“A teacher affects eternity; he can never tell where his influence stops.”
– Henry Adams
Mrs. Jones (identifying information changed) is a vibrant woman in her eighties who has been admitted to the hospital with swallowing problems and a fever. The CT scans show some swelling next to one of the major blood vessels and our team has been asked to see her and decide if she would benefit from surgery. She winces as I touch her swollen, tender neck.
“The scan shows that there is an infection deep in the tissues,” I tell her. “It will clear up more quickly if we take you to the operating room, make an incision in the neck, and clean out the infection. It will speed up your recovery.”
She frowns and looks at me. I sense that she is not at all certain that I am giving her good advice.
“Well,” she says, “I really don’t want surgery unless absolutely necessary.” She sizes me up, probably wondering if I am advising an operation just so I can make more money. She glances at her daughter. “I don’t know. What would Bob Toohill have said?”
“Bob Toohill!” I say. The unexpected mention of Dr. Toohill’s name evokes a flood of memories. “Wow! How did you know him? Did you work in the hospital?”
Dr. Robert J. Toohill was my teacher, mentor, and guide throughout the five years of my otolaryngology residency in the early 1980s and was my boss for fifteen years after I joined the faculty. He was eternally honest and hardworking; I never wanted to work for anyone else. I owe much of who I am as a physician to him. Dr. Toohill helped train an entire generation of otolaryngologists from our program and then sent us all off into the world.
My new patient relaxes and smiles. “No, we’re not medical people. The Toohills were in our parish. Our children grew up together. We knew them for years.”
Bob (I was eventually able to call him by his first name) deeply influenced me. He grew up on a farm in central Illinois and attended St. Ambrose College and then the Marquette University School of Medicine (the Medical College of Wisconsin’s [MCW] predecessor institution). After his otolaryngology residency in Chicago in the 1960s, the Navy stationed him near Boston where he worked with some of our specialty’s pioneering laryngeal surgeons. After his military service, he moved back to Milwaukee where he started a private practice and where he and his wife, Kay, raised their five children. He joined the MCW faculty in 1977, rose through the ranks, built a program, developed research, taught us how to operate, and changed our lives.
Clinically, he did everything. In the morning, he might have done intricate ear surgery and then a complex sinus case. In the afternoon, he would have moved on to a neck procedure. Few otolaryngologists exist anymore who are comfortable working in so many specialized areas.
Bob was a real character and a complex person; everyone who remembers him has stories to tell. He was forthright. He was a good and loyal friend to many. He was active in his American Legion Post. He was proud of his Irish heritage and carried the flag in the St. Patrick’s Day Parade. He liked to celebrate. Later in life, he finally had enough time to play golf and took advantage of every opportunity.
At the same time, he could be demanding. He had a “certain way of doing things” that was not negotiable. As residents, nothing we did was right, and we all learned how best to “handle” him. As junior faculty, we learned we were “yuppie doctors” because we felt entitled to things like vacations, scheduled research blocks, and time at home with our families. We loved him in an exasperated kind of way.
“Well,” I say, “let me think about what Bob might have recommended.”
I know with absolute certainty that Bob would have recommended surgery but feel the need to channel him to provide a proper response.
“OK,” I say. “Here goes. He would have looked you in the eye, wagged his finger, and said, ‘Mrs. … pause … pause … Jones, … pause … you are having surgery, and I’m the only doctor here who knows how to do it.’ I don’t think he would have given you any other options. Probably not much explanation, either.”
Bob was from “that generation.” He wasn’t paternalistic exactly, but he and his physician-contemporaries tended to be less invested in “shared decision making” than physicians today.
She laughs. “You got that right,” she says. “He would have said it just like that.”
Late in 2013, Bob died after a brief battle with pancreatic cancer. One of my regrets in life is that I never sat down with him to record his reflections about his career. He would have had a lot of opinions; “not always right, but never in doubt,” as we said behind his back at times. I have written a host of essays over the years but have never managed to pay him a proper tribute, encapsulating my thoughts and expressing my gratitude. I still have not. My feelings about him are almost as complex as he was, yet are centered around a sense of love and of my gratitude for having known him.
“Well, he might not have offered you a choice, but I will. Let’s talk about the procedure a bit so you and your family can decide.”
“OK, but if Bob would have said to go ahead, I will agree.”
Together, Mrs. Jones, her daughter, and I review the risks, benefits, and alternatives of her surgery and spend some time talking about what to expect. The next day, while hearing Bob Toohill’s voice in my head and sensing his influence in the operating room, I drain her neck abscess. It all goes well, and the patient and I both continue on our roads toward being healed.
Image credit: Bruce Campbell