The Work of Retiring From Pathology

In the final part of this three-part series, Paul Valenstein, MD, FCAP, shares what he has learned on the other side of the microscope as a retired pathologist. In this part, Dr. Valenstein discusses what life was like the first six months after retiring. 

Here is the beginning of a story I might have liked to write:

I wake up early as part of my disciplined daily routine. Morning ablutions are followed by an hour on the stair machine, then weights and yoga, finally concluding with 40 minutes of silent, loving kindness meditation. Afterwards, maybe a cup of buckwheat tea, served in a ceramic mug I threw in my pottery class, glazed in quiet earth tones and set down upon a rough, but exquisitely proportioned wooden table I constructed from reclaimed lumber. Next, an outing with friends...

Instead, I will write about what is actually happening.

Some people have an idea that after retirement they will finally be free to “be themselves.” This concept has a disturbing corollary — that during the decades we spend working for a living we are somehow not ourselves. In my case, retirement is providing me with more time to spend as I choose, but hasn’t changed who I am. I didn’t go through my pre-retirement life wanting or waiting to become someone else. I suspect my experience is typical — the person you are now is basically the person you will be when you retire.

The difference between a life dominated by paid work and life after retirement is having more time to direct as you see fit. I compared three months of my calendar before I retired with the same three month period one year later, after retirement. For me, the extra self-directed time afforded by retirement turned out to average between five and six hours a day. This total was coupled with more freedom to take extended time away from home.

As best as I can tell, I am sleeping an average of 45 minutes more per day. I either go to bed earlier, don’t wake up in the middle of the night to work, or take a nap in the middle of the day if I feel so inclined. Extra sleep consumes almost 15% of my new-found time.

I have no idea whether this extra sleep is making me healthier, happier, better able to concentrate, or producing any other benefit. I don’t feel tired when I am awake these days, but don’t remember feeling particularly tired back when I was working. I do have very few early morning meetings now, which is nice, and I don’t take late night call. I not only sleep more; my sleep patterns are more consistent from day to day.

Much of my newfound 5-6 hours of self-directed time each day is spent with my wife. The two of us have access to each other’s calendars, and by mutual agreement we can book one another for shared events without first asking. I estimate we are in each other’s company 3 more hours per day than before I left paid work. If you like spending time with your wife, as I do, this is good.

A good deal of my extra self-directed time is also spent with friends and family. I retired several years before the SARS-CoV-2 pandemic struck, and during the first six months of my retirement I saw many more movies, hosted and attended more dinner parties, went to more concerts, listened to more lectures, and turned up at more theatrical performances. My biggest concern before retirement — maintaining a social life after traditional work came to an end — turned out to be completely misplaced.

Every marriage works differently. In my marriage, my wife selects most of our outings and opportunities for socialization. For readers not married to my wife (a set that I hope includes all of you), various local publications provide dozens of opportunities to extend your horizons, every day of the week.

My wife and I are still experimenting with the best way to involve friends to create shared experiences, as we can no longer count on work to do this. Mostly we have been inviting individuals or couples to join us on outings. But I also have a standing weekly breakfast with other pathologists who retired from my practice, and we have created a monthly movie club during which we discuss a film we selected to view. Socialization is still a work in progress.

One of the first paying rolls that I shed during my 18-month-long process of retiring was as Secretary/Treasurer of the College of American Pathologists. The CAP had me traveling to meetings 1-2 weekends a month. After dropping down to regular volunteer status with the CAP, my meeting travel backed off dramatically. Shortly after I became a volunteer, on one of the first weekends when I would otherwise have been away, I chose to visit my 92-year old father down the street. While I was with him, he suffered a serious and entirely unexpected cardiac arrhythmia, lost consciousness, and was on his way to dying had I not resuscitated him (with the help of hastily summoned paramedics). The story of this event is an essay in itself — one I already wrote and will not reproduce here. Today, two years, one pacemaker, and a percutaneously-implanted aortic valve later, my father is a reasonably active 94 year-old who will have critiqued this essay before you have a chance to read it.

I could never have foreseen that starting to retire early would allow me to change the course of my father’s life. I knew my parents were not getting any younger and wanted to spend more time with them, but that was all I knew. It is impossible to predict the impact of retiring, so it is best not to overthink the decision. Uncertainty goes both ways: Some of you might have an unexpected opportunity to do something remarkable in your paid job that you will miss if you retire early. Or you might die in a freak mudslide on that “dream” two-month vacation in Nepal that you would not have taken if you had kept working. We aren’t given to know.

