At the end of August, Dr. Edwards sent a letter to his patients notifying them that he will step back from seeing patients at the end of this calendar year. He wrote this article the following week.

It is the first Monday after the announcement. This will be the first time I see patients who know that I am quitting (no R word here). The day starts with a sharp slap in the face. I casually mention to my wife Mary that many of my Brooks Brothers shirts are fraying in the collar. The statement, “I will need some new shirts” seemed innocuous enough, just planning ahead.

Mary, who was really planning ahead, responds with, “Chuck, you are retiring and won’t be wearing those shirts any­more. I don’t know what you are going to do with all those ties. You won’t need them either.”

Wait! What?! This is hard enough, but to tell a University of Virginia guy from the 60’s that he no longer needs white oxford shirts and silk ties is cruel and in­sensitive. Next will be the disappearance of my tassel loafers.

The image that crosses my mind is of me walking around the house with noth­ing to do, semi-confused, barefoot with no shirt on. I am terrified.

I arrive at the office and my schedule is up on the computer. Patients I will see are in sequence according to time. I see their faces and realize how much I look forward to learning how they are doing. A faint twinge hits that someday soon those faces will not be in my life – but it fades with Shelly’s arrival and a folder of issues we need to tackle before the first patient. I get it together and we get started.

There is a pattern that repeats itself with each patient. We talk about the letter. I reassure each family that I am being replaced by a team that is definitely more qualified than I am. Things will go on. But what I feel is that I am letting every­one down. I have made promises to be there when needed. I am reneging on that promise. This feeling is not coming from the patients or families, it is all me. It is slowly mounting with each encounter.

This painful separation was pre­dictable 50 years ago when I became “Dr. Edwards.” There are two ways to approach this doctor thing. You can take care of diseas­es or you can take care of individuals who happen to have a disease. Those of us who choose the latter are all in. We are on the roller coaster with you. In my career as a surgeon, I felt that if I made an incision on a patient that in some way we were connected for life. In this second act, caring for patients losing their memories, the involvement is even deeper. This emotional attachment to my patients and families has finally taken its toll. Cutting back further is not an option – you are either in or you are out.

I thought I had my arms around this until I saw my last patient on this Monday. His name is Frank Weaver. He comes in with his wife Pat and daughters Karen and Cheryl Anne. We’ve been to­gether now for five years and Frank has slowly declined. He was always an observer of life, quiet but involved. He literally could “fix anything” and filled his life with projects that made other people’s lives easier. Now, he rarely offers spontaneous speech but he does know what is going on around him. He can no longer sequence his thoughts which prevents him from knowing how to start on his projects. He has accepted the decline with grace. He asks for help getting started mowing the lawn, but once he is on his way he is back to the old Frank, rejoicing in just getting stuff done.

Pat is the poster wife for how to handle dementia in a loved one. She is honest about the steady decline but always focuses on what we can still do, not what is lost. She brings me up to date. “I am doing all the driving now, and am nervous. I never venture far and I always think of your advice in taking right turns.” The daughters are with her often and the whole ballet works. These circumstanc­es have brought this family closer to preserve the dignity in this marvelous man.

She adds that “he is gaining weight because of his sweet tooth. I moved the chocolate he loves from the kitchen to the dining room. I can’t take it away from him, he likes it too much, but he never goes in the dining room so he doesn’t see it.”

I go in to see him. I always get a smile. We start where we always do, with his home town of Boght Corners, NY. It is a Dutch town, he ex­plains, that has been there for 600 years. Boght means bend and the town is in a bend in the Mohawk River. The Mo­hawk empties into the Hudson downstream. He knows all this by heart and loves teach­ing me, every time. These rec­ollections are a barometer for me of where he is and what he remembers. A thought crosses my mind – I am relieved that I won’t be here if he forgets Boght Corner. It would hurt too much.

Then it happened. The inability to offer spontaneous speech lapsed and he began to speak.

“Dr. Edwards, I know you are retiring. I want you to know how much I appreciate what you have done for me and my family. I have always thought you cared about us. I want to say thank you.”

That was it. He was quiet again. Nothing could have been said or will be said that can touch me more. This still, reticent man overcame his progressive decline in speech to connect with graceful, enlightened sincerity.

Leaving the room, I sud­denly realized why this exit is going to be impossible and why Frank Weaver was able to complete those thoughts. He didn’t use his brain, it is no longer capable. He used his heart, the part of his body the dementia can’t touch. It came to me that I have been communicating with my pa­tients and families through our hearts for my entire career. That is the only reason any of this works. Leaving is going to break my heart.

Before I go, I have to be reassured that those who follow will know about Boght Corners N.Y. and the Frank and Pat Weavers who live there. Someone has to know and care that the bend is in the Mohawk River and that river has been bending there for 600 years before it flows into the Hudson. Promise me there will be a person to tell Frank the candy is now on the dining room table, not the kitchen table. He needs to know this.

I need to be convinced that those who follow will worry that Pat has not driven in three years and she is nervous. I must know someone will tell her always plan for right turns. They are safer.

Did I mention that Frank Weaver can fix anything? Everything depends on it. Is this too much to ask?

This bond with my patients and families has been the sustaining factor in my career. There will be no substitute for that in this lifetime. I know my patients are in good hands but in the next months I am going to need your help. Be patient. Forgive me for getting old and soft.

You can see I’m off to a bad start. I do know one thing, I am going to miss our chats.