Some doctors practice too long. Some realize it but don't act while others miss the signals, as do their colleagues and friends. I learned that suggesting retirement to a colleague can be as therapeutic as writing a prescription.

Some time ago, I had such a doctor as a patient. He had sent me a few patients for consultation, so I knew who he was from our phone conversations. The patients that he sent did not present particularly difficult diagnostic problems, and I later felt that they had been his advance guard to test the waters. They had in common an intense loyalty to this doctor and spent much of their visits telling me that he was a fine man and had taken care of them for years.

His first visit required several phone conversations between our office secretaries to check, change, and double-check appointment times. Yes, we would be certain to allot enough time. Yes, it would be fine if the doctor told me himself the nature of the visit, and no, we wouldn't do any testing prior to his seeing me. Thank you very much.

That first visit was marked by much bluster and posturing. It seemed he wished to portray that he was very much in control of his own medical condition, was quite knowledgeable, and was seeing me only to confirm the obvious. Later, I was reminded for the hundredth time that things that appear obvious often are not. He had a pain in the neck.

Now this was no ordinary pain in the neck. It had been so troublesome that at times he could not practice. He had consulted famous rheumatologists, neurologists, and finally a neurosurgeon. The first two did not commit, but the neurosurgeon applied his talents. Degenerative joint disease with foraminal encroachment of the cervical roots was the diagnosis. Overgrowth of bone was biting at the nerves and giving him pain—so he was told. He had surgery, was much improved after 6 weeks of convalescence, and he returned to his busy office practice. Now, 6 months later, the pain had returned and didn't I think that a simple injection of steroids into the "trigger point" was indicated?

The examination was not very remarkable. There was some rust on his iron. He was after all well into his 60s, he had worked hard, and a few creaks and squeaks were in order. I could find no evidence of serious disease. "Sure, a little cortisone here where it's most painful won't hurt you and might give you some relief". He seemed pleased that I would take him seriously and that I would concur with his own planned treatment. I guess I affirmed him and he needed that.

He called the next day to share his pleasure that indeed he was better. It wasn't too long, however, until he was back. Many visits ensued, each with more conversation and less therapy. Over the course of time, I learned much more about my medical colleague. He always regarded me as a colleague and not as his doctor. He grew fond of me in a fatherly way and invited my wife and me to visit him at his home.

He was the first doctor in his little rural town, having set up shop just after World War II. As was the case for many doctors of his day, his office and home were one: a large pretty frame house on the main street with the office entrance on the side. There was an astonishing array of lovely antiques, majolica, stoneware, ancient firearms, and bric-a-brac. As he led us on a well-rehearsed tour, he explained that most of the pieces had been payments in kind for services he had rendered to patients. He had been dearly loved. Yet, there was a bitterness in his monologue rather than fond memories of good deeds.

It is a pattern that I have come to recognize. A pattern of chipped enthusiasm, confused needs and wants, and foggy notions of identity. When a new physician starts practice alone, especially as a family practitioner, there appears to be no limit to what he or she can do. Show them that you care, that you are available. Go the extra length and bestow on them the gifts you possess. He had clearly been like this when he started. He recounted wonderful stories of bad-weather house calls, surgery just in time, difficult deliveries, and comfortable deaths, and he told humorous anecdotes about the farm families he attended. He delivered babies at home, took out tonsils in his office, ran office hours well into the evening every night, never took a vacation, and practiced his trade at church and in the barber's chair. There were both smiles and sadness as he told these stories. His sense of personal worth was wrapped in the needs of others. Nothing paid more sweetly than "Doc, you gotta come!" The rule was to never say no. After all, if you don't do it, who will, and someone might die.

So, he never said no. His office was jammed. Appointments that used to be 20 minutes dwindled to 5 or less. Pills from the barrel were dispensed with less care. He had no time to keep up with the literature. "People need me". He would not press for payments so the payments in kind began—first food stuffs and later more substantial gifts.

As time wore on, so did he. The need he unconsciously curried began to wall him in and to become his prison. His jailers, previously friends, never let up. Always calling, always nagging, never understanding that he was tired. "Always thinking of themselves, never considering me" was the last thought before sleep at night. By now the rule DON'T SAY NO was a stone tablet around his neck. Money and material things became the solace for these continual demands. If they were to fillet his flesh, then by God it was going to cost. He accumulated wealth, and bile.

It wasn't evil. It was sad. I slowly realized that what he really wanted from me was a way out. He wanted to quit practice but couldn't bring himself to do it. How do you break the stone tablet that has defined your life for so long? He would be abandoning people, he would be failing, he would be saying "I made a terrible mistake". But, if his doctor told him he had to quit, well what could he do? It wouldn't be his fault and everyone would understand that.

"You know, I think you really should hang it up and quit practice," I said casually one day.

"Quit? I couldn't do that. All those people depending on me," he countered somewhat weakly.

"If you keep this up, you will really get sick and then what use will you be? Besides, there are more doctors around now and your folks will be well cared for. You've done enough. Why not pack it in and enjoy yourself a bit. You've earned it. I'm telling you this as your friend and as your doctor".

"You really think so? I might get really sick? Let me think about that. I just don't know".

That was on a Friday. On Monday, my phone started to ring. When I came back to my office after morning rounds, there were 15 little yellow phone messages taped to my door. Each one from a new patient wanting an appointment. Perplexed, I called the first one.

"Mrs. Stoltzfus, I have your message. What can I do for you?"

"Well, I need some more of those pills that Doc prescribed".

"I don't understand. Why are you calling me?"

"Cause, that's what the note says to do".

"What note?" I asked, getting uneasy.

"Well, there's this note on Doc's door. Says he quit on account of Doctor's orders and if we need anything we should call you at the medical center".

It seemed that he had thought about my suggestion for all of 24 hours. By Saturday he was gone. He and his wife closed shop and went on a 3-month vacation, taking time to put a note on the door of the office.

He passed his stone.