Crashing Out of a Career


REFLECTIONS IN FAMILY MEDICINE

Crashing Out of a Career

Brenda Neufeld, MD

This article is meant as a personal reflection on my unexpected retirement, and includes memories and
thoughts about my career with the Indian Health Service near the border with Mexico, serving the
Tohono O’odham tribe. ( J Am Board Fam Med 2020;33:339–341.)

Keywords: Arizona, Family Physicians, Native Americans, Mexico, Personal Satisfaction, Retirement, United States

Indian Health Service

My career began with a rainbow. I had driven cross
country from Charleston, South Carolina to Sells,
Arizona, stopping in Kansas where my mother
joined me as a companion on the second half of my
road trip. My hometown of Emporia seemed like a
rough boundary or membrane between east and
west, a place where tree-covered hills changed to
grass-covered prairie. We enjoyed stopping in little
towns along the way, places where cafes had signs
saying, “free coffee for all law enforcement,” bulle-
tin boards held notices of community events, and
all heads swiveled briefly when we walked in the
door. Gradually, fields and plains became desert
and mountains. The last stretch was a mountain-
flanked drive from Tucson through the Sonoran
Desert, thick with saguaros, chollas and ocotillos.
We could not believe that it was over 100 degrees
in late September.

I made my job decision late in the third year of
my family medicine residency, after considering
and rejecting other options for reasons such as lim-
ited practice scope and minimal vacation time.
Usually the opposite of a procrastinator, my tardi-
ness in job choice did not worry me, as there would
always be the option of continued shifts in small
town South Carolina emergency departments. My
interview on the Tohono O’odham reservation was

an afterthought, an add-on to what I thought was a
more promising interview in Tucson. Although I
had spent a month on the Zuni reservation during
residency, like most people in our country I was
ignorant of this tribe of desert-dwellers on their
vast land bordering both Tucson and Sonora,
Mexico. What was it that exerted a draw for me?
Somehow the unpretentious facility, the petro-
glyphs near the small, dirt airstrip with the tattered
windsock, the dedication of the medical staff, and
the beauty of the desert conspired to seduce me. As
I drove back to Tucson, a silver moon shone on the
dark silhouettes of the desert plants and the myste-
rious mass of the mountains, and I knew that I
would be working on the reservation.

But not forever, I thought—perhaps for two
years. Charleston still exerted a pull, as did Kansas.
This job would be an adventure, a way station on
the way to something else that might be more per-
manent. As we drove over the rise into the small
town of Sells, the rainbow seemed to be blessing
my adventure, a gateway to new experience.

I soon discovered that not all would be rainbows;
this was apparent when I discovered that my gov-
ernment housing had a gas leak. The Indian Health
Service has always been and remains low on resour-
ces, and those who work with Native people learn
how to make do with less. At times less meant a
brutal shortage of medical staff, leaving those of us
remaining exhausted as we provided clinic, inpa-
tient, and emergency department care for a people
dealing with a very high burden of diabetes and
other chronic illness. Early on, clinic days were
especially long. Call was frequent and often
involved riding along with ambulance patients, as
emergency medical technicians were few and

This article was externally peer reviewed.
Submitted 10 August 2019; revised 17 September 2019;

accepted 24 September 2019.
From the Indian Health Service, San Xavier Health Center,

Retired, Tucson, Arizona (BN); University of Arizona Clinical
Assistant Professor, Tucson, Arizona (BN).

Funding: None.
Corresponding author: Brenda Neufeld, MD, 914 N. 4th

Avenue, Tucson, AZ 85705 (E-mail: brendaneufeld@
hotmail.com).

doi: 10.3122/jabfm.2020.02.190287 Crashing Out of a Career 339

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paramedics nonexistent. A year in, I turned down
federal loan repayment—I thought it unlikely that I
could last for the two-year commitment. When I
was diagnosed with lupus almost two years into my
career with the O’odham, I felt that this added to
the solidarity that I already felt with patients.

There were many rewards. I had what is so rare,
long-term relationships with those I cared for—
because despite my initial plans and my health chal-
lenges, I stayed with the Indian Health Service on
the Tohono O’odham reservation for 27 years, my
entire career following residency. As a family doctor
I had the perfect job. Early on I delivered babies who
are now well into their 20s, and I treated numerous
generations of many families. I learned about the rich
culture of the Tohono O’odham as well as many
other tribes. Tight family networks often reminded
me of my ancestral background of rural midwestern
Mennonites. It was revealing to see people in their
homes on occasional home visits, and an honor to
attend funerals at the beautiful San Xavier del Bac
mission church. I met many fascinating people and
heard many compelling stories. I always enjoyed see-
ing patients who had good senses of humor, despite
their health issues; with some patients I laughed to
the point of tears. I worked with dedicated medical
and clinic staff, and together we made many hard-
won improvements to patient care. I remain in a
long-running book group with many of the doctors
on staff, as well as their spouses.

Lupus continued to remind me of its presence,
sometimes forcefully and sometimes softly.
Eventually I had to stop taking call and gradually
reduce my number of clinic hours. Since lupus
means wolf in Latin, when it was active I had an
image of a hungry wolf on the hunt. Late last year
the wolf was particularly active, as she warned me
insistently that work was no long compatible with
caring for myself adequately. A flare of long-time
pleuritic, pericardial, arthritic, and neurological
symptoms that had waxed and waned through the
years like unpredictable tides was now, along with
migraines and crushing fatigue, too much to ignore.
Of necessity my decision to retire was rather ab-
rupt, with no chance to say good-bye during clinic
visits as I would have liked. My symptoms were too
severe to allow continued work on a temporary ba-
sis, and bureaucratic consideration of insurance
waiting periods and federal disability retirement
details also prevented me from doing any further
hours in the clinic. Brexit was much in the news at

the time and I joked sardonically that I needed to
“crash out” of my career—retirement was a firm
border between before and after.