Providence also intervened in my life and gave me something entirely new to do during my retirement. Five months before I retired, my eldest daughter informed me that she was pregnant. Three weeks later, on February 4th, while my wife and I were driving to a tour of the Detroit Public Library, she called again and told us that she was pregnant with twins. And on August 16 — six weeks after I retired — my daughter delivered two genetically identical, healthy girls.

Becoming a grandparent is an essay in itself — one I have yet to write. It is not easy to come to grips with the fact that the grandchildren you love in the most profound way are not your own children. They have other parents. And one of the parents taking care of the grandchildren you love profoundly was hopelessly undependable in her own youth. Moreover, this hopelessly undependable youth (who has inexplicably grown into a responsible adult) doesn’t want all of your advice about rearing those precious grandchildren, and may in fact be a more competent parent than you were, so long ago, back in the days when we were taught to lay infants on their stomach and smother them with heavy blankets.

My wife and I flew out to Palo Alto, California in time for the twins’ birth. Twins, even healthy twins, present special challenges, the chief difficulty being that there are two of them. At once. My wife and I stayed in Palo Alto for two and a half months, helping out. Every morning, at 5 AM, when our shift began, my wife and I would awake, take the babies out of their bassinets, change them and then feed them, one on each of our laps, as we sat side-by-side on the couch and chatted about how life was unfolding. It was one of the most meaningful two-month periods in my life and provided a beautiful bookend to mark the close of my employed life and the beginning of retired life.

What is pertinent about this experience to the subject at hand? It is that retirement not only provides the retiree with more self-directed time every day, but also allows him to take extended trips away from home. It is easy to become a grandparent while continuing to work; I have dozens of colleagues who have done it. It is not as easy to take two and one half months off from a leadership job to spend time on the other side of the continent with your grandchildren. My wife and I hope to enjoy a week helping out with our grandchildren every 1-2 months. We have done so twice thus far, after our initial trip. I simply couldn’t do this while holding all the jobs I used to hold. I wouldn’t have been comfortable checking out for so long while keeping my paycheck. It can probably be done in a responsible way, but I wouldn’t have been able to do it.

I didn’t drop any of my volunteer roles when I retired, and I converted some of my paid work to volunteer work. As a result, my calendar still contains appointments for “jobs” I hold, even though none of them pay me any money. I have far fewer appointments than before I retired.

All of my volunteer activities to date relate in one way or another to healthcare work I used to do:

I sit on two boards for non-profit healthcare companies as a member, and attend a third board as a guest.

I co-lead a multi-year federally funded project attempting to help residents in two counties receive better assistance for social issues. The research hypothesis underpinning the project is that if issues such as hunger, housing, or access to reliable transportation are adequately addressed, traditional healthcare resources will be used more appropriately. We are running a randomized control study to examine this hypothesis, and should know whether this is the case in about two years.

I volunteer on two committees run by my former employer, a multispecialty medical group. One committee focuses on improving patient access to physicians and the second focuses on risk-based contracting with health insurers.

I still volunteer time with the College of American Pathologists. I write test questions for the American Board of Pathology, which certifies new pathologists as ready to practice. I plan to end my test-writing within 12 months of my retirement date; I don’t believe retired physicians should be developing examinations for new practitioners. Knowledge outdates quickly.

Something new: serving as a mentor. I began mentoring two younger individuals with whom I worked when I was employed, and I have a less formal mentoring role with a third individual. The academic world has a well-developed sense of what mentoring involves and has formalized the role, but in my world, mentorship is less well understood and was entirely new to me.

I resisted becoming a mentor for many years because I didn’t believe I knew enough to shoulder the responsibilities. A mentor is supposed to have vast experience. My “experience” included a number of noteworthy screw-ups, and I seemed to be making as many mistakes at the end of my career as at the beginning (although I worked hard to find new ways to screw-up). So why, I asked myself, was I qualified to become a mentor?

I changed my thinking when I came to appreciate that mentorship wasn’t about solving problems for a protégé. It involves providing psychosocial support, a certain amount of modeling, and career guidance, all of which the mentee is free to take or leave. That seemed to be a role I could take on.

I meet with my mentees every other week for an hour. I am finding the work gratifying, but struggle with how to know whether I am actually helping.

One of the concerns I had about volunteer work in general, before I retired, was that I would not receive any market signals about whether my contribution was valued. Since my labor is now free, I am at risk for being retained in a role after I am no longer useful, because it is socially awkward to ask me to move on and the price of keeping me around is low. I am trying to keep my eyes open for signs that some of my work should come to an end. I remind myself to solicit formal feedback about my usefulness on a periodic basis.

In time, as my knowledge of the healthcare landscape fades, and as my mentees grow and no longer desire mentorship, I will discontinue my current volunteer work. I may end up volunteering in an entirely new area, outside of healthcare.

