My Mentor

Jeffrey H. Millstein, MD

Fam Med. 2019;51(9):779-780.

DOI: 10.22454/FamMed.2019.588459

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My dear father-in-law, Giacinto, planned his suicide attempt weeks in advance. His prostate cancer, 10 years in hiding since radiation treatment, announced its return like a thunderclap that summer, when his leg gave way as he dismounted his riding lawn mower, something he still managed easily at age 79. The cancer-induced fracture was stabilized and the doctor began treatment with a hormonal agent but, a seasoned family physician himself, he knew what was in store and wanted no part of it. He carefully stowed away the meperidine, syringes, and tourniquet from his home office in the back of his closet. The night of a holiday dinner—yes, Christmas—would be best, as he would have had a last chance to see nearly everyone in his family, or at least the ones he cared for most. He would go up to bed early, while his wife was still busy cleaning up after the guests had all left. By the time she came up to bed, he would be gone. He did not plan on his caring and devoted wife checking on him before she retired, and setting his rescue in motion.

Upon hearing of this, I was shocked and nauseous with guilt. How could I have failed to see this coming? Giacinto and I had spoken at length about his illness and poor prognosis, but I had vastly underestimated its impact and his level of despair. I was used to thinking of suicide as stemming from weakness or hopelessness, neither of which characterized my father-in-law at all. But this can also be an act of stalwart determination by a generous, grieving man who saw clearly how he would meet his end, and did not approve. Then it all made sense.

I sat next to Giancinto’s bed in the emergency room the next day, where he lay awake but groggy, connected to an intravenous solution, oxygen cannula and cardiac monitor, creating an orchestra of ambient sounds. I held Giacinto’ s hand between both of mine, and took in his look of shame and sadness. His eyes begged me to help ease him back into unconsciousness.

“You planned this and carried it out just like you do everything else,” I said.

“What do you mean?” he asked, in his soft Calabrian baritone.

“Well, you were meticulous, organized, and careful, as you are with your patients. Then you thought of everyone else before yourself.”

“Yes, but it didn’t work,” he added, with a cough.

“Well, that’s good, because I have a lot more things to learn from you before you’re gone.” This got a hint of a smile from him before he drifted off.

Giacinto’s and my medical practices could not have been any less alike. He was an anachronism—a solo practitioner, working out of a two-exam-room office attached to his family’s home. He had known and treated his patients, often along with their children and grandchildren, for decades. Some of them paid him with the harvest of their farms if they had no insurance, or could not afford his services. He had office hours, but attended to their needs whenever they arose. When the doorbell rang during family dinners, it could be a friendly visit, a woman in labor, or a frightened parent carrying an injured child. He always answered the call.

In contrast, I was a few years into my practice, a three-physician group located about 10 miles from our home. The practice was owned by a health system where I was a salaried employee with scheduled office hours and every third week night call. I worked hard, but valued a solid line between work and personal time.

My father-in-law still perused journals and went to hospital staff meetings, maintaining a solid awareness of recent medical advances. Colleagues admired him for his astute diagnostic skills. Most impressive though, was his thorough devotion to his patients. His workload was almost never-ending; patients intertwined with his home life, yet he never seemed overwhelmed. He knew their health histories and their stories. He had been there through their celebrations and tragedies; he knew their fears, desires, and family secrets. They adored and trusted him.

Giacinto planted the seed in my mind years ago that perhaps these relationships are the source of truest reward in medical practice. Even with the rapid pace of progress, the illnesses I was seeing and treatments I was offering were similar from day to day. People and their stories though, were always new and often left me more fascinated than anything on their problem list. With Giacinto as my inspiration, I began to make more room during my patient visits for these stories that injected a strong dose of perspective and meaning into my daily doctoring, and continue to do so today.

Giacinto also taught me how to respect someone’s wishes when they are ready to die. Before his final illness set in, he was the doctor, the provider, the one everyone depended on. His strength and independence were his identity. His illness advanced and the day finally came when he told me, with a tear droplet slowly coursing down his cheek, that he only wanted to avoid suffering and being a burden to his family. He was a mere shadow of himself, a permanence which he found unbearable. I wanted to say to him that he was loved for the breadth and depth of his humanity, not merely for the role he filled in the lives of others, that his life was meaningful regardless of what befell him and he would always be cared for. But I realized that this was my wish for him and not his own. I told him instead that I understood, and was honored to tend to his comfort during his final days. Giacinto taught me to view serious and terminal illness as a chapter in the patient’s personal narrative, to see it through their unique lens and not just my own.

His funeral was something to behold. The crowds of mourners ranged from family, friends, patients, colleagues, community and religious leaders of institutions where he volunteered much of his precious spare time, and many in more than one category. To me this spoke so clearly of the impact of being the kind of physician Giacinto was, one who took his time, listened, and cared for his patients both as a man of science and as a fellow vulnerable human being. He placed those who he loved and cared for above all else. From that moment I knew with clarity that it was in his image that I would find the most meaning in my medical practice. It has been 15 years since my father-in-law died, and I still think of him often. He was a gentleman and local medical doctor of the highest caliber. He was, and still is, my mentor.

Lead Author

Jeffrey H. Millstein, MD

Affiliations: Penn Medicine-Internal Medicine, Woodbury Heights, NJ

Corresponding Author

Jeffrey H. Millstein, MD

Correspondence: Penn Medicine, 1006 Mantua Pike, Woodbury Heights, NJ 08097. 609-280-7448. Fax: 856-845-0535.


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