Dr. Jerome

A father’s life of dedication—the man who would be Dr. Jerome.

Dr. Jerome
Throughout my life, his power had been inscrutable, close, and overwhelming. View full image. Illustration by Anna+Elena=Balbusso

My father was born in Valley City, North Dakota, in April 1928. I imagine a beautiful spring day then: the onset of green in the soft hills swaddling Valley City; the Sheyenne River running brown and thick with winter runoff and spring rain; the northern plains’ first wildflowers greeting my father’s entrance into the new world naked. Valley City sits hidden and poised, a gully in the infinite grasslands, even now a faraway town in a faraway place. My father was always proud of having come from there. To the end of his life, he had the sweetest spot for North Dakota jokes, the formula for which was usually one part cow, one part farmer, one part earnest, laconic humor of disarming innocence. He would helplessly guffaw at these little tales, like a kid mischievously remembering the best-ever secret of his youth. I came to know him as he must have been as a boy—playful, frightened, vulnerable—when we spent time together as he was dying and my long-dormant love for him came to life.

His family didn’t stay in Valley City long. His father’s furniture store went out of business, victim of hard times hitting farmers in the area. So the family—Dad, his father and mother, his three brothers—moved through North Dakota in the late 1920s and early 1930s until finally landing in St. Paul, Minnesota. I try to imagine my taciturn father, never very revealing of his youth, as a child of such twists and turns in that time and place: The dislocation of repeated moves; two houses burnt down; the vast blackness of bitter winter nights on the northern plains; summertime dust lying over field and furniture; his father away for long stretches of time, seeking business opportunities or selling medical products in the wide open country from Wisconsin to Montana. We are not talking Dorothea Lange and Dustbowl Okie poverty here. But we are speaking of a time when my father, disguised as a child, had to contend, along with millions of others, with the vast, punitive forces of the Great Depression. How much fear would all of that leave in any little boy! Even if my father had wanted to forget all of that, he couldn’t. You could see that fear in how he was possessive of things. You could also see that fear in how he loved. When he was under anesthesia for surgery later in his life, the nurses said that he kept enumerating the things that needed to be done to ensure my mother would never face such economic hardship in case he died.

My grandfather was the son of Catholic Quebecois immigrants who homesteaded in western Wisconsin in the 1880s. I remember him for his big laugh under circular, wire-rim glasses and for his unselfconsciously protruding stomach sitting tight beneath a bright red vest and spindly, Western-style tie. I think he was the kind of man whose good cheer warmed and drained a room at the same time. You were happy because he was happy. But his laughter came too easily, as if it hadn’t been bought at full price. In the 1930s, he liked to listen on the radio to Father Charles Coughlin denounce Roosevelt, the New Deal, and Jews. My grandmother was Swedish pioneer tough and pushed her sons hard. She also had numinous warmth, her yearly visits to our home a happy memory of her soulful laugh and the kitchen running over with baked goods. I think my father loved my grandmother, but his heart for her was in conflict with itself. She had always been there for him but had pushed him and his brothers hard because their life was hard and because her pride for them rested heavily in their accomplishments. She was the only person who called him “Jerome” instead of Jerry and, when she did, my high-achieving father bristled to be brought back within her maternal fold. After she died, he went to her funeral but skipped her burial.

By the late 1940s, my grandparents had settled in Bozeman, Montana, the hard years behind them. They were the kind of people against whom Sinclair Lewis set his sights in Main Street: self-conscious about their rectitude; bourgeois in their values; fearful of what was different. But they were much more than that, too: driven, tough, kind, warm, zealous for family. My father was never the kind of American who had to flee the confinement of the small town for the openness of the big city. He carried many of his parents’ Valley City virtues with him throughout his life. But he did have to go, not so much to get away from the small town as to pursue his dream of being a doctor.

I knew my father more as a doctor than as a father. He went to St. Thomas College in St. Paul and then to the University of Minnesota Medical School. Afterward, he was a resident at St. Luke’s Hospital in New York City; served as a surgeon in the Army in the burn unit at Fort Sam Houston in San Antonio; and then began advancing from one highly desirable surgical and teaching position to the next. He was at Memorial Hospital in New York; then moved to the State University of New York at Syracuse; to University Hospitals and Case Western Reserve in Cleveland; to County General Hospital and the Medical College of Wisconsin in Milwaukee; to chief of surgery at Memorial Sloan-Kettering Cancer Center in New York City and a position on the faculty of Weill Medical College of Cornell University; to, at the time of his death, the Lewis Thomas University Professorship at Cornell and a well-earned reputation as one of the world’s leading surgical experts on colon cancer. A photo shows him at the height of his career during his years at Memorial Sloan-Kettering: supremely self-assured brown eyes staring into the camera and owning it; strong forearms folded in surgical scrubs; a near-smirk on his aquiline face, looking for all the world amid the lights and instruments of the operating room as if he had really figured out a way to surmount death. Here was hard-earned pride tilting toward cockiness. I hated him for that hubris.