Several opportunities have arisen that I turned down. I said no to taking a leadership role in a genetic testing company, because I didn’t think the work was appropriate for a volunteer. I also said no to doing consulting work, but might reconsider if someone comes to me with a project that seems meaningful, and I can figure out how to consult on a volunteer basis. A consultant who volunteers is likely to have special credibility with a client. If there is some worthwhile project where extra credibility might tip a skeptical client in the right direction, I would consider a limited engagement.

Here is an unexpected development: After retirement, my wife and I have become more domestic. Admittedly, we were so far out on the curve that some movement towards domesticity was highly likely. When we were working for a living, my wife and I outsourced house-related tasks to a caretaker who kept our home clean, scheduled and received repair people, and generally knew more about our house than we did. My wife and I cooked occasionally, but mostly foraged for food in our pantry.

Since retiring from paid work, we have been systematically going through our home, learning about what we own, and giving a great deal of it away to the less fortunate. At our current rate, it will take us about a year to work our way through the entire house, and perhaps a third or more of our possessions will be given away. The rest will be highly organized. Simplification is satisfying.

To learn about homemaking, a skill neither my wife nor I possessed, we both read what we believe to be the best contemporary book on the subject, Cheryl Mendelson’s Home Comforts: The Art and Science of Keeping House (2005). Ms. Mendelson went to Harvard Law School and taught philosophy at Barnard; her treatise is not designed to turn readers into 1950s housewives. I needed to learn how to take care of my house, but also wanted to develop an appreciation for why each task was necessary, the science behind home care, the historical context of various activities, and how homemaking might fit into a more meditative and social life. The book helps. Our housekeeper is also helping, by teaching us what her mother taught to her. She has cut back to coming twice a week as my wife and I pick up more of the housework, and will move on soon.

I am developing my culinary skills, which is helpful now that we are having more people over for dinner. I feel comfortable with a sous vide machine and pressure cooker, and am coming to appreciate the role of salt, fats, acidity, and different types of heat.

I did not expect domestic arts to appeal to me when I contemplated retirement. I have heard that aging is accompanied by a gradual narrowing of horizons, and it is possible that the appeal of domesticity can be understood in that context. “Small” tasks that once held little interest now bring the same satisfaction as doing work on a larger scale.

An important part of being retired is learning to live within one’s means. This is also an important part of pre-retirement life, and if one masters the discipline before retirement then the post-retirement regimen is less onerous.

My wife and I stopped receiving paychecks, and the “salary” we pay ourselves every month from savings, plus my wife’s pension, seems to have carried us through the end of the calendar year, even during December when we make most of our charitable gifts. My wife and I plan to take two out-of-country vacations and are likely to be supporting a relative who needs financial assistance. It is possible that we are on the road to economic ruin and don’t know it, but I suspect not.

When I was working for a living, I cultivated three hobbies: skepticism, finding humor in the everyday, and obsessional thinking. These hobbies can be enjoyed during retired life too, and I have. Obsessional thinking is proving to be the hobby most difficult to maintain, because I have less material to preoccupy me. But for those skilled in obsessing, and I count myself among them, retired life affords reasonable opportunity.

A long time ago, I taught sailing, and enjoyed sailboat racing for a number of years. I also played the piano, and wrote music, including songs with lyrics. I still bang on the piano now and then, but not that often. I may spend more of my time playing the piano or sailing during my retirement, but have no concrete plans. Retirement, so far, has not rekindled old pastimes.

I have not picked up any new hobbies, although I do find myself writing more. I would never have written an essay of this length while I was working for a living. I also journal now, writing an average of three days a week about the best parts of my day. (A randomized controlled trial suggests this activity increases personal happiness, by the way). I will probably take a writing class in the future.

I am spending more time reading. I now finish 1-2 books a week, about three times the number I read before I retired. I am also able to keep two or three books going at once. Several of my friends have always been able to read several books at the same time, but while I was working for a living I spent much of my time reading work-related material and my mind was too busy to handle more than one pleasure book at a time.

Retirement has allowed me to become more fit. I walk outdoors most days, even during the coldest days of winter. I exercise every day. When it snows, I have time to shovel the front steps and walkways, and to enjoy the workout nature has brought to my doorstep.

Between exercising more, and doing less stress-related eating, I have lost 17 pounds in the past year. According to my digital watch, I am now exercising an average of 74 minutes every day. Before I retired, I averaged 38 minutes on days when I exercised, which was about three times a week.

