Written April of 2017
I feel like it was yesterday. But, something tells me that's the way it is when you think about turning points in your life. These memories are crystal clear and they form an indelible imprint in your mind and on your heart.
I was in his "little house". (The code name for the garage apartment where he was allowed control of the TV, his cigars and the ability to have everything to suit his needs separate from the main living space he shared with my Mom.) Growing up, I knew that going out to the little house in the evenings was my opportunity to discuss topics with my Dad out of earshot of my Mother. This day was no different. Of course, I was older, married and considering starting a family, but I felt the need to go out to the little house for one of our talks just the same.
After some encouragement from my Mom shortly after my wedding, I decided to try going back to school to see if a career in medicine might suit me better than my previously chosen field of public relations and marketing. Taking the pre-med requirements at the local college in California turned out to be the easy part. I treated school like a job, and as a newlywed, this new "job" allowed for much more time in the evenings with my husband.
Now, I was sitting in the little house trying to imagine what my life as a "nontraditional" medical student would look like, and whether it was worth it to invest so much time learning to do something that may or may not work out. After all, I was starting a family with my husband, and we would have many challenging times ahead as most young families do, no matter their circumstances.
All of these little details hung in the air of the little house, having been said, and often said again. My Dad — a physician, a pathologist— and I sat there. In between thoughts and concerns, Dad and I watched TV and we sat in quiet companionship with the exception of the background noises in the room.
After a long comfortable silence, Dad summed it up for me:
"We all get old at the same rate Leilani," he said breaking the gap in conversation. "What you choose to do with that time is entirely up to you."
I didn't answer. I thought, was it really that simple? My future was mine to choose? And to choose again if it didn't work?
And just like that, everything made sense. I would decide to study and learn. I would choose a path that meant long days, early mornings and sacrifice for me and my family. But, I would choose to do it. I would also reserve the right to choose another path if I needed to do so, if my family needed me more, if my interests changed. Because, time was passing no matter what I did, and I could choose how to spend it.
It really was that simple.
I'm not sure at the time I realized how this one piece of advice, almost whispered in the familiar surrounding I associate with my Dad, would shape the next two decades of my life and hopefully the rest of my life to come. This simple but profound idea, in a society and a culture and maybe even a family full of expectations for us, that we alone have the power to choose.
I carried his mantra with me to medical school starting my first year with a four month old infant who (thanks to my Mother's coaching) had learned to sleep through the night by that time giving me ample time to study in the evenings. I needed to remember the advice again when our second child was born in the middle of my third year instead of at the beginning of my fourth year (like I had originally intended). I considered Dad's advice carefully when I weighed my love of pathology against my love of surgery. During residency, I again asked myself how I wanted to spend my time when considering less than ideal but more readily available fellowships, finally holding out for the position I wanted. And finally, when looking for a place to practice, I knew I needed to choose something that would allow me to be close to my children and be part of their day to day lives. Because, that is how I choose to spend my time.
Knowing that at anytime, I could choose another path if and when I needed to do so, took the edge off the enormous pressure of completing medical school, residency and fellowship while starting a family and raising young children.
There were other pieces of memorable advice from Dad along this journey. Like the time I called home during my first year of residency wondering hopelessly how I would ever be able to learn all the different diagnoses required of a pathologist. "Leilani, the most important thing to learn during residency is to be able to recognize what you don't know." In other words: the best pathologist has no ego when it comes to making the right diagnosis for a patient; it's always ok to take the time to ask for an expert opinion, but you must learn when you need to ask. This advice that I now include as one of my favorite pathology adages, will serve me and my patients for my entire career.
It was not part of the initial "ah ha" advice, but peppered throughout those "little house" conversations, I learned that if you choose to spend your time doing something you love, you will not regret your choices. I learned that "choosing" how I spend my time -- with family, with friends, at work, in my communities and experiencing new things -- allows me to enjoy each minute as it passes me by. Dad did this too -- he chose to use and give his time meaningfully.
And later as my partner in pathology practice, my Dad continued to mentor me in ways I am only now learning to acknowledge. From handling difficult cases to managing staff, his advice proves valuable time and time again.
Then, almost seven years ago and one year into our working relationship, the completely unexpected happens. After suffering months of back pain, my Dad decided to see a gastroenterologsit. Despite a completely normal colonoscopy five years prior, the doctor found a rectal mass on exam and the next day he had a diagnostic colonoscopy biopsy.
It was a Thursday. The specimen was on my desk first thing in the morning marked "stat". It was my case to diagnose, as it was just the two of us working that week. I knew before I looked at it more than likely what it would be. Common things were common after all (he had taught me that), and ninety-nine percent of the time, a rectal mass in a 65 year old man was adenocarcinoma, until proven otherwise. But wasn't I, as the pathologist, the one who could prove otherwise? He had taught me that too.
However, despite my greatest hopes to the contrary, the view through my microscope showed the all too familiar pink and purple cells forming atypical glands with all the hallmarks of cancer. I pressed the pedal to dictate the diagnosis. Time didn't stop. It continued. The words describing the tumor flowed from my lips like so many other times before, like it was any other patient. I finished dictating and placed the slides on his desk. My colleague's desk. My Father's desk. I did this knowing it would be the first thing he would want to see when he came in for the day.
Not too much later, I heard him come down the hall and sit down at his desk in the office across from mine. I heard the click as he turned on his microscope.
"Well," came his voice from his office loud enough for me to hear. "Somehow you think your cancer is going to look different from everyone else's." Always, even in the most trying of times, he had the gift of humor.
We spent the next year working as a family to buy just a little more time. Those were his words. He wanted whatever time the radiation and surgery could buy him. And he used that time to teach and tell stories to his grand kids, advise his children, drive my Mother crazy (as was their habit) and make memories with all of us. How he chose to spend that time was an example for all of us.
Fast forward to a few months before his passing, and we are back in the little house exchanging conversation and sitting together in comfortable companionship.
"Tempus Fugit.” Dad said, without preamble. “That's what I want on my grave stone.”
"Ok," I said. After a pause I asked, "What does it mean?"
"Time flies," he says smiling with just a hint of tears.
"Oh, okay," I said. After a long pause I added, "It realty does, doesn't it."
"It really does," he answered in agreement. "Yes, it does."
Thank you Dad, Papa, Leonard, Dr. Gietz and Friend for giving us your time.
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