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The autumn of a career

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But now the days grow short, I’m in the autumn of the year
And now I think of my life as vintage wine from fine old kegs
From the brim to the dregs, and it poured sweet and clear
It was a very good year

By Warren R. Heymann, MD

I have always been haunted by Ervin Drake’s lyrics of “It Was a Very Good Year,” as sung by Frank Sinatra, since I first heard them as a 10-year-old boy listening to WMCA on my transistor radio. The journey of a man’s romances from his teenage through senior years resonated with me as I wondered how my life would unfold.

If we are fortunate enough to experience old age, reflections of a long life lived are likely to focus on love, be it family, avocation, or career. As I was leaving the Duhring conference at Penn last week, I encountered my good friend Maurice Thew. He informed me that he and his wife Marguerite, two marvelous dermatologists (and people!) will be closing their practice in a matter of weeks. As Maurice told me of the intricate logistics and costs involved in closing shop, it was clear that their decision was wistful.

Perusing the day’s mail, I opened JAMA and read an essay entitled “Aspects of Ending a Lifelong Dream” about the musings of a 70-year-old cardiologist as he retired from practice. Clearing out his office, the artifacts of his professional life, from a stethoscope to a signed Denver Broncos Barrel Man mascot adorning his desk, triggered memories of cherished relationships with patients, and profound medical errors which altered his clinical approach (1). I wondered what emotions the Thews were experiencing – I forwarded the commentary to them. I received the following from Maurice:

Thank you for your note.

He certainly expresses the feelings that many of us have and our concerns that the medical profession is being destroyed. Our standards are much higher than those of business or politics.

Many physicians feel a sense of “burn-out” apparently, particularly the older ones.

It is anticipated that there will be a shortage of 150,000 physicians within 10 years.

I hope that our profession can rally and protect us and our patients in the future.

Many other countries have had doctor strikes in an attempt to fight back against excessive work and controls. I believe we need to unionize.

The feelings of sadness he expresses are real as is his guilt feelings about failing to make a diagnosis years ago.

What Marguerite and I have experienced, however, is an outpouring of expressions of appreciation from our patients. We feel overwhelmed by notes, letters, and personal statements of thanks for our efforts on their behalf. We have also received flowers, food, many bottles of wine, and several dinner gifts.

One of our patients told me that when she received our notification that we were retiring that she cried.

It is difficult to retire but I think it is time. We will never regret going into medicine when we did although we are not sure we would do it today.

I think it is significant that the sad retiring doctor had gone back to offering his services even though his office is empty and his memorabilia have been stored in his attic.

We hope to see you soon.



Every day, patients ask me when I plan to retire. I know I look older, although I don’t feel it at work (exhaustion at night is another issue!). I believe I’m still sharp, continuing to grow, and am at the “sweet spot” of experience and academics. My response is that I will “hang up the spikes” when I would not wish to go to myself as a physician. I’m relieved when they smile upon learning that I plan to be around for quite some time. Although I am somewhat more sanguine about the future than many in our profession, I can fully appreciate Maurice’s perspectives. When the time comes for my valedictory, I hope it is with as much grace as Maurice expressed.

To the Thews, I wish both of you many years of health and joy, as you embark on the next phase of life. Although you may be closing your practice, I am confident that your zeal for dermatology will remain intact. Thank you for all you have done. I, and many colleagues, look forward to continue absorbing your humor, knowledge, and wisdom.

1. Hergott LJ. Aspects of Ending a Lifelong Dream. JAMA 2017; 317: 137-8.

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