Sunday, October 29, 2023

My Father Was Left To Cope On His Own

My father was a neurosurgeon, which I always thought was a defining characteristic. He was dominant. He was also loving and supportive, at least to me, and he treated my mother basically as an equal, or nearly so. They had a traditional marriage, and Dad said of her, she always supported me. When she died at 72 of breast cancer, they had already moved to a senior living facility, the Quadrangle near Haverford College on the Main Line in Philadelphia, because my father got nervous, worried that if my Mom died first, he would find it very difficult to live on his own. Impossible, really. When I suggested once that he make lunch for himself, he growled at me. “I've never made my own lunch and I'm not going to start now.” Or maybe he was nervous that his house in center city Philadelphia would lose value – Dad could never hold onto assets.

He lost my Mom and I didn't understand what would happen, and I didn't worry about it. As my Dad would say, caring goes down and it doesn't come back up. I did care about him, but I didn't take care of him much. I figured it was up to him to take care of himself, and that he would. I didn't worry about him. I didn't think about what it would be like for him to have an apartment where he lived alone. Of my kids, it would probably be the youngest, Peter, who would be most conscious of his father's plight. The others are more like me. I wasn't in Peter's class when it came to caring.

So in maybe less than a month after my Mom died, my Dad had hooked up with an old friend, Reva, the divorced wife of a doctor friend, Richard, an orthopedist. I had met their son years ago, a boy whose son's lips were always blue from Tetralogy of Fallot. He had died in early adulthood of failed heart surgery. I had never experienced compassion for this blue-lipped boy, just as I hadn't experienced compassion for the boy in my high school class who was frequently absent from school because of kidney disease, who died in adolescence. Actually, truthfully, I thought I was lucky not to have known either of these boys well, because then I didn't have to confront their death and my feelings about the death of a friend.

My Dad called me, as I'm sure he did to my brother and sister, to tell me about Reva and I said fine, that's good, kind of amazed at his speed, and he queried me about if it was too soon, meaning was it disrespectful of my Mom, and I said no, and he was relieved.

Richard, Reva's ex-husband, had actually operated successfully on my deformed right foot when I was in tenth grade. My father and Reva got along well, he was proud of her artistic prowess and she painted quite a nice portrait of him. He was also proud that she knew enough about art to buy the right pictures and make money on them. She was a real expert. They stayed together for maybe 10 years until she died. Her gynecologist missed a diagnosis of cancer when she had some bleeding, finding out the true diagnosis late, but I don't know if it would have made a difference. I didn't worry about my Dad's being alone, again, and I can't tell you why. I was busy, I had my own work and my own family. I was attentive, I called, but he was back to taking care of himself.

Even though he had a very nice relationship with Reva, it seemed like it was my Mom who he missed. My Dad would be hot sometime, there was a little shunt his mind would take and he would be hot, his emotions would take him away. So I remember once when he was in a mood, feeling lonely I guess, and he said about my Mom, “She had no right to die! She had no right!” Of course he knew that that was ridiculous, but that's the only way he could express himself.

She had no right to die and leave him alone. He didn't worry about sounding ridiculous with me, he said what was on his mind. If something goes wrong, find out who is guilty and throw the blame their way. Everyone has to have a way to handle setbacks, and this was his. Took me a while to get my own way to react, I naturally followed the family tradition, but I found that my kids tend to laugh at something that happens to them, and I've kind of picked it up.

But then with both my Mom and Reva dead, there he was alone in his apartment. I didn't think that much about it, although I was attentive, and he didn't want me to worry about him, either. He just wanted me to stay in touch and to visit when I could. He had his friends around the Quadrangle, and they seemed to take care of each other. Meals were in the dining room, and Dad had his regular tablemates. A nice man named Steve, and his wife, and then a woman named Anne who attached herself to him. That's what happens in these places. You trade independence for company and security. Anne adopted him as hers, told everyone that he was the love of her life, she was kind of weird, a lawyer who had practiced in Texas, I think, but her family was local, and I have pictures of Dad with Anne and her family for holidays at her daughter's house, where he looked jolly, which I found strange. He adapted well to being adopted, I thought. He was her man-friend, or something. Dad tried to tell us her good points, her achievements about being the first woman to be counsel of a company or something, the way he had praised Reva's art prowess, but my brother hated her, and I tolerated her and was polite if not very warm and of course, Dad needed her and was lucky to have someone.