He was hard to love until we both became patients ourselves. Illustration by Anna+Elena=Balbusso

Throughout my childhood, he worked long hours. Out the door by 7 and not back until 7 or later at night. He worked Saturdays and parts of Sundays and was often away at medical conferences. My father was comfortable being a doctor, sure of what to do and of how to progress. He read medical journals at home and responded quickly to residents calling for advice about a patient on the surgical floor. He was respected and admired by his peers. But he never had the same ease—or success—as the father of the five of us (three boys and two girls). He wouldn’t make time to attend parent-teacher conferences or swimming meets (all five of us swam), much less family dinners or birthday celebrations during the week. He might marshal all of our sibling forces to clean up the spacious yard of our suburban Milwaukee home on a Saturday morning, but he didn’t know how to have fun with us. The effort would inevitably prove a certifiable job, with him as grim task master. I think he loved us, but there was an awkward, fearful distance between that affection and its expression in words and gestures. Often enough, the expression would go unstated until it would erupt as a blunt, uncompromising command. Occasionally, on a weekend afternoon, he’d take one of the boys to play golf. When it was my turn, as we walked from green to tee and couldn’t avoid conversation, I learned out of fear not to say anything much. On what budding aspiration of mine would his inscrutable force come crashing down? Even now, the smell of a cigar—my father would smoke one as we went around the course—evokes the memory of anxious, beautiful fall afternoons when I was happier to hunt alone for my ball in some grove of trees than to expose myself to too much talk with my father.

For my father, only the results counted. He’d want to know our times in competitive swimming and our grades in school. On his desk, he kept a small, framed picture of a hand extending upward and the Robert Browning quotation: “A man’s reach must exceed his grasp.” This phrase captured a crucial part of his philosophy of life. He admired hard work and excellence and left all of us siblings with a powerful inner drive and an intolerance for shoddy work. I came to appreciate my father’s love of the Browning phrase, but I also came to find the phrase, as it existed in his mind, tyrannical. The way that he understood the phrase was all reach and no grasp—all some objective, impersonal goal called excellence and little sense of the subjective challenges along the way. During our weekly Sunday dinner, the one meal of the week we shared with him, conversation nervously walked the fault line of saying what you had or had not accomplished during the preceding week. A dutiful if half-hearted effort by the competitive swimming siblings at an off-season competition failed his Robert Browning test. His incredulous, angry criticism—how could we swim in a meet, any meet, and not do our best?—hung over the dining room table and ruined the meal. I wanted such dinners to end as soon as possible.

All of these currents in my father came together in a bitter, months-long argument with him over my decision to stop competitive swimming at the end of high school. I had been competing for 10 years, but it had become a grinding chore. I didn’t have a sense of what, if anything, was to take swimming’s place in my life, but I knew I wanted to stop. My father thought this was the wrong decision, and from April into August he demanded to speak with me almost every day to get me to change my mind. He thought I was talented as a swimmer and was giving up an opportunity to improve. He thought that I had gotten into Harvard on the basis of my swimming and that, therefore, I had an obligation to continue swimming there. I dreaded hearing him come home from work and then hearing the heavy step of his slippered feet as he came to the base of the stairway and called up, “David, come down. We need to talk.” I hated myself for submitting for months to this demand and remember now the shame I felt as I walked, again and again, down the stairs to his home office. There I sank low in the couch while he sat high in a leather chair, trying to persuade me to change my mind. His list of complaints grew: I was too emotional; the Jesuits at my high school had duped me; I was stuck in a cycle of self-indulgence; and so forth.

