What Does it Mean to
Finish Well?
by William G. Hoy

In just a few weeks, I will submit my “letter of intent” to retire from Baylor University, my teaching home since 2012. Now of course, that doesn’t exactly have immediate results; my final “date of employment” will be May 17, 2024, two and one-half years from now; universities prize a long off-ramp because hiring new faculty is such a long process. At Baylor, at least, the administration handsomely rewards faculty who provide this two-plus year “notice,” as well. And of course while I will be retiring from Baylor, that does not mean I am really going to be retiring! I plan, for example, to keep writing this column as long as I can continue to create coherent paragraphs. And as long as I have the physical stamina, I will continue traveling to teach and interact with colleagues who are eager to provide the best care possible to the dying and bereaved while also taking good care of themselves.

One thing that will change for me, however, is the opportunity that has been mine this last ten years to interact with some of the brightest rising stars in contemporary health care. Just this week, I got an email from a young physician who was in my end-of-life class several years ago and who conducted his undergraduate thesis research with me. In that research, he interviewed African American pastors to better understand their counsel to congregants about end-of-life care and options. Now in his first year of an internal medicine residency, David ran a care conference with an African American family last week and tells of how he applied the principles he learned in his focused research and classroom experience. Marveling at his command of what is a very difficult experience for young physicians, his older attending (supervising) physician told him he did not think he could have done it better himself. David surmises that his medical humanities experience and his focus on understanding the end-of-life and bereavement experiences for patients and families equipped him with tools most medical students simply do not get. Sadly, I am afraid he is right.
 
At Baylor’s homecoming brunch for medical alumni this weekend, another young medical student approached me just to say that her experience in my class had caused her to choose a family medicine residency followed by a palliative care fellowship. “I have realized,” she told me, “that I can have an amazing impact on the world by caring for people at the end of their lives. I would never have even considered that opportunity if it had not been for our class.” And just this summer, we welcomed back to Waco a young physician to complete her family medicine residency in the same amazing Waco Family Medicine program where Morgan was a volunteer while she was my student and wrote her guided thesis on the life and contributions of hospice pioneer, Cicely Saunders.
 
When I gave up clinical practice to teach, I did so with great angst. Not a day passes that I don’t miss the patient and family interactions; maybe I have erased from memory the horrible experiences as a bedside clinician and the night call in my early years of hospice care! Over the years of teaching and mentoring this “next generation,” however, I have come to see my contribution as bigger than the one-patient-at-a-time success of clinical practice. I cannot fully compute the possible impact of future physicians learning correct information about end-of-life care; believe it or not, my former students regularly report that medical schools are still teaching the “five stages” as if it is the newest thing in death and bereavement. And they like to brag about how “evidence based” they are; well when it comes to end-of-life care and bereavement, maybe not so much since our community of scholars and clinicians largely dismissed that theory more than 40 years ago (Stroebe, et. al., 2017).
 
But these women and men whose lives our Medical Humanities Program has touched during their formative early 20s will go on to be the leaders in the future of health care. It will be their generation that will figure out the solutions to health care reform that have so far escaped my generation. They will advance the care of patients far beyond what any of us ever dreamed. If I had seen patients every day for the rest of my career, I would likely have touched patients and their families numbering in a few tens-of-thousands. By my best guess, these women and men who I have been able to teach and mentor will collectively touch patients and their families numbering something north of two million!
 
With about 30 months left to go, all this has set me to thinking: how do I finish well? How do I make sure that these last four or five semesters in the classroom have the kind of staying power needed to help students make a difference for a lifetime? How do I make sure that I don’t just “coast” into retirement, an easy choice to make when one “hides out” in the ivory towers of academia. After all, once my final contract is signed in a few weeks, there is no pressure to “publish or perish” and I am absolved of all university committee responsibilities, not a bad perk in itself!
 
But in the reflection about this period to come, I have gained clarity about how I think all of us in caregiving practice might want to think about “finishing well,” even if we are still years—or even decades—away from that day. And of course, I am painfully aware we should all spend some time thinking about the “finish” of our life; as most of you know, my brother just three years older than me died early this fall and my father was only ten years older than I now am when he died in 1993. Many of us have fewer years ahead than we might like to think. In other words, it might just pay to always be thinking ahead to how we will finish, intentionally living out Steven Covey’s (1989) second of his seven habits: “Begin with the end in mind.” Here are some ways I think we can do that, starting now.
 
Rekindle the spark of your “big why.”
There is a lot of talk about purpose these days, perhaps engendered by so many people who seem to have “lost their way” during the pandemic for why they do what they do. Because Baylor is an unapologetically Christian institution, we talk a lot about vocational calling in our medical humanities courses, helping students articulate a sense of why they are slogging through biochemistry, histology, organic chemistry, and pathophysiology. We demand that future physicians understand the fundamentals of the biological, chemical, and physical sciences that are foundational to the practice of medicine but we want them to have more. We want them to have a strong sense of why they practice medicine in the first place.
 
For many of the mid-career clinicians I meet, their sense of calling seems to be deeply buried beneath an avalanche of other pressures, many of which I fear have little to do with effectively caring for patients. Take a few minutes every week from now until the beginning of the year and reflect on your “big why.” Why are you doing what you do? What are some of the measurable—and unmeasurable impacts of your life and work? When have you felt most “alive” in your career and how was that period different from now?
 
