Taking stock

I was seeing patients when someone gave me the news. Tom, a local neurologist, had dropped dead from a heart attack at age 52. Tom was not one of my best friends, but I had known him for years. We referred to each other and had served on a few hospital and medical society committees together. He was very bright; I respected his medical advice and enjoyed his sense of humor.

Tom wasn't an athlete, but he looked trim and fit. In fact, I had just turned 51 and was probably in worse shape than Tom had ever been. Not only had I been gaining weight, I had begun to get short of breath going up stairs and even had some sleep apnea symptoms.

Tom's death came at a time in my career when, like many physicians, I was wondering if there was a less arduous way to make a living. Too many outsiders were interfering in my practice-insurance companies, HIPAA, OSHA, workers' comp. Too many patients were demanding more of my time. Too many financial pressures: taxes, tuition, retirement planning.

I told my partner I needed time off to reflect and think about the future. He agreed, and that day I moved as many of my appointments as I could to my partner and our nurse practitioner. I rescheduled my favorite older patients for a time when I would be back-or at least thought I would be back. I cleared out meetings and cancelled drug company lunches. It was a Wednesday. I would be free starting the following Monday.

On the first day of my hiatus, I slept in a little, then made some coffee and drank it on the patio. That week I read a book, played the piano, walked the dogs, cut the grass, and drove my children to their summer activities. By Friday, I was sleeping better. My head was clearer. My neck and shoulder muscles started to loosen up.

The next week was a little harder, because I had to find things to do to keep busy. I began to think about where I was in my life and career. Should I change professions? What else could I do? I made a list of options. Applying for a job in hospital administration was one possibility. Another was to quit clinical medicine and join a pharmaceutical firm. I had done a few depositions for malpractice defense lawyers: Could I make a career out of that? Or should I look for a medical school teaching position? I had been on the faculty at two medical schools before.

As I went down the list, it became clear that a lot of these options were unfeasible, because they would require relocating. My family had been in this community for more than 16 years. Our children had been born here. We loved the house that we had built, our friends, our church. Moving wasn't likely to make us happier. And going to work at a hospital, pharmaceutical firm, or medical school would probably mean exchanging one set of headaches for another.

By the third week, I was thinking about the positives of my life and career. My wife and children were healthy and happy. And as a private practitioner, not only was I helping patients, I was essentially my own boss-I didn't have to report to anyone as I would if I were an employee or a faculty member. I decided when I would take time off, just like I was doing now. Indeed, I realized, I had a good deal of control over my life and career; I just wasn't using that control to make it better.

I had originally planned to stay home for four weeks, but I returned to work a week early. I was surprised to find that the office felt more comfortable than before. The staff noticed that I was more relaxed, not as snappish and hurried. I had even lost a few pounds.