As I look back on it, I thought he had lost all his neurosurgical power – well, that's not true. He had his prestige, he had his past, he had the dignity of his achievements and his former stature, some of which still applied. But do you really need that when you approach 90 and you're in a big institution where you've been for close to 15 years and you've seen them come and go, and when you walk to your meals down long hallways, or drive your cart as time went on instead of walking and where some busybody complains that you drive too fast, and you drive past the little shelf off to one side where the latest deaths are announced in little white cards and the day and time of the upcoming service, and when you go up to the nursing home part of the Quadrangle and you see the debris of wheelchairs with slumped occupants and maybe a TV on and you see that you never want to be like that – do you really need your past stature? You're in the long corridors of the Quadrangle, driving toward the end, and you're lucky if you have someone to keep visiting you in those last days when you need constant attention and when you can no longer hardly get up to go to the bathroom and you can't wipe yourself and who cares about stature then? That's when you pull yourself together and tell the doctor you want to stop taking the pills that keep you alive, you just want to keep taking the pills that make you comfortable, and I'm not sure what you think about, but Steve and his wife and Anne visited in the days, and when one of your four children is there every weekend, and then your California son comes in Friday night on your last weekend and it's like you've been waiting for him, and he brings you a little video player and he puts in a CD of your favorite movie, The Producers, and your oxygen level must be low by this point but you see the movie and you recognize it and you point to it and you look around to see if the others are seeing it, too, and you make sure they do, but then you relax back down on your pillow and everyone goes home for the night and Buddy and Bobby and Susan go out to dinner and Bobby says I've never seen him this bad, and he's right because they discover him in bed dead about 6 AM or so, as though he had been waiting for me to come.

And I wonder if he thought of my Mom, or if he thought of anything really, that night before he died. He was dead when I sat in his room after Bobby had called me to tell me he was dead, and everyone else cleared out and I sat and I cried so hard, and I called him Daddy, and I knew I loved him so much, and I think he knew it, too, but one way or the other, I was there in time, and I brought him a present that he loved in time, and one of the last words he had said, I'm not sure when, was “92,” which was how long he lasted, to 92, and who'd a thunk it, he seemed to say, his last achievement, lasting that long. An achiever to the end. And as far as I know, he never had to make that goddamn sandwich for lunch on his own, his contract called for three meals a day and he was having three meals a day, or at least two, and he was being taken care of in that infirmary until the very end full service because he had been an original resident and that's what his contract called for, back when they were offering good terms to attract people to get things started, and Dad made sure that he was going to get one of those good contracts for being an original resident, and God help them if they tried to charge him. And some old friends, or at least acquaintances from his former life would themselves move to the Quadrangle and see that he was already established there, and he took care of himself, more or less, until close to the end. Or rather close to his end, not the end, because the world goes on and nobody is irreplaceable, they say, although I don't believe that. My Mom was irreplaceable for my Dad, although he did replace her, but not really, because he had had her when they were young, and when their kids were born, and when they traveled together, and when they were amazed and delighted at their successes and the life they had built so far above where they had been born, and they would remember that together, and only they could do that, no replacements allowed for that.

And no replacement allowed for my Dad, either. No one ever loves you like your parents, I think, but maybe that's overgeneralizing. Some marriages are really so strong, and good on them.

In retrospect, I regret that I never thanked my parents enough, for all they did for me. I did tell them I loved them, which was good, but I didn't thank them. I didn't thank my wife enough either. I should have thanked them more. But at least I told them I loved them, and for all of them, I was a good boy. I did get to take care of my wife, to walk the walk, but not my parents. But my Dad took care of my Mom until she died, she didn't need me. And for someone who couldn't make himself a sandwich, Dad did pretty well for himself.

I did what I could, I was attentive, and I told them I loved them. Thank God I did that.

Sunday, October 1, 2023

The Terror of Medicine


I think it was starting this new book – new to me, anyway, used edition, 1984 – L'Amant (The Lover) by Marguerite Duras, that got me started thinking about this thing I have successfully repressed for a long time. That, and our Class of 1967 Harvard Medical School project on Humanistic Medicine. I'm only a few pages into it, but it's a book of images and interiors, a French high school girl in colonial Saigon, with two brothers, a father who is going to die, and a mother who it seems won't last much longer, a mother who is distracted and ineffably sad as she tries to cope. At the same time I'm hearing from my med school classmates about their own coping with the medical care system as we age and our medical needs increase, how some of us are well served and others aren't. And how everyone is coping with the choice to move to a facility for older people or keep on going as we are.