During the first week of my end-of-life and bereavement course, I ask these health care students in their early 20s to create their epitaph, a brief statement that could be inscribed on their tombstone. I tell them to write about how they want to be remembered by family, friends, colleagues, and future patients and to make their words count because every letter inscribed in granite or bronze is expensive. It is especially sobering to write an expected date of death at the top; it reminds us all that we have a certain, though presently unknown “expiration date.” Later in the semester, the same students must write an obituary statement as if they died now while still in college. The assignment simply says, “Write an obituary suitable for posting to an online obituary site such as Legacy.com that articulates your contributions to the world in your all-to-brief two decades of life.”
 
I have begun thinking this is not a bad exercise for us all to engage in once in awhile. Thinking intentionally about why we are here might just cause a reordering of some priorities. Such thinking might even engender in us the courage to make an overdue job or career change.
 
Keep close tallies on the success stories in your life. Nearly 35 years ago, I created a folder, neatly filed in the “K” section of my old-fashioned paper filing cabinet. The tab on the folder simply says “Kudos” and it contains notes and letters I have received over the years. Periodically, I replace some of them but at any given time, it contains the 25 or so best notes and printed emails I have received from patients, students, and colleagues saying thank you for a specific impact I have had on their lives. In particularly “down” periods, I read through those again just to be reminded that my impact has been broad and deep. So has yours but the only way sometimes to see it is to look at some of those impacts all in a “batch.”
 
Who are the patients who have touched your life in meaningful ways? What feedback have you gotten from them, their families, your colleagues, and your supervisors over the years? On whose life have you had a significant enough impact they took time to write it down for you in a thank you note? Keep those forever; they are golden honey for the hardest days.
 
Put a specific date on your retirement.
If you are reading this column as an early career professional, perhaps just having completed your MSW at the age of 25, those might be surprising words. Hopefully, your employer asked you to think about your retirement when you signed your hiring paperwork and you filled out the myriad of forms to begin retirement fund contributions.
 
Now is the time not only to think about our retirement in terms of how we will live financially but also, how we will make a difference between now and then. Whether your retirement is days away (or even now in the rearview mirror) or decades away, having an estimated “finish line” will likely help you think strategically about how you want to use those days or years. Is there a contribution you want to make in the literature of your field? Is there a new way of doing your work you want to try? How do you want to set yourself up to mentor the next generation in the same (or better ways) than you yourself were supervised in an internship during your training? These long term projects and goals can help give you as sense of what you want to accomplish during your career. Even if it changes ten times during your career, putting a retirement date on the calendar of your heart helps you think about how you invest your life.
 
No matter how young, begin thinking now about your “encore” career.
What will you do next? In his new book, Ken Coleman (2021) promises to help us think about how to move from “paycheck to purpose.” I have been receiving a paycheck for more than 45 years; it is statistically probable that I will be paid to do something for another 15 or 20 years. How will that “encore” career look? How will I use the freedom of a reduced schedule to travel and experience “retirement” but also to make a difference in the lives of others?
 
Both my father and father-in-law retired from their companies with more than 40 years of experience but that is unlikely to be the experience of anyone reading this column. Even if we stay in the same organization, our roles change as they did for our parents. For most of us, we change jobs ten times or more in a forty-year career (Bortz, 2021) as we change and grow; more often, we change job titles and organizations many times over our career.
 
The day will come, however, when you will be neither able nor hopefully need to work at a full-time career. What would you do differently if time and money were no object? How can you maximize your time investments now to make that future hope a reality? What changes can you start making now to move toward that “encore?”
 
I happen to think Steven Covey was right. We live more effective, fruitful lives when we practice key habits throughout our lives. One of those, perhaps among the most important among a group of key ideas, is to begin with the end in mind.
 
 
References.
 
Bortz, D. (2021). How your professional growth can benefit from changing jobs every four years. [Weblog post]. https://www.monster.com/career-advice/article/dont-stay-in-same-job-more-than-four-years
 
Coleman, K. (2021). From paycheck to purpose: The clear path to doing the work you love. Ramsey Solutions.
 
Covey, S. R. (1989). The seven habits of highly effective people: Powerful lessons in personal change. New York, NY: Simon & Schuster.
 
Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. Omega: Journal of Death & Dying, 74(4), 455-473. https://doi.org/10.1177/0030222817691870
 
 

Covey, S. R. (1989). The seven habits of highly effective people: Powerful lessons in personal change. New York, NY: Simon & Schuster.
 
Reviewed by Molly A. Keating, MA, CT
Editor, GriefPerspectives
 
Given the subject of our newsletter this month and the consistent references Dr. Hoy makes to this infamous book, it felt like an appropriate time to highlight Covey's most prolific work.
 
The Seven Habits of Highly Effective People was first published in 1989 and since then has sold over 40 million copies. Covey’s book continues to make a significant impact in new generations of readers because of the intention of his book which is to help cultivate a life that makes a difference and has held intangible value.
 
In the Maturity Continuum that Covey introduces, he argues the need for each person’s shift out of dependence and into independence. The first three habits serve to help foster and create an individual that is less reliant on others and more fully sustained and trusting in themselves. But this is not Covey’s ultimate goal, though it seems many of us think that independence is the pinnacle. The next 3 habits change focus and shift to interdependence, or life in connection with others. We see through Covey’s Maturity Continuum a move from dependence on “you”, to independence and the emergence of “I” and land with the interdependent “we”. The wisdom of Covey’s road that takes us beyond ourselves and into life lived well with others is tremendous. Relationships are arguably the most important aspect of any life. To do them well is where true value, meaning and love exist.
 
The final habit promotes continual improvement. The upward spiral is evidenced in the person that is continuously learning, seeking, and desiring greater balance and wisdom.
 
It’s more than a recipe for success; it’s a roadmap to a good life. Covey’s book matters because it’s based on more than routines and patterns. His book is designed to move its reader into mature ways of functioning and thinking that then lead to ever-renewing sources of discovery and growth.