My father was right about one thing. The Jesuits had taught me something new. They never counseled me to stop swimming, but they took seriously the fact that I no longer wanted to do it. And, in itself, taking such a desire seriously opened up in me the possibility of a sense of self that stood rightfully on its own. In his Spiritual Exercises, St. Ignatius of Loyola counsels spiritual directors to refrain from being too directive with a person on a retreat. Suggest this or that. Let the retreatant determine the best course of action, and then let him or her try it out. The test of experience will tell all. The logic here is practical but spiritual, underscoring the immediacy and primacy of a relationship between the retreatant and the divine. As Ignatius, the founder of the Jesuits, puts it: “He who is giving the Exercises should not turn or incline to one side or the other, but standing in the center like a balance, leave the Creator to act immediately with the creature, and the creature with its Creator and Lord.” My father was not a close-minded Catholic for whom obedience to papal directives exhausted a person’s sense of responsibility. As a young man, he had read Cardinal Newman’s careful parsing of Catholic authority and personal conscience. In the early ’60s, he admired Xavier Rynne’s New Yorker dispatches from Rome as bishops at the Second Vatican Council created a new, more open church. But that intellectual openness did not translate into emotional attentiveness—especially toward the confounding obstacle of a son with a growing mind of his own. In any case, I did not think in elaborate Ignatian terms as I sat humiliated in my father’s office. But such ideas were taking root in me nonetheless. In college, I stopped swimming.

Telemachus set off on the wine-dark seas in search of his absent father. My father was missing but at home, sitting imperious on the leather chair in his study. It would take time to realize that I was, nevertheless, on a journey to find him. The first landfall came 20 years after high school with my divorce. I came down from graduate school in Boston to spend weekends at my parents’ vacation home in East Hampton on Long Island. I was shocked by the divorce; paralyzed by dread of a loveless future; humiliated by shame (divorce, I had thought, was an affliction that only other people suffered); and oppressed by guilt for how I had contributed to the failure of the marriage. For the next year and a half, I feared lying down at night because I knew that at some point in the empty early-morning hours I would be jolted awake by a current of anxiety that ran through my body. Days dragged on in hazy attention to work and people, while my heart seemed to be traveling some wild, frightening river. I was also deeply fearful at how my father would take the news of the divorce. The only times I had cried in front of him before were when he took his belt to me as a child or when I imploded in blustering rage during one of his don’t-stop-swimming inquisitions. Now, though, I could not help it. “Don’t cry,” my father said, as we talked one evening in the living room. “Get a hold of yourself. Let’s look at this situation and see what you can do.” He made no move to leave his chair and embrace me. His voice wasn’t soothing so much as matter-of-fact. I thought: I am the patient and he is the surgeon. We both know the terminal state of this marriage. I am not bearing the news well. He is speaking to me clinically and precisely and with complete conviction. I realized then one of the things that made him an excellent cancer surgeon: His authority in the face of mortality, when sickness strips away every false hope, invited a like-minded, assertive response. My father wasn’t very interested in his own emotional life, much less mine. In that, he was the antithesis to the wisdom and excess of our therapeutic age. But he was very interested in action: in what, here and now, you can do. Faith without works, to him, was really dead. As we spoke in the living room, I straightened my back and began to imagine steps toward the future: finish the dissertation, marry again, move to California.

In the next months, my father started to falter. One afternoon we were playing golf when he turned to me—away from the group we were with—and confided with frightened bewilderment: “Dave, have you ever had one of those days when it seems like nothing at all matters?” He had never before shared such a thought with me. He had certainly never intimated that I help him understand his own troubled spirit. I still see him on that eighth tee box in the late afternoon light of a desultory round of golf at the country club on Long Island, his tall, strong frame enfeebled by the confused, faraway look in his eyes.

Then he began to falter in other ways, too. He fell several times while on vacation with my mother in Florida. A formerly agile man, he developed a pronounced limp, one leg lifting high at the knee as he walked. Other involuntary muscle movements and twitches began to appear. One night at dinner, he was close to anguish. “I’ve seen the best neurologists in the world,” he said, citing his office visits with colleagues in Manhattan, “and no one can give me a goddamned diagnosis.” By then I had moved to California, where I was working at a tiny Internet company and making steady progress on my dissertation. The geographical distance made me less fearful of him. And we had each awkwardly started to cross the line of speaking about things falling apart beyond our control. I started to call back East weekly. My father and I would laugh when he’d cut me off in midconversation to say that he’d be happy to hear about anything but the damn weather in California. He was characteristically to the point in his dating advice: “Just ask her out and don’t think too much about it. Whatever she says, keep moving.”

Finally, a diagnosis came through: My father had Lou Gehrig’s disease (ALS), the incurable and debilitating condition that steadily atrophies the muscles until it brings about death. After hearing the news, I felt a tremendous weight of sadness. Throughout my life, his power had been inscrutable, close, and overwhelming. But this disease, I knew, would strip that power and, in time, render him helpless. I was sad, too, that the inexorable wasting of ALS would be that much harder for him because, as a physician, he would know everything that was happening to his body. Whatever anger that lingered from the past was irrelevant in the face of his coming future. And that anger, anyhow, felt like an obstacle, a trap. So I thought: I will walk with him through this to the end. I started to make more frequent trips back to the East Coast.

