My Father, The Eternal Optimist

My father is a brain surgeon, which also makes him a natural-born skeptic, a person with a god-like penchant for saving lives, and a touch of Hubris. His dedication to science and his own knowledge and abilities makes him exactly the kind of person you’d want drilling into your skull as I watched him do recently on an extended take-your daughter-to-work-although-she’s-grown-and-already-well-on-her way-into-her-own-career weekend of sorts.

The experience confirmed what it is I already know about him: he is a brilliant surgeon, life and death literally hangs on his ability to hold steadily onto a knife and make immediate, precise calculations, without time for pause or reflection. What I did not know is that he does not always win. His best cannot always heal his patients and yet he gives his best to them, day after day.

The weekend began as I watched him remove a large blood clot from the temporal lobe of a sixty-some-odd-year-old patient. I’ll call him Richard, for the sake of this piece. His tools were as age-old as a carpenter’s-- a drill and hack saw, which he used to remove a piece of skull and plunk it into a metal tray for “safe keeping” until the end of the surgery when he would summarily screw it back into place with tiny metal hinges. He also wielded a suction instrument in concert with an extraordinarily complex computer generated model of the Richard’s brain that helped guide him during surgery, so that he did not damage any critical parts that would incidentally shut off heart or lung function. He said to me excitedly during the surgery, “Look there’s Wernicke's area. If I nick that Richard wouldn’t be able to talk when he wakes.”

Of course, my father didn’t nick Wernicke's area or any other critical parts of Richard’s brain. He did as he set out to, successfully remove a pulsing clot the size of a golf ball. Richard woke up; squeezed my father’s hand upon instruction and then that of his grateful wife. After some time and rehabilitation, he would resume his normal daily life activities.

That night, after the grueling eight or so hours on our feet, we went to dinner, we danced, we toasted. This, of course, is what we mere mortals want to understand about medicine and surgery. We go to the doctor because we want to be healed.

What I did not know, what I came to discover in the course of that weekend is that my father does not save everyone he meets. In fact, Richard was the only patient my father would save during the course of that weekend. The other two would die, not because of what he couldn’t do for them, but because even if he did operate, in the end it would not save them.

One was an elderly lady (we’ll call her Faith) he had operated on a few days before, but her recovery was not going well. Although he could have operated again, she had signed a DNR before the surgery and he was reluctant to prolong her life against her wishes, even if she was the matriarch of a family of twelve. The other (Pete for the sake of this essay) was a forty-five-year-old with a nine-year-old son who came into the ER with chest pain and his scans revealed both lung cancer and four metastatic tumors that had broken off and found refuge in his brain.

As he looked at each chart, explaining to me the intricacies of each case, the cause and effect channeled through science, it became unbearably clear: these people would not make it. Despite his extensive training at the best medical schools, his years of experience, his best science, he could not save them.

This is exactly what we don’t want to hear from our doctors, what we don’t want to know is that medicine is still a roll of the dice. What you have determines if they can save you and we are still creatures bound to a matter of when not if. As a kid, I knew this in a distant kind of way, but I’d never actually seen him lose a patient or tell a family that there was nothing medicine could do. I also thought it was a rarity, an unlucky few that were lost.

As the weight of this played out through the weekend and the score card shifted in the favor of loss, I began to wonder how it is my dad got out of bed each morning, how he even kept trying at all.

It was when we met with each of these patient’s families to tell them that their loved one would be lost, that I came to understand my father as truly an eternal optimist.

Remarkably, during the course of each conversation, he did not look down and away as I expected he might. He did not bemoan what his hands could not do for them. He did not send these families away in tears, either. Instead, he asked each family member what their loved ones liked to do the best. This got the family members talking, not about the death imminently before them, but instead about life.

Faith’s family started talking about how she liked to make pirogues and weren’t they all lucky that she’s been doing that in her own kitchen up until last Saturday afternoon. My father used this fact to help them understand that even if he took her to surgery again, she would not ever be able to make her pirogues and did they really want her to live like that?

Pete said that he liked to play golf. My father told him, he should go with his son to do that. Even if he felt dizzy? My father assured them it would be okay as long as he didn’t drive there himself. He also told Pete that he hoped when his time came that he would be out on the course.

When we left each room, I expected my father to look down, to be sad, to walk with the weight of the world on his shoulders, laden with a heavy heart. Instead, he walked upright, moving quickly and eagerly toward the nurse’s station where a stack of charts, his next patients, waited. After all, there were some he could save. And for the rest? It was the time they spent here he reminded them to cherish.