No, we didn’t do it better “back then”

Originally published as a Facebook note on April 7, 2015. Possibly more relevant now. 

Between family, acquaintances, coworkers and – of course – the internet, I seem to be bombarded with an onslaught of “What’s the world coming to??” comments lately. These comments – both unadulterated in statement form and pseudo-sly, in pithy meme format  – enrage me like nothing else.

They started out just irritating me, but the more exposure I got the more psychotically angry I got until I very nearly had an epic facebook explosion in just exactly the wrong place and time. Luckily, extensive experience in regretting previous facebook explosions prevailed and I left the keyboard to cool off. But it did bring to a head the need to unpack my issues over this common viewpoint and the seemingly blind agreement it fosters.

First, let’s look at the types of comments I’m talking about:

“What kind of kids are we raising these days?” said by a coworker in reference to younger people who don’t subscribe to her version of respect.

Any number of “back in the old days we did things differently and we should’ve stuck with it!” memes, posted all over facebook by people I otherwise like.

“People (and/or kids) today just want to be famous,” applied universally to anyone receiving the lion’s share of attention for anything.

I’m sure you’ve seen your share of these types of comments, and perhaps have contributed a few of your own in what you thought was a tongue-in-cheek, yet still adroit, commentary on modern society. (I have some bad news for you, by the way: it was neither of those things.) So now that we know what I’m talking about, let’s get to unpacking.

1. These comments are supremely unoriginal.

In a quote wildly misattributed to Socrates, but still written by a student of classical Greek culture: “The counts of the indictment are luxury, bad manners, contempt for authority, disrespect to elders, and a love for chatter in place of exercise. …Children began to be the tyrants, not the slaves, of their households. They no longer rose from their seats when an elder entered the room; they contradicted their parents, chattered before company, gobbled up the dainties at table, and committed various offences against Hellenic tastes, such as crossing their legs. They tyrannised over the paidagogoi and schoolmasters.” (Kenneth John Freeman, 1907)

Plato may not have quoted that directly from Socrates, but the odds are overwhelmingly in favor of both men having said something similar. In fact, I’ll lay odds that anyone reading this has made the joke that they “sound like their parent(s)” while chiding, reproaching, blaming or otherwise bemoaning the state of today’s youth. THAT SHOULD BE YOUR FIRST CLUE. Every generation thinks their elders’ reproving scolds are out-dated and old fashioned and have no practical place in modern society. This “tradition” has been going on for centuries – like head lice and other undesirable symptoms of large groups of people congregating together.

2. The implied insult.

“Repost if you agree the way we did things was the RIGHT way!” Which would make everything opposed to that agreement… what? The “wrong” way? We no longer put children in the back of open pickup trucks. That’s “wrong”? Tell you what – why don’t you argue your position from the open bed of a ¾ ton Chevy barreling down the highway at 75 miles an hour. No? Are you sure? Could it be that your position, when stripped of the bubble-wrapped safety of nostalgia, looks a lot like reckless endangerment?

But let’s leave aside obvious and logic-defying issues of mechanical safety. How about those childrearing techniques of ages past? Never mind what my personal opinion is on corporal punishment, let’s address how each of the statements made with regard to “we raised kids better in those days” implies that kids today having nothing of value to offer. And don’t give me that bullshit about “exceptions”. If you post that nonsense where I can see it, I am under no obligation to assume that you think my kid is an “exception”. I think my kid is extraordinary, but not exceptional.

As Elizabeth Gilbert pointed out in a remarkably satisfying rebuttal to the “kids these days” argument (it’s on her public fb, and I encourage you to seek it out):

Today’s American teenagers are the most sensitive, least violent, least bullying, least racist, least homophobic, most globally-minded, most compassionate, most environmentally-conscious, least dogmatic, and overall kindest group of young people this country has ever known.

They were raised to be nice to each other. They have always been encouraged to be tolerant with each other. They weren’t allowed to hit each other in the sandbox while adults looked the other way and let them “work it out on their own”. They don’t smoke as much as my generation did, they don’t drink (or drink and drive) as much as my generation did, they don’t beat each other up as much as my generation did, and they aren’t as mean to each other as my generation was. They don’t even have as much sex as my generation did.

