Sunday, October 9, 2011

Remembering my father

Yesterday my father would have turned 65. He died two weeks ago after having had a lung and its surrounding tissue removed, as an attempt to fight the spread of mesothelioma.

James Sr. (I was a Junior) was born in 1946, second of four. When he was thirteen his father died suddenly (most likely of mesothelioma), and Jim became the "man of the house." He had his impish streak but he was also very hard-working. He knew what he wanted and he got it. He worked his way through college since his mother did not have much money. He pursued my mother from high school, despite not being the favored suitor with her family, and married her following college. He bought a Piper Cub airplane in high school (under his mother's name) which he flew out of the field at the family farm. He did not want to go to Vietnam, so he went to medical school instead. He became a renowned ophthalmologist specializing in cornea transplants, and was the chair of the ophthalmology department at Loma Linda University for a decade. He founded the Inland Eye Bank for sourcing eye tissue.

My father was a meticulous (nay, obsessive) record keeper. Ophthalmologists are gadgeteers (as sure as neurosurgeons are egotists or pathologists are grim or orthopedic surgeons are fun-loving) and my father bought pretty much every generation of IBM PC as a means of keeping his own personal surgery databases. He let me play with them when he wasn't at home and as he saw my interest he kept me supplied with programming software. He gave me copies of IBM Logo, MS QuickBASIC, Borland Turbo Pascal, and eventually Borland Turbo C. I think I first encountered Rogue (the computer game) on a PC in the eye bank offices when I was hanging around there on a weekend with him. Being raised Seventh-day Adventist I had little exposure to pop culture of any kind. Rogue was riveting; I made a copy of it on a floppy disk, took it home, and played it furtively and obsessively. I wanted to make games like this!

After the university sold its ophthalmology department to a private practice, my father did some soul-searching and decided to move to the Pacific Northwest and join up with a "cataract mill," as they were derisively called by many ophthalmologists. To cut costs, these practices devolve most of the pre- and post-op care to a supporting network of optometrists, handling just the surgery bits that the optometrists cannot do. The optometrists love this because referring a patient to a traditional ophthalmologist typically means losing future business; the ophthalmologist will just absorb the patient into their own practice. With a cataract mill the optometrist stays in the game.

Focusing on just surgery meant that my father racked up incredible numbers of them: up to twenty-five surgeries a day, adding up to a lifetime total of over 55,000. (Remember the meticulous records?) He had two surgery suites. The nurses would prep a patient in one while he was operating in the other. He'd walk in, read the patient's name off a sign, and a few minutes later they'd have their cataract out and a plastic lens implanted. By then a patient would be ready in the other room and he'd swap gloves and start over again.

This is incredibly demanding performance work in the space of a square centimeter. There is no tolerance for error. Fortunately the high volume of surgery that he was doing meant he'd seen just about everything and could react appropriately. He experimented with making improvements to his instruments and ran studies on them to see whether the modifications were effective.

They say that when you have your mid-life crisis you buy the car you had when you were a teenager. Remember the plane? Yeah. My father bought a brand-new Super Cub and flew it all over eastern Washington, Oregon, and Idaho. Every time I would visit he'd get me out in his plane and we'd range all over. We dropped in on Red's Horse Ranch (now defunct) in Minam Creek; you can only get there by horse or by plane. We dropped in on a friend's wheat farm; the neighbor boy would come racing over on his quad to get a ride. We'd chase coyotes with the airplane, buzz herds of cattle, do touch-and-go landings at the Lower Monumental dam.

Surgical careers don't tend to run long. Retirement was looming. I think my father was waiting for his 65th birthday to start thinking about what came next.

What came next, last April, was mesothelioma: a cancer of lining tissue, in this case the lining around his right lung.

There isn't any particular reason that we know of why he would have gotten it: he wasn't a smoker and hadn't been exposed to asbestos (the two major causes). My father did several rounds of chemotherapy. I sat in with him on the infusion days and was reminded of how blunt our medical instruments still are in many areas. Chemotherapy is basically poison, to be absorbed by living cells. The cancer, being more vigorously alive than the rest of the body, will hopefully take the brunt of it. There is inevitably a lot of pain, which can be addressed with opiates at the cost of addiction and reduced mentual acuity. Taking the opiates results in constipation. Vitamins are getting destroyed. Sleeplessness is common. Before you know it you're taking a giant regimen of pills and patches around the clock.

The chemotherapy didn't do anything to the cancer. A surgeon at Swedish Hospital in Seattle wanted to have a go at removing the lung; my father was relatively young and in excellent health other than the cancer. After a lot of deliberation he decided to give it a shot. He made it through the surgery but could not sleep in the next few days, which made him paranoid and combative. After sedation he deteriorated steadily until his remaining lung could not supply enough oxygen even with pure oxygen being pumped in via a respirator. We took him off life support (he had not been conscious, I think, since he was sedated three days before) and he died quickly.

Given who my father was, and who I am, it was inevitable that I would disappoint him to some extent. I didn't go to medical school (despite plenty of urging). I didn't marry a nice Adventist girl (despite being sent to an Adventist college). I didn't pick a particularly respectable line of work (and started out in Las Vegas, at that). Nevertheless he was always very good to me and seemed to get on very well with the girl I did marry.

We loved him and we'll miss him.


Andy Korth said...

Sorry for your loss, James. Thanks for sharing about his life.

owen said...

its always sad when someone dies. but we all rock the boat while we can.

Mark said...

I lost my father earlier this year... it's pretty much the worst thing. But it sounds like your dad was a great man, and did a lot of good with his life. Hope you're doing OK.