Life With Father

Life With Father
After forty-three years as a nephrologist-internist and teacher, I recently retired from medicine. This final stage of life is a time of reflection. Was I a good physician? On a more fundamental level, was I a good friend, husband and father?
Despite its many challenges, I have never regretted following my cherished vocation. There were far more rewards than regrets. By contrast, my record as a father feels a bit less exemplary.
During my first three decades as a physician, the prevailing professional ethos could best be described as “macho medicine.” When I trained as a resident-fellow, and later, when I practiced full-time as a nephrologist-internist, my colleagues and I were routinely expected to work sixty or more hours per week.

At the time, I never questioned this: It was de rigueur for my generation of physicians. But now, in hindsight, I can see that my unwavering commitment to my profession often eclipsed my obligations as a parent.
In the mid-Seventies, during my first year of residency, I met my future wife, who was a nurse on the kidney service. Back then, before the advent of work-hour limitations, I was on call every third night, sometimes more often. My wife and I, along with the rest of our colleagues, accepted this grueling schedule as the norm. After my residency, I embarked on a renal fellowship, during which our sons were born. My work schedule remained unchanged.
Then came twelve years in solo practice, as one of only two nephrologists in the area. It was a grind of nights and weekends on call, without the aid of hospitalists who could have handled my inpatients at those times. My wife never criticized my professional commitments and did her best, as a parent, to compensate for my absences.
On one of my alternate weekends off, our older son, age eleven, was slated to compete in a Sunday wrestling tournament. Keenly aware that I had missed many such events, I had carefully arranged my call schedule to permit me to go to this one. That, at least, was the plan.
Early on tournament day, I learned that a dear friend’s mother had just been admitted to the hospital where I worked. I decided to stop by and visit her–as a civilian, not as a physician–before heading off to see my son compete.
I arrived at the hospital wearing street clothes, as befitted my off-duty status. Even so, a nurse I knew well approached me.
“When you’re here on Monday, you should see Mr. Jones right away,” she said, then shared some details about the patient, a fortyish gentleman in acute kidney failure.
Hearing her description, I could tell that her concerns were well founded. True to my calling, I hastened to scout out the patient.
As I entered Mr. Jones’s room, he screamed, “Don’t touch me! I’m in agony…everything hurts! It’s the worst pain of my life!”
A glance at his chart crystalized the problem: His enzyme levels indicated severe muscle injury–an occasional consequence of influenza A, for which he’d tested positive. And his last potassium level, taken two days earlier, had been 5.5 meQ/L. A potassium level higher than 6 can stop the heart!
My new patient (at this point I was no longer a visitor) needed another potassium check, fast.
Should I call the other nephrologist to take over his care? I wondered fleetingly. After all, he’s the one on call. And there’s my son’s tournament….
No, I could not. In the code under which I’d trained, it was unacceptable to sidestep an urgent professional responsibility. I hurried off to tell Mr. Jones’s medical team to get a potassium level, stat.
Returning from this, I heard a Code Blue called–in Mr. Jones’s room. His heart monitor displayed the disrupted patterns characteristic of excess potassium.
Intravenous calcium brought him back to a normal heart rhythm–success! But his potassium level was a whopping 8.4 meQ/L. To bring it down, we had to put him on dialysis right away.
In fulfilling my professional duty and staying with Mr. Jones, I knew that I was forfeiting my fatherly commitment–and in that era before cell phones, there was no way I could get a message to my son. But I already knew: There would be no wrestling tournament for me.
I ordered the dialysis, and for the first two hours, things looked good. Then, all of a sudden, Mr. Jones screamed and clutched his chest: It was a severe heart attack. Within seconds, he went from chest pain to ventricular tachycardia to fibrillation.
We ran another code–this time, unsuccessfully.

Afterwards, I had to go to Mr. Jones’s family and break this tragic news. I also had to struggle with my own sadness and frustration. Why had all of Mr. Jones’s potentially treatable issues turned fatal?

Meanwhile, just a few miles away, my son was competing. At home later that evening, I learned that he’d won the tournament, despite separating his shoulder in his final match.

I was proud of him.

Of myself, not so much.

