PracticalDermatology

Now the wolf is knocking at my door
Bang Bang it asks for more
Stand here we stand tall
We can move beyond these walls

—Foals, “My Number”

Is there anything more inevitable in life than “Goodbye?” As morbid as it sounds, goodbye is a part of life, but is a term saved for the last time you will encounter who or what that is leaving you. Are we ready for when the wolf knocks at our door? And are we prepared to stand tall as the song mandates, but rarely feel like that moment is upon us? Many would agree the Beatles said it best in terms of saying “Hello, Goodbye,” but as the debate continues in the stanza, one way or the other there is a shift of energy … and usually loss of sanity.

A bunch of you picked up on my reference at the close of the editorial before last, and clearly that rang a few bells: sometimes there isn’t much you can do about saying goodbye except maybe replacing that sadness with the joy of a “Hello” or two. Getting older definitely sucks when it comes to saying goodbye, especially when it comes to friends and family, and we never know when we are working the clock and may not see him or her ever again.

By the time this is published I will have said goodbye to Aaron Rodgers from Wisconsin and the Monsignor (my trusted sidekick in the office) as he moves into the world of accounts and field reimbursements. Sadly, we even had to say goodbye unexpectedly to our dear friend Tom Prunty, even days after seeing him in New Orleans. So let’s see if the “Hello” that follows is worthy. As in the fairy tale, wasn’t it the job of the wolf to bring some balance by eating the three little pigs despite us rooting for them to stick around? Hard to be the bad guy. Maybe in this era of participant trophies we should just give the wolf some Impossible burgers and say thanks? Maybe part of the problem in that example is that without goodbyes the playing field is diluted, just like with the accumulation of friends who really aren’t friends or with too many established patients that just don’t need to be seen that often. On the other hand, there is a lot to be said about a refreshing “Hello” to some new faces. After all, that’s what is happening here with the new Editor-in-Chief, Heidi W. Moore, and Sally Cioci Fischer, the new Group Publisher, and so far so good on that front.

Maybe it is the fear of that hello that makes appealing delaying that goodbye as long as possible. There are those who can’t let go no matter what and have to hold on for dear life to stay relevant, or because they don’t know what else to do with themselves. It happens all the time: bad relationships and marriages, bad working environments, and bad committees that all should be dismantled but linger because fear of the unknown that comes with goodbye and what exists on the other side. Then there are those who don’t stay long enough to earn connection and depth and only allow themselves to be involved for the time that works for them. Keep in mind there are those who think that life has nothing left to chance … oops sorry, slipped into Rush mode again.

So to bring it back to dermatology—in terms of patient care, or office politics, or even consulting relationships—is there a point at which saying goodbye is the better choice for the long-term upside? Isn’t it sad that every January employers hang on too long to bad employees because of the fear of reprisals? Are clinical trial participants often enrolled instead of discharged because of risk of whistleblowers and study shoppers? And even worse, are bad arrangements among clinicians allowed to go too long with the “cancer in the locker room” staying too long and burning the house down?

So what do we do from here? Do we find new strategies to absorb the pain of goodbye and welcome the hello as often as we can?

Every story doesn’t end like Trinity and Neo, in the world that time does not govern, and where we don’t let go in theory but the end finds us. We have all lost parents, loved ones, and friends to the sadness of goodbye but many of us also know the pain of letting go of relationships that could not be salvage as sometimes we want to do to our patients. We probably could all do with more positive greetings but should face the pain of goodbye head on. Then again, we could take the easy way out like the Seinfeld character who didn’t really say “Hi” to George, she just sent “Regards.”