"Though much is taken, much abides..."
Robert King, M.D.
The notion of "retirement" remains alien to me. Although I've had wonderful mentors, I haven't had good models (save for John Schowalter) for graceful retirement. My grandfather practiced medicine until he died at 85. Donald Cohen died too young, still in mid-career at 61, and even Al Solnit's death at 82 in an auto accident, ending a decade as Connecticut Commissioner of Mental Health, seemed untimely and premature. Perhaps Sam Ritvo had it right, retiring at 90, though still staying in touch with patients.
I can see enjoying working fewer hours and travelling and reading more, but being a child psychiatrist isn't something I can imagine "retiring" from or finding "recreations" that provide the meaning and engagement the work offers.
It's been my wonderful good fortune to have had training and a career that hasn't forced me to choose a false dichotomy between a psychodynamic understanding of children and families versus a neurobiological one. After my time at NIMH, I was lucky to do my analytic training at an institute with a broad object relations perspective and learning about patients' inner lives is still the most engrossing part of what I do. After a decade as managing editor of Psychoanalytic Study of the Child, I'm gradually turning the work over to a new co-editor.
My principal "day job" is as Medical director of the Child Study Center's Tourette/OCD/Anxiety Clinic. The highlight of each week is having the luxury of our spending 2-3 hours evaluating and getting to know a new patient and family in depth. I've followed some of these families over twenty years and come to appreciate the wisdom of Doc Caleb Parry's observation (circa 1800) that "It is much more important to know what sort of patient has a disease, than what sort of disease the patient has."
The research questions these disorders raise continue to take our group down fascinating pathways of genetics, immunobiology, and developmental neuroscience, along which paths I've had the opportunity to tag along. Just as the secret of longevity is the wise choice of grandparents, I've benefited from the wise choice of a department and colleagues whom I deeply respect, admire, and enjoy, among whom I number my closest friends.
Despite all the sophisticated scientific advances, the core of the work remains a caring and empathic relationship with patients and families. My impression is that in an age of increasingly fragmented and commodified care, parents hunger to have clinicians who can take a broad developmental view of them and their child's vicissitudes and appreciate their strengths as well as their vulnerabilities. I'm very grateful to have gotten to know so many lives so intimately and I'm awed by the daily, often life-long heroic efforts parents and youngsters make to overcome many types of adversity.
I try to remain vigilant against the hazards of obsolescence or "premature hardening of the categories." My grandfather was an immigrant pushcart peddler who put himself through Harvard Medical School in 1896. I often wonder whether much of what he learned then was of use to him in practice fifty or sixty years later and, as a corollary, how I can stay knowledgeable and competent. [On a different level, as my own kids have moved off to college and beyond, I'm no longer au courant about the latest bands or Internet memes (though they would insist I never was). Increasingly I have to rely on Hilda Bruch's "constructive use of ignorance" to learn about the cultural interests of my adolescent and undergrad patients].
So far, the best antidote has been being able to be around younger colleagues and trainees, though it often entails coping with more than a little envy. Done right, trying to teach is the best way to learn what you don't know. I've also loved being at Yale; I've audited courses on Job, Ulysses, and modern Hebrew and met extraordinary people, young and old. Poets like Yeats, Stevens, and Amichai remain an important part of my life; I've finally managed to finish Proust, only to start at the beginning again.
So I hope to go on doing what I love to do as long as "slow decay...[or] testy delirium" permit. Thus far, life is good.