Yeah. Kids these days are also kind of glued to their electronic screens, which can be annoying when they run into you headlong on the sidewalk (speaking from experience), but do you know what they’re looking at? No, you don’t, so quit being so judgey, McJudgeFace.

3. Direct insult.

I am morally and intellectually opposed to many of the attitudes embraced in these romanticized notions of the past. The past wasn’t a very nice place to live, especially if you belonged (or were forced into) a marginalized group.

Fun fact: women were only granted the privilege of carrying consumer credit in their own name in… 1975! That’s right. While you’re waxing nostalgic about how great baby blue eye shadow was, your mom was buying that with cash because she WASN’T ALLOWED TO HAVE A CREDIT CARD in her own name. You know who got her the right to have her own credit? Loudmouth and militant feminists who definitely DID NOT sit down and be quiet in the presence of their elders.

Because I’m on a roll with quotes, let’s revisit this one from George Bernard Shaw: “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.” If you honestly believe that the world was a better place when one class of humans exercised the power to keep another class silent, please just practice that silence yourself. You are an anachronistic albatross around the neck of human dignity.

4. Appeal to antiquity/tradition. 

Just don’t even go here. I can’t say this better than Wikipedia, so here ya go:

Appeal to tradition (also known as argumentum ad antiquitatem, appeal to antiquity, or appeal to common practice) is a common fallacy in which a thesis is deemed correct on the basis that it is correlated with some past or present tradition.

The appeal takes the form of ‘this is right because we’ve always done it this way.’

An appeal to tradition essentially makes two assumptions that are not necessarily true:The old way of thinking was proven correct when introduced, i.e. since the old way of thinking was prevalent, it was necessarily correct. In actuality this may be false—the tradition might be entirely based on incorrect grounds.

The past justifications for the tradition are still valid at present. In actuality, the circumstances may have changed; this assumption may also therefore be untrue.”

Note that the opposite of this is to appeal to novelty (“it’s better because it’s new!”), and that is NOT what I’m doing here. Just because something is new doesn’t make it better. Making it better means identifying the inherent problems in the old system and weeding them out. Homeopathy is not better because it’s “new”, but that doesn’t make the medieval practice of bleeding someone less wrong.

5. When we know better, we do better.

I’m slightly embarrassed to admit that I first heard this statement from Oprah, but I still embrace it whole heartedly. As referenced above, sometimes past justifications were valid for the time and place. It’s okay to kiss a child’s boo-boo, it makes them feel better. But, if I may be so bold, grow the fuck up.

We now know that many human behaviors and identities exist on a spectrum; it’s not okay to label people based on ignorance. “Back in the day” we may have been somewhat justified in raising our kids in a culture of fear, but I’m going to take a leap here and say that era died out with the saber-toothed tiger.

If you, personally, still equate respect with fear, then you have my sincerest sympathy. I don’t know what happened to you to make you think that (though I suspect it was the generation before you going “IT WAS GOOD ENOUGH FOR ME AT THAT AGE!”), but I implore you to get to a library and look up virtually anything written after 1991 on the subject of early childhood education. Please. Just go. You’ll come out with a profoundly more empathetic value system, and not just a little resentment for your parents’ and grandparents’ generations. It’s a feature, not a bug.

In case I haven’t made myself clear, I think that clinging to unexamined notions of the inherent “rightness” of past habits and traditions is not just immoral, it’s dangerous. Not only am I happy to live in a time and place where knowledge, discourse, and scientific discovery are made available to the vast majority of people, I am actively looking forward to more of the same in the future. And yeah, I’m personally offended when you express regressive attitudes.

I know you think you’re cherishing your past, but there has GOT to be a better way of doing that than by parroting the exact same complaints your parents, grandparents, and other ancestors voiced going back at least to classical times (see #1).

I was going to close this out by apologizing for offending anyone, buuuut, let’s be honest: I’m not sorry, really. It wasn’t my intent to offend, but if that’s the outcome, I can only hope you’ll take a closer look at why you hold those ideas in such high regard. Why does it make you feel better to hold yourself up as an example of a good and moral upbringing while tearing down everyone who doesn’t agree? If you don’t mean “everyone”, then maybe examine who the hell you think is listening to you when you say such things. Either way, you should know that I am listening.

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What sound does a Scarlet Virago make? Snarky ones.

