Retirement Letter fRom A surgeon !

When is a surgeon's sell by date, and what is the shelf life of a
surgeon? Surgeons young and old should merely look around them; theyoung to make mental notes about what to do [and not do] when they areolder, and older surgeons should do so as a reality or insight check.I made mental notes about teaching about 25 years ago. I overheard agroup of students referring to our famous, emeritus, retired, renownteacher who had stayed on: "There was this funny little old guy withround glasses who burbled about hernias." It had something of MariaCallas returning to the Royal Festival Hall after a long absence, andhalf the audience walking out on hearing the cracked voice, or thereappearance of an ancient rocker with an exuberant wig, and guitar. Ialso remember noting when I was a trainee that the very old surgeonssecretly felt, and sometimes said, that radical mastectomy was theonly proper operation. In the same spirit some may feel thatlaparotomy is the only real operation and not laparoscopy. Anothermarker of age, and perhaps a nudge to retirement is when the olderspeaker gravely announces that there is nothing to beat a good historyand physical examination, and all this endoscopy, spiral CT and MRIstuff is nonsense. Thats another nudge to retirement. Go, my friend.Operating is brutal and unforgiving. I saw this and migrated fromvascular to oncology in my thirties, realising that I would not do, orwant to do, a ruptured or dissecting aneurysm at 2am when I was older.Those that did, including some American vascular VIP's I knew,disappeared down the neck of whiskey bottles. Manipulative skillsdeteriorate with time. Less often do you pull off your gloves and saythat that was a perfect thyroidectomy or adrenalectomy. The surgerybecomes coarser. A famous academic went into private practice onretiring at 65, did a Whipple, which took 12 hours, and made him liedown on the OR floor drenched in sweat, and was his operatingswansong. Surgery is like professional sport, with a limited [but ofcourse longer] life, and a short time in the sun. In your late fortiesyou become aware of the young pack at your heels, slick and quick inthe OR. They are arrogant and unforgiving and condescending. Just likeyou were.Should you just go on operating until you kill someone, or killyourself? If you believe that surgery is all there is in the world youare living in blinkered pathos. You have missed out, and will miss outon the pleasures and satisfactions our limited life has to offer. Bythe time you are in your sixties, you should have made and investedenough money from unnecessary cholecystectomies to retire. Osler said:"Study until twenty five, investigate until forty, profession untilsixty, at which age I would have him retired on a double allowance."We cant have that luxury. Pilots used to have compulsory retirementat 60, and this was extended five years ago to 65. The pilot's deathin the plane from Brussels to the USA in the last 24 hours may makethem want to rethink that.If you are very lucky - and perhaps wise - you can have a period oftransition into retirement. Perhaps administration and no surgery,perhaps less and a lesser type of surgery, perhaps no night call. Themost important thing is to think about it, and to plan it. Most can'tdo either._._,_.___