Retirement is the final career for both you and your spouse. Make no mistake, if you have a partner, the two of you will retire together. No one retires alone. When your last graduate student has dropped off the family payroll; when you no longer leap out of bed at the crack of dawn in eager anticipation of defeating the freeway hassle and making early rounds before spending another challenging day in the office; when your trusted financial advisor smiles and gives you the green light; when you have sufficient assets safely squirreled away to enjoy the next 20 or 30 years in nearly the manner to which you have become accustomed; and, perhaps most importantly of all, when you and your partner really believe, after much discussion, that you will have fun living eyeball-to-eyeball, 24 hours a day, 7 days a week, together-in short, if all of these responses are positive, you are almost ready. But there is one additional requirement: You must have a plan.

This is your final career. And have no illusions, it is a career, and it will require every bit as much scheming and planning as any of your other careers. You may have some options after you retire, but they will be far more limited then than at any other time in your life.

Several prime ingredients make up a successful retirement. Some are a matter of luck and sound genes, but most are more controllable. Robust health is cardinal and most often represents a bit more than the blessing of genes and luck. At least 30 or 40 years of conscious attention to the controllables will pay off. I refer to such medical truths as rational dietary discipline, reasonable regular exercise, avoidance of cigarettes and excess alcohol, insightful management of stressors, and even using your seat belt and removing slippery throw rugs. You don't have to be obsessive about your health, just sensible about it.

It is tragic to arrive at the great moment of retirement in a state of physical disrepair, especially if it could have been prevented. How sad if, when you retire, you are no longer certain that you can handle the whitewater run down the Colorado River or tackle the Milford Trek on South Island-dreams you have been planning for 20 years or more. If you are in poor health, all of your physical options are severely limited.

Next in importance is financial security. You might assume that this should not be a problem for physicians; compared to most people, we are in excellent financial shape. Some of my wisest clinical colleagues, however, are incredibly naive about money. Brilliance at the bench and wisdom in the clinic do not transfer automatically to economics. These clinicians tend to underestimate what will be required in retirement to maintain their current standard of living. I cannot stress the importance of long-term association with a trusted financial advisor during your years of maximum earning.

The next facet of your retirement plan focuses on a realistic calculation of how to balance your intellectual, physical, cultural, and social activities. For each person and each couple, this balance will be different and very personal. Many long, serious hours of conversation with your spouse are critical to this facet of the plan. Friendly chats before the fire with good wine and soft music many years in advance of the final career may be the most crucial element in the preparation for retirement. You will be amazed at the infinite scenarios that evolve-shared shared dreams that may never have found expression in the rush of daily events.

I have many physician friends who seem incapable of having such conversations. They suffer from what I have called a "retirement lacuna." They love their work so much that it is beyond their comprehension to retire from medicine while they can still make a contribution. They will not discuss the subject. But there does come a time when one must step aside before it is too late. Some of the most pathetic figures in medicine I have known were great clinicians, true masters of the profession, who hung on too long. It is similar to the magnificent tenor whose voice has faltered or the champion boxer who has lost his agility. To compound the tragedy, none of the disciples of these clinicians can find the courage or heart to tell them to give it up.

When I encounter the physician who plans to die in harness, I become confused and sad for another reason. How narrow, how impoverished, are an intellect and soul that have not hungered to savor some of the intellectual, cultural, or social delights that swell beyond the world of medicine? Retirement does not mean that a fascination with medicine must cease. For most of us, this will never happen. But the pace can become slower and less demanding. We can read the literature with more reflection. We can be selective about the pro bono work we do. And retirement provides the opportunity to explore the vast, wonderful universe that the arduous pursuit of medicine virtually precluded. We gave our all to this demanding muse, and we did it with enthusiasm and delight. But now, at retirement, it is time to wander through those other untended gardens of interest that have been tantalizingly beyond our grasp. We have earned that privilege, after all.

Of all the elements in the balanced program of planning for retirement, intellectual activity is the most important. In my own teleological reasoning, I have always been taunted by the suspicion that some day, just as we have discovered endorphins and mysterious transmitters, some bright young researcher will identify other peptides that flow in response to intellectual stimulation. This researcher will find that they surge forth, bathing all organs in a felicitous, even rejuvenating, manner. If this is a fountain of youth, I think it springs from the higher intellectual centers of the brain in response to periodic stimulation. When this fountain ceases to flow, I believe that we see the mental and physical deterioration of the organism-I believe. This is my explanation for the phenomenon that all clinicians have observed for centuries: Without intellectual stimulation, the human organism withers and dies.

Admittedly, the best-laid plans do not assure success in retirement. Ill health is always an unpredictable villain. So is a serious, unplanned financial setback: "Janice just called from Oberlin. She's changed her mind. She doesn't want to teach Oriental philosophy next year after all. She wants to go to medical school! And Ted has decided to open a men's clothing store." Or, as you look up from your brochures describing the snorkeling off the Great Barrier Reef, your faithful spouse of 35 years looks you in the eye and says, "Now that you're home all the time, I think we need to give each other a little more space and free time."

But the ultimate catastrophe is to wake up each morning and just lie there, contemplating the day without the anticipation of joy. At that you must take aggressive evasive action to escape the demon boredom and its infamous handmaidens, melancholia and depression. This joyless awakening means you have made a mistake; your planning was badly flawed. You must step back and regroup to set the quartet in harmony once again, intellectually, culturally, socially, and physically.

Occasionally, a colleague will ask me whether I miss the action of being an active physician. It is a much more complex question than one might suspect. I have been privileged to savor several careers. But with each new adventure, one closes another door. This is never easy and is always done with regret. With every career change, I tried to maintain the connection with my other world. It never worked for long. The new job was so challenging, so all-consuming, that I was compelled to sever ties. I could not do justice to both jobs. I always had some lingering doubt about having done the right thing, but good fortune always smiled upon me. Each time it seemed I made the right decision and that it was time to move on.

Thus it is with retirement. There are occasional twinges. You never completely stop missing the sense of fulfillment that comes with teaching bright students, caring for the sick, writing editorials, helping guide the destiny of a great medical organization, or discussing global marketing strategies with eager MBAs. But you must fill your life with other fascinating things: those left undone or neglected, yet always within your peripheral vision.

Finally, let me discuss a most sensitive aspect of retirement frequently overlooked in other writings-the intimacy. My wife and I share a great deal. We love almost all of the same things, yet we are quite different people. Equal in intelligence, we have very different skills and interests. We respect this difference. We give each other space and time. It is an easy, unspoken thing. We argue, but rarely. And when we do, the one least invested in the subject yields, usually with good grace.

I wish I could say we divide the chores. We do not. My wife does much more than I. Yet I am beginning to see what needs to be done. A small point perhaps, but it has to do with fairness and keeping the peace.

Here is the sense of what retirement has meant to us, and a proposal for your own plan for retirement: You will enjoy the colors and scents of the flowers if you plan now for your final career.