 

My daughter graduated high school in 2015, college earlier this year. Her peers that attend 4 year colleges are entering their junior year and are now, on average, $30,000 in debt. That number will continue to increase at the same rate or faster over the next two years. My daughter has zero debt and supports herself with her first entry level position.
Do I sound a little snarky? Yes, yes I do. I received a LOT of criticism for encouraging her to obtain a professional certificate over a bachelor’s degree. A LOT. And it takes nothing away from those kids getting their bachelor’s to point out that she is already living and working in the adult world, accumulating skills for her next goal and beholden to NO loan holders. She can start building her credit from 0, rather than -30,000.
Are there kids out there trying to accomplish their dreams? Absolutely, and I wish them the best fortune possible. Are they, along with their less ambitious but no less educated peers, going to be in fierce competition for a level of employment that can’t accommodate them all? Also yes. Are a ridiculous number of them going to be working two or three entry-level jobs (that require no degree) at the same time just so they can make payments on their student loans? Also yes.
I am so sick of this pervasive and pernicious idea that dreams are ALL that matter. That one’s personal happiness rests entirely on the idea that they ONLY do what they love. I love to eat, and sleep under a roof. And not spend my days stressing about my credit score and how I’m going to pay for an emergency medical expense. There is more than one way to accomplish one’s dreams, and the idea that mortgaging your soul to a bank, or risking a basic standard of living to achieve them is… well, it’s just foolish and naive and downright harmful in some instances.
Not to mention the fact that my life fell apart in such a way that I would not have been able to help my kid in any way if she’d needed it during or after her last two years at college. And given the number of college graduates living at home, she definitely would have needed it. At this point, she’s the one helping me, who doesn’t have a choice but to incur student debt to achieve the same basic level of education that she was able to get for free, because we utilized the resources available to us at the right time.
So yeah, I’m feeling a bit snarky. And ridiculously proud.

Updates for Real Life

It occurs to me that my friends and family don’t really understand where my life is at right now. Even though I’m fairly regular about posting to facebook, I understand not everyone is as glued to that medium and might miss out on some pertinent details. This post is meant to rectify that, so if you don’t know me in real life, it won’t mean that much to you.

Ro and I (and all three dogs) have been moved in to a 900 sq. ft. duplex since mid-May. It’s tiny as hell, but allows all three of my dogs and is in a conveniently-situated part of town. It’s also affordable. These three items generally outweigh the numerous inconveniences, which I don’t want to complain about because my landlady is a good friend and went out of her way to make this place as accommodating as she could. I’m immensely grateful, and will learn to live with the things that are difficult.

I’m in college full time now. 10 credit hours over the summer, and 14 in the fall. It is utterly exhausting. My brain just hurts all the time now and every second I’m not studying or walking my dogs, I’m sleeping. This will get worse when I get accepted into the Physical Therapy Assistant program which starts in January. There wasn’t any other way to work out my school schedule – the “luck” of my ex-husband’s choices put me in a precarious position and I had to just do the best I could. That means working hard, which I’m no stranger to, but it’s a lot different at 41 than it was at 21.

Speaking of exes, I expect my divorce to be finalized within the next week or so. It was a drawn out, expensive process with a few arguments, but ultimately I got what I asked for, which was a temporary, modest living stipend until I finish school. I also kept my car and my IRA, and the dogs.

Which brings me to my next point: modest living. I’m back in a financial position I haven’t seen in over 14 years, which is scary-poor. Not nearly-homeless poor, thank goodness, but that is only because my daughter is gainfully employed and can pay the rent and utilities. But because I had to pay for some of my school out of pocket, which ate up the last of my savings, I’m now in “Oh Zeus please don’t let anything bad happen to me, my dogs, or my car or I am up shit creek” poor. I am uninsured, medically, and I don’t qualify for state aid by virtue of living in the state of Missouri (yay red state conservatism that doesn’t give a fuck if you die!). Every cent I have goes toward living expenses, which even shared are not negligible, and I’m literally holding my breath that nothing unexpected happens. Which is usually a strong indicator that it will.

I have no time, no money, and generally no patience. I am stressed out most of the time, living on a razor’s edge of catastrophe, but at least I’m too tired to freak out about it very often.