Medicine is such a helping profession that at first
I had a panicky feeling about not aiding people in
any formalized fashion. Where would that caregiv-
ing impulse go now? The sudden absence of my
patients felt like a hole in my life. In the immediate
phase I was helped by trying to make the transition
as orderly as possible, caring for patients by manag-
ing the handoff as best I could. I wrote a letter to be
sent to all my patients, expressing regret that I
needed to retire, thanks for my time with them, and
assurance that my colleagues would take good care
of them. I called as many long-time patients as I
could. Patients were unfailingly kind and gracious as
I bid them farewell. They were already aware that I
had health challenges, as the signs were visible. I
had worked while using an arrange of wraps, splints,
special shoes, canes, walkers, and scooters, many of
which came in handy as visual aids when I was urg-
ing devices on patients who had needed them. Not
wanting visits to become about me, I had not talked
much with patients about my health challenges.
However, in response to questions I did often give
short-hand versions that patients could often relate
to. “I have neuropathy” illicited knowing sympathy,
diabetes-related neuropathy being an ever-present
scourge on the reservation. Perhaps the knowledge
that we were both persons with impairments helped
in some cases for the 2 of us to more easily form an
alliance. As I called patients to say good-bye and to
wish them well, I knew that patients would be curi-
ous and that vague explanations might make closure
difficult for them. As a result I felt more free to talk
about lupus and the challenges that it had brought
me, while at the same time assuring patients that
retirement would be good for my health and that
they need not worry about me.

As I contemplated my new life, it was also help-
ful that I had started the process of acceptance years
prior, during other major lupus flares. I had always
known that early retirement could be a possibility,
and now tried to cultivate gratitude that I had
worked as many years as I did. Of course, I had not
done the job perfectly, but I had the satisfaction of
knowing I had done it to the best of my ability. My
work would live on through the patient care that
my colleagues picked up from me, the committee
assignments and chair positions I handed over, and
the policies I had written and revised that would

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remain in effect and gradually take different shapes
under new hands. It was deeply fulfilling to think of
the hundreds of medical students that I had super-
vised through the years, especially those who were
influenced to choose family medicine for careers. I
started work on this essay as soon as I knew I would
need to retire, realizing somehow that it would be
useful to review my career and put my thoughts
into words.

I gradually came to feel that each of my myriad
patient encounters continued to reside in me in
some way, and that in some indefinable fashion
the work of memory was continuing service, built
into a career in medicine from the beginning.
Some memories came back to me vividly whether
from visits long ago or last year. Surely even a
visit that I did not remember continued to be a
part of me, just as a dinner with friends, a poetry
reading, or a hike that I no longer was part of my
layered experience. That experience of memory,
both conscious and below the surface, consisted
of so many strata of joy—prenatal patients await-
ing new life, squirmy children happy to chatter as
I examined them, college students anticipating
their careers, elderly patients tenderly cared for
by family, and so much more.

Of course there was also a toll of sadness.
Historic trauma is a heavy load for large popula-
tions of peoples in our country, my patients
included. Many patients have told me of unbearable
personal trauma and crushing family tragedy. As
physicians we all see the effects of social, environ-
mental, and historic factors that we cannot change,
and that was certainly the case for me. Many of my
patients struggled with poverty, lack of opportunity,
and the difficult burdens of chronic illness. Many
died too young. Caring for this population was
challenging, but incredibly meaningful.

Now I find meaning in time with family and
friends, enjoyment of nature, and the study of
humanistic pursuits other than medicine. Always a
voracious reader, my appetite for books has only
grown. I am taking full advantage of the University

of Arizona Humanities Seminars, studying every-
thing from Chinese poetry to the musiciology of
the Beatles to the surrealist films of Luis Bunuel. In
my more whimsical moments I imagine, without in
any way regretting the path I did take, other paths I
might have taken, such as my childhood ambition
of becoming a librarian. Had that happened I might
be now reviewing my library career, whimsically
wondering what life would have been like had I
become a family doctor! Life contains so much pos-
sibility for experience and knowledge that perhaps
it takes a multiverse to contain it.

As I continue to live in Tucson, which abuts the
reservation, I sometimes see patients and their fam-
ilies around town. I run into them in stores, at
events, in church, and at the wonderful San Xavier
Mission when I take visitors onto the reservation.
I’ve attended a Tohono O’odham Community
College basketball game, and I intend to go to
patient funerals when I can. A friend asked me,
“Are you still a doctor?” A question that surprised
me. Retirement does not negate that identity, but it
does change it. Now my interactions with former
patients, though tinged by the memory of my time
in examination rooms with them, are of human
beings interacting on a more level playing field.

Does anyone really understand the term “life’s
work” at the start of a career? I am so grateful that I
had the privilege of sharing joys and burdens with
patients. I continue to do so in retirement through
memory as I proceed with a different phase of life’s
work. As I told patients good-bye they offered their
prayers, good wishes, and assurances that they
would remember me. I am happy that my patients
remain presences for me, even as I no longer see
them in the same role, and that I can offer the same
to them. Maybe I was successful in softening the ex-
perience of “crashing out.” Maybe the border of
retirement is more of a membrane than a wall.

To see this article online, please go to: http://jabfm.org/content/
33/2/339.full.

doi: 10.3122/jabfm.2020.02.190287 Crashing Out of a Career 341

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