My father, Allen Kleiman, M.D., died last night, after several years of increasing debility and discomfort.
The slippage in communication between his home health aides and his internist that allowed an infection in his foot to develop into gangrene doesn’t say much for the quality of health services available to the debilitated, even if they’re prosperous and well plugged in to the social system, but in this particular instance it’s hard to regret it very much. Two years ago, when he was much better shape mentally and physically than he was over the past few months, he said to me, “I’m just waiting.” Another time he told me he was sorry to longer have his handgun — taken in a burglary years ago and never replaced — because he had regarded it as a guaranteed exit if things ever got too bad.
He didn’t ask me to get him a new gun; under Maryland’s recently-passed “Kevorkian statute” it would have been a felony for me to do so knowing he intended to use the gun to kill himself. Not that it would have mattered; toward the end he lacked the strength and dexterity to sign his name, let alone hold a gun and pull the trigger. I’m not sure he would have been capable of suicide in any case. “Tired of living and scared of dying” more or less summed it up.
Some years ago, though, he wrote and left an extremely strong advance directive. As a result, when the surgeon said to us “We’d need to amputate above the knee, and even then the odds aren’t good” the decision was entirely straightforward.
He was a man who, like James Branch Cabell’s Manuel, “lived according to his own notions.” One of those notions was to dislike intensely the ritual of funeral and memorial service, and therefore the advance directive specified that he was to have neither, and that if there was no medical use to be made of his body it was to be cremated, and the ashes scattered over his favorite rosebed. Those instructions are being carried out to the letter.
However, he never said I couldn’t post something about him on this weblog, and I have no reason to think that he would have disapproved of my doing so, as long as I told it straight and didn’t pull any punches.
My father discovered that living according to his own notions was anything but an easy business, even for a private practitioner with no boss to answer to. (A shouting match with the Chief of Surgery in the lobby of the Veterans’ Administration Hospital in Phoenix put an early end to his career as a civil servant.) Since he found Chevrolets and mail-order suits from Haband perfectly satisfactory for his purposes, he refused to buy the sort of cars and clothing that make a surgeon look successful, thereby encouraging referrals. It wasn’t as if he didn’t understand the logic and the arithmetic of the situation: he knew perfectly well that his cheap suits cost him a lot of money in lost business. But he simply wouldn’t stoop to participate in what he regarded as an irrational process of dressing and driving the part of the prosperous doctor.
There’s a lot of my father in me: the part that thinks the world would be a better place if more people valued integrity over success. Another part thinks he was mostly being, to use one of his favorite words, “stubborn.” (He’d draw it out to three exaggerated syllables for emphasis: “stub-ree-UN.”)
His education was indifferent; he rushed through college in three years on the way to medical school and rather prided himself on giving his coursework no more effort than it absolutely demanded. But his curiosity was intense — though his opinions were sometimes cranky — on a range of topics from cosmology to Egyptology. As a reasoner, he was acute, stronger than most of my teachers and colleagues, though I grew to doubt the soundness of some of his factual premises. He wasn’t especially voluble, regarding talking a lot as showing a lack of gravitas, but he could hold his own in an argument. (I remember him, the atheist in an Orthodox Jewish family, saying to his rather observant — and beloved — uncle Joe in a post-Seder discussion “Yossel, are you really trying to tell me that Whatever made the cosmos and the elementary particles cares whether or not I eat pork?”)
As a physician, he was, or so I’m told, highly competent and conscientious, without being at all cutting-edge. Most of the surgery he did was routine: appendectomies, tonsillectomies, gall bladder procedures, etc. (“Don’t ever let anyone tell you the appendix is a useless organ,” he told me once. “It put you through college”) and he didn’t bother to keep up with the journals.
In one regard he was a generation ahead of his time: he took pain extremely seriously. “Pain is always an emergency,” he said. “It hurts right now.” The only time he ever mentioned blowing up at one of the hospital nurses was when an order for pain medication wasn’t promptly acted on.
On the other hand, he was extremely old-fashioned about the doctor-patient relationship. He no more expected to seek a patient’s opinions about how to treat his illness than to ask his car whether it needed oil. And it was up to him to decide what the patient needed to know.
This wasn’t mere personal arrogance; he was quite willing to adopt his own ideal of the patient’s role when he was the patient. After the near-fatal heart attack he suffered at age 60, his cardiologist concealed from him just how bad things were. (Pretty bad. When he finally got a look at the chart a few days later and saw an enzyme level above 3000, he commented: “In my professional opinion, this man is dead.”) But he didn’t regard that concealment as problematic in any way: “Of course you don’t tell a cardiac patient how bad things are. Bad for his heart.”
He was, in the Yiddish he strongly discouraged me from learning or using when I was growing up, a mensch: that is, he accepted the responsibilities of being an adult as he understood those responsibilities, and he met them uncomplainingly. As far as I could tell, he never really considered not doing whatever he thought it was his menschlich obligation to do. (Not that he’d ever express it that way: he’d just say, “You can’t X,” where X described any evasion of duty or derogation of what he thought was owed to another.) If anyone tried to push him around, he would push back, hard, but correspondingly he was very reluctant to push anyone else around or make anyone else feel uncomfortable. (He liked his meat very rare, but I never saw him ask a waiter to take an overcooked piece back to the kitchen.) He didn’t seem to derive any great satisfaction from doing the right thing, but he did have a quiet pride in his integrity: another word I never heard him use.
As a parent, he was astonishingly patient and non-directive, giving direct orders very seldom (and then expecting them to be obeyed automatically); even unsolicited advice was rare and offered in a way that made it clear the choice was yours. I found out only a few years ago that he mistook the awe he inspired in my sister and me for emotional distance, and never really grasped how much love and admiration he generated. He laughed easily, but he regarded any expression of strong emotion as a sign of weakness, which made it hard to show him affection. As my sister puts it, he needed more closeness than he could tolerate.
He had more than his share of suffering and disappointment, some of it self-inflicted, and his naturally sanguine disposition soured over time. In particular, the rigid self-command I recall from my childhood weakened as he aged, and he was subject to outbursts of anger that left him, I think, ashamed, though never apologetic. He was an upright man and a useful member of the community, but he was not, all things considered, a happy man.
I’m sorry he didn’t have a better time, and that I didn’t find more ways to tell him how important he was to me. I wish there were more like him.
Many thanks for all the kind words I’ve received, both in blogspace and by email.