Dr. Jerome in his element: self-assured, at the height of his career. Photo courtesy David DeCosse

I marked time by seeing my father’s steady decline: the increasing difficulty walking; the need for a cane; the loss of mobility in his arms; his reliance on an electric scooter that he loved to drive too fast down the long hallway of his apartment building in New York. Once I helped lift his naked body into the shower, embarrassed as I did and shocked by the loss of muscle throughout his frame. Of course, he directed all aspects of this delicate maneuver in and out of the shower stall. And we laughed together as we got the job done. At the hospital he had been assigned a new, smaller office, many floors removed from his former perch on the power corridor of the surgery department. The disease had stripped away any lingering hubris from that photograph of 20 years before. He was left with his native, inalienable resolve tinged with a bewildered, childlike worry about what was happening to him and what was to come. It was as if all that he had learned about disease in his decades as a doctor could no longer help him. He had become a frightened boy again. The last time I saw him, we celebrated his 73rd birthday. I will never forget the eyes-bright boyishness of his then-gaunt face as he looked up from his wheelchair to see us walking toward him with cake and candles and singing “Happy Birthday.” Now I think that our voices were joined with the springtime birdsong that must have greeted his arrival in the world in Valley City—the one, inseparable song, an impromptu “In Paradisum” that recapitulated his life and lullabied him into eternity. Days later, he passed away in his sleep, having gone to the office on the day he died.

My father’s funeral was at St. Catherine of Siena Church in Manhattan. The parish is surrounded by hospitals and medical research facilities where he had spent many fruitful years of his professional life. Across the street is Memorial Sloan-Kettering Cancer Center. A short walk away are New York Presbyterian Hospital, Cornell Medical School, and Rockefeller University. Doctors, nurses, and hospital administrators all crowded the funeral, far outnumbering our sizable family.

The Gospel reading for the service was the story of the Good Samaritan. In his life of faith, my father was certainly not a contemplative in action, in the formulation that Thomas Merton and others made popular in the 1960s. Nor was he even “in action a contemplative,” as St. Ignatius of Loyola more finely formulated the distinction. Instead, he was a man of action, pure and simple. And the magnificent, clustered verbs in the story that describe the actions of the Good Samaritan—he “saw” the man beside the road; he was “moved with compassion”; he “approached” the man and “poured oil and wine” into his wounds; “bandaged” him and “lifted him on his animal”; “took him” to an inn; “cared for him there”; and “gave” coins to the innkeeper to cover any additional costs—articulated the deepest intention and greatest fulfillment of my father’s life as a physician. At the funeral, I saw that life in a new light.

To be sure, I saw more clearly how much my father had achieved professionally in the way these things are commonly measured: to have traveled the long road of success from Valley City to the finest hospitals and medical schools in the world. I also saw more clearly, in a moral sense, how much good he had done as a doctor; how much responsibility for life and death he had constantly shouldered; how all of his achievements had provided us as a family with abundant opportunities for housing and education.

The parish priest who said the funeral Mass had not known my father; nor had my father known him. That lack of familiarity made it all the more surprising to hear Father Carmody, from start to finish at the funeral, refer to my father as “Dr. Jerome,” “Dr. Jerome,” “Dr. Jerome.” Before then, I had only heard his mother call him “Jerome.” Now hearing it, I saw him in a wider perspective. He was a father and a son and a boy once, too. The juxtaposition of those two words, “Dr. Jerome,” worked softly on me through the solemn pace of the Mass until I realized with a start: “Yes. Exactly. My father was knit in his mother’s womb to be Dr. Jerome; he was a better physician than he was a father; he was not the father I had always wanted, but he was a physician that many people had wanted; he was hard to love until we both became patients ourselves, compelled by divorce and disease to confront our limits.” In her short story “Babette’s Feast,” Isak Dinesen writes that in the infinite perspective of grace—a perspective we struggle to imagine—“that which we have chosen is given us, and that which we have refused is, also and at the same time, granted us.” After years of estrangement, I had chosen to love my father as he was dying, and my love was returned manifold. But I realized, too, that loving him meant I could no longer refuse to accept him as he was and will forever be: first, Dr. Jerome, and then my father.

David E. DeCosse is director of campus ethics programs for the Markkula Center for Applied Ethics and an adjunct associate professor of religious studies.

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