Somebody recently said how proud they were that I was “living my dream”. They meant pursuing my education, and I’m grateful for the sentiment in that respect, but this was most definitely not my dream. My dream went up in flames with my marriage and I haven’t had the energy or optimism to form a new one. I’m living my survival right now, and that’s all.

If you know me in real life, please don’t tease me about any of the above. My sense of humor has taken a scarily long hike and anything that resembles “blue skying” from you is going to be interpreted as willful ignorance about the reality of my situation. If you literally have no idea (and if you haven’t seen me face to face in the last 4 months, you don’t), kindly keep your “advice”, “cheering up”, or any other form of platitudes to yourself.

I’m in survival mode, and that leaves nothing left over at the end of the day for nonsense.

Things That I’m Over

An abbreviated list:

The idea that selfies are narcissistic, especially for women. Firstly, so what if they are? Like the mental masturbation that you do to feel superior isn’t? Secondly, no they aren’t. Women putting themselves front and center with their own agenda is simply weird because they’ve never been allowed to do it before. Welcome to the future. It has filters.

Purity progressives. Fuck those guys. Guess what? We’re nowhere near a revolution, guys. And policy making equals compromise since the founding fathers. Who were no saints, by the way, but it WAS their lives on line at the time. It’s so great that you can pontificate from metropolitan cities where your wi-fi is fast, your food is slow, and your activism is a giant circle jerk with other pasty white people who try on “bi-curious” for size. How’s the air up there? Some people do real work. You might want to try it some time.

Getting older. I pulled a muscle in my sleep the other night. How the fuck does that happen??

“Devil’s Advocates”. Shut up. Just shut up. The devil is his own best advocate, okay? He gets around making his argument JUST FINE all on his own. It’s called life. You’re not an advocate, you’re a stinky troll. Go back under your rock.

People who don’t understand privilege. Really? C’mon, it’s part of the vernacular now and if you still don’t get it, it’s because you don’t want to get it. Privilege does NOT equal wealth or fame. Privilege DOES equal certain unearned “free passes” from daily struggles not shared by everyone. Privilege does NOT mean you’ve never had it rough. Privilege DOES mean that you could’ve had it rougher. Privilege does not mean you can’t vent, privilege does mean you might not want to vent about Starbucks being out of your favorite flavor to a single working mom drinking yesterday’s Folgers. Use some sense. Then use your privilege to speak up for those who don’t share it.

Women’s clothing industry sizing. SERIOUSLY GET IT TOGETHER GUYS!! MY WAIST HAS A MEASUREMENT AND SO DOES MY INSEAM. YOUR “12” IS BULLSHIT AND SO IS YOUR METHOD FOR SEWING ON BUTTONS.

Commercials. I’ve lived so long without network television that I forget how offensive they can be. And then Pepsi invades my internet news feed.

Divorce. FML, I really, really want to be over this. Hurry up already.

Selling things on Facebook. Nope. People are entitled, pushy assholes. Over it.

Living in “rural America”. Where the church folk are terrorists and anti-intellectualism reigns supreme. Look, hillbillies and rednecks, I’m sorry you are constantly picked on and made fun of by “liberal elites”. MAYBE STOP GIVING THEM SO MUCH MATERIAL TO WORK WITH, MMMMKAY?

Listicles. These things suck, don’t they??

Dr. Empathy – Or How I Stopped Judging and Learned to Love the Millennial.

I talk a lot of smack about people who dis millennials or “kids today”. My low opinion of that attitude is well documented. What I don’t talk about is if I sometimes struggle with my perception of youth or youth culture, and the answer is: I do.  “You little twerp” has crossed my mind on numerous occasions. In some instances it’s because I’ve interacted with a little twerp (being a kid doesn’t exempt one from being a jerk), but more often it’s because I have a set of expectations that aren’t being met. This is a story about one of those times.

Before I left my previous job, I made small bags of holiday candy and gave one to everybody. For the people who weren’t there, I just left it on their desk. They went over well – almost everybody said they enjoyed their treat, or thanked me for thinking of them. The gratification filled me with holiday cheer. Except that one kid, the senior college student who worked for the vice chancellor. I left his bag on his desk when he wasn’t there and that little shit never once even acknowledged that I gave him anything!

Ugh, rude! How dare he ignore my hand crafted gesture of holiday goodness! What a little twerp! Boy, if I was still going to be working here, I’d never give him anything again!

