Riding the buses

How to retain the rewards of engaging with others when retirement moves life beyond the consulting room

Retirement embraces all practitioners at some time in the course of their careers, provided they are spared “dying in harness”. For those in salaried service, her blandishments may entice quite early. Those whose discipline has been less than absorbing may court her openly from the first opportunity. Those whose professional involvement has been passionate and requited may yield reluctantly as mental and physical acuity gradually falters. Peers and patients sound the tocsin. Skills requiring long hours of dexterity are increasingly scrutinised with the passage of the years. Doctors who continue to practise despite advancing age and dwindling clinical intelligence survive largely on trust and wisdom gained through experience, fortified by the inertia engendered by loyal patient patronage. But they too will eventually totter or be gently pushed into her arms.

Depending on their preparedness, health and agility, retirees can choose one of many different pathways to cope with the marked change that retirement from medical practice entails. Each has the backdrop of a life spent in service bringing gratitude, satisfaction, stimulation and even love. These rewards are not abandoned lightly.

There are ways to maintain the redolence of this lifestyle. As a physician accustomed to an uninterrupted hour with each new patient, I could forge an understanding of the whole person in that mosaic wherein the disease is an incident in a continuum of life. Even when the cloistered privilege of the consulting room is lacking, there is potential for bonding between two individuals seated together on a bus, if one possesses empathy and interest and the other recognises the safety of an exchange that most of us deeply desire. Having disposed of my car, I now ride the buses and, in the 20 minutes or so of my daily travel, I can recapture the insights, pleasures and surprises of intimate human engagement, facilitated by a narrow bench seat and a mutual destination.

People love to talk. Encouraged by an aura of involvement and lack of interruption that is alien to most medical consultations, they will divulge the most interesting and intimate confidences, particularly if the exchange is devoid of the need for the listener to maintain the objectivity that an integrated diagnosis demands. My journal documenting these exchanges overflows. The front cover has inscribed La Comédie humaine and the back, What the bus driver said. Between the covers lies a treasure trove of human experience.

The bus drivers are often men and women with much life experience and considerable life trauma. For them, the sheer discipline of a timetable, regular hours, reasonable remuneration and a sense of responsibility do not make the job romantic, but are sufficient to make it palatable. I usually try to occupy the jump seat, whence I can illegally converse with them. This involves leaning forward and crosswise. Apart from the risk of ultimately developing scoliosis, the position appears to carry only one hazard — recently, an elderly myopic lady “tagged off” on my forehead with her electronic ticket, causing me to offer up a beep to requite her.

Here, in brief, are some of the experiences I have enjoyed and which, I hope, may induce the reader to abandon the car and take to the bus.

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Terry came here from Bristol 15 years ago. He lost his first wife to Huntington disease at the age of 45 and his elder daughter at 35 as the disease predictably anticipated itself. His son is unaffected, but his father-in-law was killed when his truck struck a lamp post. Terry remembers him as having curious waving motions of his arms a long time before the accident. When he suggested to the family that this flailing might be an adumbration of the dreadful disorder which took his wife and daughter, he was disowned, lest their insurance claim for accidental death be rescinded.

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On a bleak, wintry public holiday, waiting for a bus that failed to appear, a metropolitan transport, empty and depot-bound, halted at my feet. “I can't have you loitering here”, said the driver; “get in and I'll drive you to the terminus”. As I thankfully mounted the steps I said, “I really wasn't loitering, I'm not a paedophile; actually I'm a flasher”. “No way”, he said, “you've got the wrong sort of raincoat!”

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Saturday mornings find me taking a bus across the city to the synagogue. Attired in a jacket and tie, I recently mounted a “limited stops” bus and asked the driver if I could disembark at the infrequently used stop close to the house of worship. “You shouldn't be driving in a bus on a Saturday, my friend”, he said, whereupon the whole journey was occupied by discussion of death rituals across various faiths. He was extremely knowledgeable.

***

Broaching the boundaries of human communication in this way is a wonderful pursuit. There are, however, some rules for successful kibitzing:

• If earphones remain in place, let them be.
• Really listen. Listen in the way we are not taught to do as clinicians, where we are seeking clues and gauging innuendos, often to the detriment of mutual understanding.
• Be prepared, early on, to exchange first names. This simple act of bonding engenders trust and ensures a dissipation of barriers.
• Respond as much as you wish; most encounters become more frank and fruitful thereby.
• Avoid advice and discussion of any medical matters unless they are integral to the exchange.
• In rare circumstances, follow up any evident need that you divine your interlocutor has. Strong friendships and wonderful benefices may accrue, enhancing your health, your mood and your wellbeing.

Bon voyage!