None of the above should imply that I am as fit as I was in my youth, or that I have somehow arrested the aging process. Neither is the case. Getting old involves many physical changes, some of which are now being understood at the molecular level. To keep matters simple, think of aging this way: everything that was once hard gets soft (such as your abdominal wall), and everything that was once soft gets hard (such as your abdominal aorta).

Reasonably rigorous studies show that the elderly, which is what I now consider myself, benefit from three types of exercise: strength training, cardiovascular exercise, and stretching. I am involved in all three, in a haphazard rotation that takes place at a fitness center located next to the hospital where I used to work. I alternate self-directed exercise with a personal trainer and group classes. I feel better about myself physically than I have in years, but I don’t feel any younger.

Perhaps the biggest change I have noticed in myself since retirement is that I feel more “present.” I am better able to live in the current moment and pay attention to the people around me than when I was working for a living. I can do this because I don’t spend as much time thinking ahead about all that needs to get done.

When I was working for a living, I often felt as if I was not giving the people with whom I worked the attention and care they deserved. Today, I spend more of my time (although certainly not all of my time) taking in the present and the people I am with. Some mornings, it seems as if a yoke of responsibility has been lifted off my shoulders, or at least lightened considerably. A colleague who retired a year before me said it took her a few months to relax after she stopped working. For the first two months of her retirement, she would awake in the morning and immediately start thinking ahead about what tasks were upcoming or overdue. I didn’t have to wait two months to notice this change myself. I felt it immediately.

In Saint Joseph Hospital, where I used to work, the two nuns with whom I interacted seemed particularly able to live in the moment and connect with the people around them. I do not know if the Sisters of Mercy train their postulates in some special way, or take care to ensure that their nuns have a manageable amount of work to do. Maybe the people who decide to become nuns are cut from a different cloth, or the work of nuns lends itself to paying the right kind of attention. Regardless, my experience with these two Sisters suggests that it is possible to be “present” while working. But for me, leaving paid work helped considerably.

It is fitting to conclude with the existential. One of my concerns about retiring was losing a sense of meaning. I worried that when asked to describe myself, once I no longer worked for a living, I might stammer. Would the personal narrative I developed for my post-retirement life resemble, in any way, my pre-retirement story? Would it be satisfactory?

“Meaning” is an elusive concept. Authorities who write about meaning don’t all use the same language. Researchers who have conducted surveys about meaning don’t all draw the same conclusions. Even the importance of having a sense of meaning is debated; some people seem to live happily without any need for existential meaning while for others (such as me) consider it an essential ingredient in a fulfilling life.

A personal sense of “meaning” can probably be acquired in any of several ways:

• Belonging — identifying with and caring about a person or group of people
• Purpose — adopting personal goals that fit within a larger set of values
• Narrative — being able to form a coherent story about oneself
• Transcendence — seeing oneself as part of something bigger
• Accomplishment — creating a worthwhile work or doing a good deed

These pathways to meaning are not mutually exclusive. The world’s major organized religions all provided a sense of belonging, purpose, and transcendence. This essay increases my sense of meaning by connecting me with a broader community of readers, recording part of my life narrative, and giving me a purpose -- helping others who are contemplating retirement. What a bait and switch, I hear you cry! You have read this far thinking my essay was written for you, only to learn it was really created for my own benefit.

Building meaning in my retired life is a work in progress, as it was before I retired. Here are some of my observations:

Retirement has allowed me to feel good about volunteering my time, rather than asking to be paid for my work. I cut off the small payments I was receiving from my old employer, IHA, because the good feeling I obtained from volunteering was worth more to me, at my stage in my life, than the money I received. I also derive satisfaction knowing that by retiring, my salary and the opportunity to develop as a leader can accrue to younger people, who need the money and experience more than me.

Following up on a suggestion I heard in a lecture, I have decided to make myself personally accountable for my wife’s happiness. I have no idea whether I will succeed in this quest, but it gives me a sense of purpose, and my wife isn’t objecting.

Showing kindness on a broader scale continues to be a challenge for me. I wouldn’t describe myself as selfish, but I would like to be more compassionate.

To sum up, retirement has not upended my sense of self or caused me to question my pre-retirement values. But neither has it provided me with new meaning or clear answers to questions that eluded me while I was working for a living.

I hope this essay helps my readers retire at the right time and for the right reasons, and that all of you enjoy a purposeful and rich retired life.

Paul Valenstein, MD, FCAP, practiced pathology for 33 years before retiring. At the CAP, he served on many committees and councils, chaired the Council on Scientific Affairs, authored a book on Quality Management, and served on the Board of Governors and as the CAP Secretary/Treasurer. He held major administrative roles leading a group of more than 500 physicians and a consortium of more than 80 non-profit laboratories. He currently divides his time between Ann Arbor, MI and Berkeley, CA.