I had those thoughts for two days. The cognitive dissonance was really fucking with me. I couldn’t reconcile my affinity for millennials with the voice in my head that kept telling me he was rude and (Zeus help me) “entitled”. What follows is a transcript of the conversation I had with that Voice.

Voice: This is why people call millennials entitled, you know. He doesn’t even think he has to say thank you.

Me: I know! Although, maybe he wasn’t brought up to have those kind of manners.

V: So? He’s an adult living in the adult world and that shit is basic. Ignorance is not an excuse in adulthood.

Me: Exactly! It’s just basic good manners to say thank you.

V: Besides, we’ve heard him say it before – it’s not like he doesn’t know how. Remember when you brought donuts and hot cocoa? He thanked you twice!

Me: I remember. I made some kind of joke about bringing them and he was laughing and talking with the rest of us. Um, actually…

V: Right! Now here is, just ignoring you. So rude. He should be acknowledging your gift! That’s why you gave it to him!

Me: Wait, what? No, that’s not why…

V: But didn’t you feel awesome when everybody else specifically came to you and thanked you for your gift? Didn’t it make you feel all glowy and validated? Isn’t that why you gave them gifts??

Me: (whispering) Sort of?

V: Of course it is. So why don’t you just march right over there and take away his gift?

Me: Because that would be horrible! And rude! You don’t give gifts with the expectation that the recipient is going to make you feel good about it! You give gifts because you want the recipient to have it.

V: Are you sure? Because I bet you’re related to a lot of people who would disagree.

Me: This is not the time for that conversation. Look, hold up. The point here is that I gave him a gift and I feel bad that he didn’t make me feel better about giving it to him.

V: And you’re not taking it back because…?

Me: Because if it comes down to it and I can only have one or the other, I’d rather he have the gift than I have my thank you.

V: But that doesn’t excuse his behavior!

Me: Only if I’m operating on a very specific mode of social etiquette.

V: Everyone operates in that mode.

Me: No, they don’t. If I really wanted him to acknowledge my gift, I could go right over there and ask him if he likes it. Better still, I could have waited until he was present to offer it to him, instead of sneaking it onto his desk like a reverse thief. Santa leaves presents in the dark when nobody is looking and nobody thanks him! Maybe he’s respecting MY boundaries? Ever think of that?! Maybe he thought I left it for him because I didn’t WANT to interact. Otherwise, wouldn’t I have said something by now? You know, millennials are really sensitive to introversion and boundaries on personal interaction, it’s part of what makes them so great. Maybe all this time I’ve been listening to you call him rude, and from his perspective, he’s being super respectful!

Voice: (a little quieter now) It still feels rude.

Me: Yes, it does. Because I’m functioning on an unspoken set of rules of social interaction that date back to the Victorian era and I’m too full of myself to just go over there and talk to him about it. That’s my failing, not his.

And that’s when the voice shut up, my cognitive dissonance disappeared and I felt even better about giving gifts at work.

I’m not saying social niceties aren’t valuable or that we should all abandon expressions of gratitude. What I’m saying here is that sometimes empathy is hard work. Sometimes anger feels better than understanding, especially when that understanding only comes after a lengthy struggle. Sometimes overcoming social programming and what is “normal” is a lot of goddamn work and we don’t want to do it. I have found however, that it is nearly always worth it.leftridgepick-strangelove-650

An Open Letter to My New Primary Care Manager

It was busy the day I met you. You were the only nurse practitioner in the office that day, and I was trying to fit in an appointment in my own busy schedule. Since this was a disadvantage to both of us, it sort of cancels out. I only mention it because it may have had an influence on your approach.

I didn’t choose you, but you undoubtedly knew that. I was assigned to you because my own doctor left the practice. Such is the nature of our health care system. Due to a confluence of scheduling issues and timing on my prescriptions, I was forced to take a next-day appointment, squeezed in among patients who were able to make their own appointments well in advance, as well as acute care patients with urgent medical needs. Not an ideal situation, but the best I could do to take responsibility for my own health care.

The intake nurse was pushy and condescending. She told me to get an eye appointment because I was -“Don’t throw your purse at me” – 40, as though she was delivering unexpectedly bad news to a toddler. I tried not to take it personally, though her attitude did set my teeth on edge. I know nurses and medical assistants at that level are over-worked and underpaid, and I’m sure she thought her advice was medically sound, so I made a concerted effort to forgive her thoughtless and trite delivery. After taking my vitals and checking off the list of meds I was asking to be refilled, she left and I waited for you.