But all of a sudden, as I was reading L'Amant in the bed that my late wife and I shared for years – I slept there last night for the first time in a long time, I've been staying in the attractive front bedroom in the house were I slept when Ann had to sleep alone in our bedroom and be attended our health aides – all of a sudden, the image came to me of my patient Ms. Ratto, I forget her first name, but Ratto is a common name in Oakland and Alameda, there's Ratto's Delicatessen around 8th and Washington in downtown Oakland, and there's Ray Ratto, the local sportswriter turned TV, radio, and podcast analyst and raconteur, known for sardonic humor, whose family became my patients when we opened our Alameda office and he and his wife showed up for a prenatal visit and when I heard he was a sportswriter for The Examiner, I told him I was thrilled to meet him, and he told me I'd get over it. Anyway, this Ms. Ratto, a fair-skinned red-haired-to-auburn, very sweet mother of two, was my patient, and they claimed not to be at all related to any of the other Ratto's that I was familiar with. Right. Somewhere along the line, somebody didn't want to be known to be related to somebody else, I guessed.

So I had the image of her face in my mind, in our Alameda office, an old-fashioned office that took the whole second floor of a two story building that could have been an old house, that we rented from the dentist who occupied the first floor. She was distracted, too, like the mother of the narrator of L'Amante.

What do you do when you are dying of breast cancer and you have two little kids? Thank goodness you have a good husband. But, she looked at me full in the face – I still have tears when I recount this – she was still apparently healthy to look at her, hadn't yet lost her looks or her energy, it looked like, but she said to me, straight-on – what is going to happen to my kids?

Oh, how I wanted to help her. I wanted to take her in my arms and hug her and cradle her and tell her something and do something and make things all right. I could have tried. I could have said that her husband was a good guy and he'll find someone to be a good mother to them, which was probably true. I could have at least said I would be a good and loving pediatrician for them. I could have cried with her, making things worse, no doubt. I wanted to do something. I should have been able to do something, shouldn't I have? I was their pediatrician, and I cared for her and them, and they cared for me, too. It was everything that a medical relationship should be.

But I was helpless. I could have told her how much I wanted to do for her, but I had no idea, and I still don't, of what I could do. What do you do when there is nothing to be done?

I don't recall seeing her again. I must have seen the kids, I don't know, I just don't know. All I know is that it was searing. What do you do when there is nothing to be done? I could have asked her what she was doing, what could she conceive of doing that would give them the best chance ever. True belief in religion used to help with this, the Lord will provide, and sometimes I tell myself that now, knowing that I don't believe in God, but it's a great heuristic, an as-if.

I bet there are people around, in the medical schools and in practice, both, who know a lot more about what I could have done, what the medical system or the social care system could have done. It was probably up to the family, her husband, the grandparents, the aunts and uncles, everyone, to pitch in. I didn't know. But that's not what she was about. We had a relationship, she and me, patient and doctor. She could bear her soul to me. I could listen and accept her projection of what she wanted me to be, as her pediatrician. The way a pastor must feel when parishioners turn to him or her, what do you want me to be. She just wanted to tell me her deepest thought, wish, fear, terror. What will happen to my kids?

If I had known what I was doing, I would have found the time to sit with her, and listen, and reassure. Share her feeling. Then I would have been a good doctor. Avuncular, paternal, something. Helpful. Maybe I did

But I didn't know. I don't know, maybe I did do something good. Maybe I actually reassured her, although I don't remember that. Really, I was in the shock of being confronted by life in all its terrors. Talk about not being prepared. The fact that tears come to my eyes now tells me that I wasn't prepared for that. Maybe I had heard a rumor about her condition, maybe from another patient – so many of them knew each other in Alameda, although apparently not the various Ratto's – or maybe from one of my staff members. The best medical offices have staff and professionals who share a mission, and help each other to cope and do good. But whatever it was, I was still in shock. Face to face. Terror.

I'm just into the first few pages of this book. I don't know what happens to this girl. I don't know how autobiographical it is. I have intentionally not read too much about it, I want to confront it face to face. I just read my sixth Annie Ernaux book, Se Perdre (Getting Lost), and the shock of vivid and consuming autofiction (I doubt there's much fiction in it, really, maybe some compression of facts, and as in all non-fiction, the choosing of facts to fit a narrative) is still reverberating.

Life, literature, reading and writing, medicine, helping people, being helpless, the unrelenting pace of events that won't stop, time stops for no one, the earth is 4.5 billion years old and our universe is apparently 13.7 billion years old, but this is what we have, the here and now, the present, the awful unrelenting present from which we try to extract happiness, love, support, the illusion of eternity here in the present.

But at least, I hope that our Humanistic Medicine Initiative from our HMS Class of 1967 helps some of the present students and trainees, the age of our grandchildren perhaps, at least what little we can do will help some of them to cope and help with their mission of being physicians, and helping people with the burden of life.

Budd Shenkin