One Last Goodbye: I’m Not Ready to Let You Go

“It’s your last day, Dr. M! I couldn’t remember if you liked almond or soy milk, but I got you a soy caramel macchiato!”

Parked at my work station, I spied my sugary coffee treat in front of a stack of cards, gift bags and succulents.

“Thank you! I’m going to need ALL the caffeine today… what’s all this?”

“Oh, just a little something from us, and your patients have been coming by to drop off gifts. They just can’t believe it… some of them only came in to ask if the letter was some cruel joke because you wouldn’t leave so abruptly.”

I shook my head. Although I had given my mandatory 120 day notice per my contract, the letter notifying patients of my departure hadn’t gone out until 2 weeks ago. All of a sudden my schedule had been flooded with patients trying to get in before my last day.

That’s part of the reason you’re leaving, M. You know how poorly this place is run.

Looking up, something about my three medical assistants struck me as odd.

“You’re all wearing black scrubs?!”

“Yeah! We’re in mourning, ok? It’s just not going to be the same without you.”

As S wiped away the tears that were collecting, she added,

“You’re wearing black too! You can’t pretend you’re not a little sad. I suppose that makes you less of a traitor, but not by much!”

“I’ll miss you too, S. But I’m sorry, I can’t cry with you right now… maybe later after I’ve had this delicious coffee you bought for me because I know you still love and forgive me!”

As I took a swig of liquid strength, I steeled myself for the rest of the day. It had been like this all week, the entire month of January, if I was being honest.

I thought the hard part was done once I finally committed to leaving primary care, but I was greatly mistaken.

Taking a quick peek at my schedule for this final day, I tallied up the number of goodbyes I had left: 14.

How many goodbyes had I already said in the last 2 months when they first allowed me to start telling patients?

How many kiddos would I regret not being able to see grow up after having taken care of them for their well checks at 2, 4, 6, 9, 12, 18, 24 and 36 month checks, with little colds and ear infections scattered throughout?

How many more tears would I have to fight back as my patients recounted all the ways my little colloquialisms about self care and healthy habits inspired them to change their lives when I thought those words had fallen on deaf ears?

How could I still want to step away from this?

Every goodbye was pushing me away from where I had thought I wanted to be, not closer.

Just chug the whole thing, M, and power through. You didn’t wear the black suit to your interview, but you did wear black today. You knew it was going to be hard.

In an effort to make sure my morning went smoothly before heading into work, last night I had spent 10 minutes standing in front of my closet to select my outfit: my faithful little black dress with pockets. Little did I know everyone else would follow the same colour scheme today.

Tracing the edges of a card with my finger, I could feel the palpitations start as the caffeine from my first cup of black coffee this morning started to kick in. Or was it anxiety from the emotions I was trying to stuff down?

Better not open these just yet.

Clearing my area of all these distractions, I felt the buzz of my phone alerting me of a text from J.

“Enjoy tearing the last link of the paper chain today.”

I smirked at the reminder of my ridiculous methods of counting down the days. Not only did I have my countdown app going, but I also had been victoriously ripping links off my paper chain remnants from when the medical assistants Christmas-bombed my office in celebration of my grinchiness.

Ok, M. You can do this. You just need to cross the finish line.

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“So I just wanted to give you the update before you left – my surgery is scheduled next month, and my retinal specialist is really pleased with how much vision I’ve recovered. You know, he tells me every time I see him how I really dodged a bullet there. Better to stroke out my eye than my brain!”

As Z recounted the diagnosis of his central retinal artery stenosis last year, I attempted to etch the familiar worn lines of his face into my memory.

The first time I met Z 3 years ago, I had a hard time reconciling the spry gentleman appearing to be in his 60s with his actual age of 80, popping right out of his seat to shake my hand. He had lived so many lifetimes – active military duty, marching with Martin Luther King Jr., being one half of the only mixed race couple with his wife in a small town in middle America back in the 70s. So much more to learn from his experience, but this would be our last conversation.

“Dr. C couldn’t believe how quickly you got the ball rolling when he gave me the retinal stroke diagnosis! He called you in the morning and by the afternoon, you had me scheduled for the ECHO, holter monitor and all the labs! He told me I was probably your favourite patient, and I let him know, ‘Yes, yes I am!’”

That day was so vivid to me even now – phone calls initiated directly from specialists were never a good thing. It was the first time in 2 years I had missed eating lunch as I scrambled to organize everything. It was the first time in a long time I had felt like I was actually accomplishing something in a sea of saying no to demands for antibiotics and performing my whole food plant based diet and exercise monologues.

“My wife and I are going to miss you… we had hoped you’d be our doctor until we died. But I understand. You gotta do what’s right for you. And you’re young – you’ve got plenty more people you’re supposed to help. I’m just glad we got to meet you in this lifetime.”

This coming from a man who’d met THE Martin Luther King Jr. Who had met countless people in his eight decades here on earth. What had I done to deserve such adoration?

“Anyway, that’s the update for the chart!”

And just like that, our time had come to an end.

Had I adequately traced the wrinkled outline of his face? Memorized the way he waved his hands to punctuate his speech? Figured out the cadence of his filler words of “anyway” versus “anyhow”?

You’re making these final stops of your farewell tour much harder than they need to be, M.

“As much as I loved seeing you one last time, Z, you know you didn’t have to make an appointment to update me. All of this information was already in your medical history – your new doctor will have access to this.”

“I know, I know. But when you get to my age, you just need to appreciate the people in your life. And I knew I needed to let you know in person, or I’d regret it.”

Popping out of his seat with a familiar stoop of his shoulders, he turned and held out his hand one last time. Patting my dwarfed hand in his, Z finally stated after a long pause,

“The best thing about you, Dr. M, wasn’t that you were a great doctor. It’s that you were human. And you recognized your patients were human too.

Thank you for indulging this old man. Now I’m ready for you to go.”

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As J and I collected all the cards and goodies on my coffee table later that evening, I couldn’t bring myself to open them all just yet.

“So how was tearing down that last chain?” J asked.

“I totally forgot about it! There was just too much going on.”

But maybe it was my subconscious not allowing me to fully let go.

I once told A, my old scribe,

“I fall in love a little bit with all of my patients.”

If I hadn’t, would I have lasted longer in primary care? If my heart hadn’t splintered in 1800 ways, could I have kept going?

The move into hospitalist medicine is as much about shielding myself from these long term emotional investments as it is running away from the diaper of medicine that is primary care.

But do I even know how to practice medicine without exposing my heart?

Should I know how?

I guess we’ll find out.

***

Photo taken of waves crashing on the Oregon Coast.

I’m officially living that #vanlife in New Zealand! Check out my photo adventures on Instagram HERE to see the latest pics!