As a professional and a physician, I’d done my duty, but as a parent, I had failed. When I apologized, my son said that he understood.
Over the years, this pattern of absence became the norm. On the surface, my sons reluctantly accepted my professional commitments; they kept their disappointment to themselves and never openly blamed me for not being there. Only much later, as an adult, did my younger son tell me that I had been an absentee father.
Reflecting on it all now, I feel guilty. My patients loved me for the care I had given them over so many years. My sons love me too, but I can’t help thinking that they feel, as I do, that something was missing from our relationship during those years–something that can never be revisited or repaired.
Now, seeing the way contemporary doctors are trained to practice, with regular days off, work-hour caps and the support of hospitalists, I don’t smirk and smugly say, ‘The days of the giants are over.’ I really believe that the influx of female physicians has had a major, positive impact on the medical ethos and has changed macho medicine for the better.
I can see that it’s possible to be both a dedicated physician and an involved and loving parent. In the early decades of my practice, there simply weren’t that many subspecialists or hospitalists available to ease some of the burden of care. Nonetheless, I still struggle with my past. My macho brand of professionalism was an inadequate excuse for so often being missing in action as a dad.
All I can do now is to tell my sons that I am sorry, and try to make amends by being an attentive father and grandfather.
Ironically, in reflecting on my failings as a dad, I love my sons even more–and especially because they themselves are exemplary dads.

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Greg Rutecki is retired from general medicine practice at the Cleveland Clinic. After graduating in 1974 from the University of Illinois Medical School in Chicago, he trained as an internist at Ohio State University and then completed nephrology training at the University of Minnesota. Over the last ten years, he has written medical-humanities pieces on topics including the impact of composer Gustav Mahler’s endocarditis on his Ninth Symphony, and the use of radium to treat opera composer Giacomo Puccini’s laryngeal cancer.

Comments

13 thoughts on “Life With Father”

  1. Tim Sanborn MD

    Greg, It was nice to read your article and to reconnect with you after all these years from when we were in practice together in Evanston, Il. You make a very good point about the importance of “balance in life”. Send me an email and include some of your writings on medical humanities. Ilook forward to reading them.

    Tim Sanborn MD

  2. Roger Williams Schau

    Thank you for sharing your message, Dr. Rutecki. I completed med school in 1971, and Family Medicine (FM) residency in 1974. We moved to a progressive rural community where I practiced FM, caring for multiple generations,with focus on women and children’s health. I too missed too many dinners with family and a variety of sporting events to be with laboring mothers. The second half of my career was primarily academic medicine. My spouse, also a nurse, supported my absences. Fortunately, our children too have done well in their lives, although they have chosen to be more present for their children. I too have regrets about the missed opportunities, but no regrets about my commitment to my patients and their families. And Happy Fathers Day to all of us.

  3. Ronald Uva Md

    As a retired ob/Gyn from a small community hospital my residency and practice experiences were identical to those of the author. I thought my kids would resent my missing events but they were rather proud of my devotion to the specialty. I’m not convinced that the current model is better but life style is now more important than ever. Better for the patients? Only time will tell.

  4. Thank you for your insightful story. I graduated from medical school in 1990, when things weren’t any different. I went on to work at a teaching hospital, where I worked to change the culture. Some of my generation and older were slower to adjust, lamenting the “good old days” when everyone worked 80+ hours a week. I’m pleased there’s now a better balance for some of our physicians. My own daughters, like your family, certainly missed out on a lot of my time because of the prevailing culture in medicine of my generation. Thank you for articulating your story so well. -Mimi Emig

  5. In about the time frame you write about I was trying to decide whether to become a psychologist or a doctor. I loved neurology and surgery was appealing. I looked carefully into both. When I realized the hours involved both in training and then practice I knew I didn’t want that to be my life. Thank goodness some of you made the medical choice, despite your many personal losses.

  6. I practiced law, not medicine, but my generation of lawyers did the same grind doctors did. Before I went to law school my doctor warned me that law would be like medicine in the time commitment. He told me that at 10 pm on a Friday night. And I wasn’t his last patient that night. He was right and I often thought of his warning late at night on a weekend. That’s changed too and I think for a similar reason—women joining our profession in sufficient numbers. Thanks for your story. Enjoy your family and a well earned retirement.

  7. Dr. Louis Verardo

    Dr. Rutecki, we are of the same era, and I have struggled with the same parenting issues as you describe in your piece. I have discussed my feelings with my (now adult) children, and they have graciously acknowledged my attempts at balancing work and home throughout my years of practice. Like you, I have tried as a grandparent to be present in the most complete way possible, and that has actually provided a good opportunity to engage with my son and my daughter in a very special manner. Bottom line: we all did the best we could, and I will pass along the best advice I ever got on this subject. A nurse I worked with said, “Be gentle with yourself”.I try to remember that every day of my retirement.

  8. This is a beautiful father son story well-told. Of course, you did what from a sense of duty you had to. There are always regrets, self-doubts but you lived a full life. That requires no Monday morning quarterbacking. You did good.

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