‘‘Once a Doctor, Always a Doctor?’’ 229
around to it; money was an issue. But really, they just weren’t
prepared to make the decision.
Indeed, some physicians literally worked until they dropped, post-
poning or never retiring—even when fatigue may have impaired their
judgment.
Reasons for Retirement
Illness led other physicians to retire promptly—most importantly, be-
cause of deterioration of health and physical function. For some physi-
cians, retirement became paramount once further practice could endan-
ger their health. Risk to a doctor’s health is understood to be part of the
profession (e.g., when treating infectious disease or epidemics, or soldiers
in combat). But these physicians now had to decide where, exactly, to
draw the line—at what point they should cease to endanger their own
health. Ordinarily, physicians’ sense of their own invulnerability helped
shield them from fully recognizing or confronting this issue. But illness
now confronted them with this question anew.
A variety of personal factors entered into understandings of how much
sacrifice and risk to accept. Dilemmas arose regarding the exact degree to
which physicians should—if at all—sacrifice their own well-being for that
of their patients. For example, Dan, who had chest metastases, came to
accept, in retrospect, that his research had probably induced his cancer.
I did research using radioactive markers, injecting them into
patients—never thinking that I should have a thyroid scan, or take
potassium-iodine. My disease was probably due to the iodine from
the isotopes.
As mentioned earlier, immunocompromised physicians faced a variety
of infectious threats. Many with HIV debated retiring when they risked
exposing themselves to opportunistic infections such as TB. Several wor-
ried about exposure, but continued to work—often because of wanting
to keep their diagnosis secret. Some retired or transitioned to other work.
Eventually, Jennifer stopped clinical work due to the dangers of exposure
to TB, and growing time commitments to speaking engagements about
HIV. She was still able to consult and participate in other activities.
Our clinic had an enormous amount of TB—any public hospital
does—and was starting to see drug-resistant cases. A new patient