It wasn’t a long wait, but sadly, that’s the best I can say about our time together.

After introducing yourself, you sat down across from me and began telling me that the prescriptions I was taking were ineffective for the symptoms I was taking them for. That threw me back. Is this guy for real?? was my thought, but even had I wanted to voice it, you didn’t give me a chance before moving on to your next item of business, which was to tell me that at least two of my medications were narcotics and carried very high risk factors for addiction. You spent the next four minutes lecturing me about my medications, telling me how you wouldn’t have prescribed them yourself, how ineffective and risky they were, how I wasn’t taking them properly, and how the way YOU practice medicine is to establish a “partnership” with your patients. I confess that the rest of the four minutes is now lost to my memory, but you did repeat yourself a lot so I doubt I missed much.

Tell me, sir – what kind of “partnership” is it when one person does all the talking, lecturing, and condescending while the other person is held hostage to the first’s profession? But let’s set that aside for a moment while we deal with the facts that were missing in your extremely one-sided “discussion”.

Had you bothered to ask me how I was coping with my symptoms, I would have told you that in the six weeks I’d been taking these particular medications, my quality of life had improved immensely. That I was relieved and calm for the first time in almost a year, and that in addition to the lifestyle changes I had implemented, I felt that my symptoms were finally manageable. Then, I could have told you that I spent no less than 12 years as a pharmacy technician, so I am well aware of what the medications I am taking are for, their dangers and inefficiencies as well as their success rates. Perhaps I would have lectured YOU for telling me that an anxiolytic, particularly a seratonin receptor agonist, isn’t effective for anxiety, or that the particular norepinephrine reuptake inhibitor I take isn’t effective for depression. I could have told you that when I was in my previous doctor’s office, suffering from sleep-deprivation-induced psychosis, near constant panic attacks, and had to use nicotine as a self-medicating aid, she rightfully concluded that the best medications for me would address all my symptoms and have the fewest number of adverse affects.

Maybe that would have slowed you down for half a second, and I could have reiterated that one of the narcotics you referenced was NOT part of my refill request, as that had been a short term medication only, and the other one was a rescue prescription that I only used for emergencies. Instead of freaking out that I was trying to hoard benzodiazepenes and telling me that I was abusing it, you could have asked how often I was taking it. Then I could have told you I still had over half my original pills in the bottle, but as it is highly effective as a rescue rx, I didn’t want to run the risk of not having any while I was without a provider for 30 days (or longer, since it’s not unusual to wait even longer for a non-emergent appointment).

I doubt we would have had time to go into why I needed these drugs in the first place, what my medical and psychological history was, but at the very least you could have asked me what lifestyle changes I was implementing before jumping to the conclusion that I was ignorant about my own health care. Literally asking a simple question was the very least you could do, and you failed to do it. If I am very generous, I could allow that your intention is to practice medicine in a reciprocal way with your patients, but I can assure you that was not the end result of our visit.

After listening to my lungs and heart, and grudgingly allowing my prescriptions to be refilled (after referring me to the wrong pharmacy, by the way), you finally asked if I was seeing a behavioral health provider, which I affirmed. Then you had the unmitigated gall to tell me “You rock!” and shake my hand while patting my back, not unlike one would do to a Little League player who just hit a single.

As a woman and as an American, I have a long history of receiving inefficient and belittling “health care”. Of being told that I don’t understand my own body, that I am generally ignorant about matters of health, and/or that I am deliberately misrepresenting my symptoms. You managed to hit all three, and even at “don’t throw your purse at me” 40, I’m honestly surprised enough to almost congratulate you. But having had an insider’s look at our health care system, and having a spine made of stiffer stuff than a wet noodle, I won’t. Instead, I am holding you accountable for your actions, and seeking a provider who will put into actual practice the idea of a health partnership. Someone with at least a basic understanding that such a partnership entails two-sided conversations, and a modicum of sensitivity to a petitioner of health care. You appear to be capable of neither. I was told that you are retiring from the first phase of your career while you transition to the second. Perhaps that is something you could work on.

Most Sincerely,

Your Former Patient.