself. I believed I knew their health care needs best. I had a new role, however, that prompted my 2020 retirement: a move to Canada to help with grandchildren, so our children, far from family support, could pursue their own medical careers. Reflecting on my many years in practice, how things have changed! The 5-year survival rate for childhood cancer increased from 58% to 85%.1 When I started medical school, my neighbor's nephew died of ALL, 3 months into his diagnosis. He was so cushingoid. That was a time "when care for children with cancer was only compassion."2 For individuals with sickle cell disease (SCD) (my area of expertise), the survival gain was more modest: in the 1970s (10 years before my fellowship) 80% of individuals with SCD died by age 303 and now life expectancy is currently believed to be 54 years for both sexes.4 Clearly, there is much work to be done, but I look to the future of pediatric hematology-oncology with excitement: the promise of immunotherapy, targeted therapies, gene therapies, and new drugs for sickle cell disease are either now "mainstream" or on the near horizon. It would have been nice to be there to see more of these promises realized. Then in February 2020, SARS-CoV-2 arrived. Like for everyone else, my life and plans were thrown into disarray: my retirement had to be reformatted. I could not travel to help our children: borders were closed and international travel all but halted. Plan A was to take care of our grandchildren but suddenly I was retiring with no plan A and no plan B. I was now very conflicted. I recognized that not having to share life-threatening diagnoses with families would take a weight off my shoulders. Not having to watch, helplessly, as patients suffered painful vaso-occlusive crises might allow me to sleep better at night. I would no longer struggle to concentrate at work after losing a child to an untimely death. I would cease, however, to be one of a team working painstakingly to help children and their families understand life-impacting illnesses. Despite the sadness that permeates our work, pediatric hematology-oncology has so many rewards. Stepping away from it means losing deep family relationships, daily meetings with friends and colleagues, and forgoing wonderfully stimulating interactions with the young trainees whom we are privileged to teach. I quickly learned that retirement means the loss of daily structure: no getting up so early to catch the train, no juggling bedtime with completion of that day's work and planning for the next, eating and reading just when I want to, not in stolen time between charts and lectures. I wondered then: why retire from a secure job, with rewarding work, and a sense of serving the greater good, particularly if one is fortunate enough not to experience "burn-out" and one continues in good health? I did realize that my leaving would allow a younger physician the opportunity to take a leading role in the care of patients with SCD and eventually have as rewarding a career in pediatric hematology/oncology as I had. A critical aspect of retirement from clinical work may be to afford the opportunity to replenish the workforce with younger, more adaptable workers. Individuals trained recently have newer skills and knowledge and may improve efficiency. But is that my responsibility to determine and step aside for? I also realize that junior doctors have lesser salaries than those who have been in practice for many years. Is this why my financial administrators jumped on the idea when I first discussed retirement as the solution to my helping my children in Canada? Do you have to retire and if so, how should you prepare for it? What does life look like after a fulfilling career in clinical medicine? I had never once asked myself that. It was not until the pandemic arrived that I realized I had to ask myself these hard questions. Recognizing that I could not enact plan A and move to Canada, I offered to continue in whatever capacity I could during the pandemic. Lockdown and Telehealth changed everything: very few patients were having in-person visits and my division and hospital, like other medical centers across the country, needed to rein in expenses with fewer visits and fewer health care personnel. In addition, coronavirus did not have a significant impact on children, so more pediatric help was not needed, and I am no expert in adult medicine. Six months into retirement, I am still wondering what no longer being a clinician means. Will there be a time, after the pandemic, when I can again contribute to "the greater good" and provide patient care? Is it true: "once a doctor, always a doctor?" Or maybe I will find nonclinical life satisfying: caring for my grandchildren and finding new pastimes? Having spent all of my working days caring for others, with responsibilities for making accurate diagnoses, recommending potentially curative management, and provide compassionate care, retirement means a new life: a life of giving (or doing) without the rewards of clinical practice. My advice for younger colleagues is do not wait until retirement to plan. All along the way, find activities that can be fulfilling, rewarding, and rejuvenating, so that when you do finally retire, plans A, B, and even C are ready and waiting.

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