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My Father's Daughter

It's not uncommon for good doctors to be bad patients. But my father's inertia to the disease that is killing him represents the ultimate self-destruction.

By Lara Devgan

Should I, after teas and cakes and ices,
Have the strength to force the moment to its crisis?
- T.S. Eliot

Lara Devgan is in her second year at the School of Medicine. Last spring, she won the School's Henry G. Saltzstein Prize for Medical Writing for "My Father's Daughter."

My father used to pick me up from school on Friday afternoons in his dark blue vintage Mercedes. It handled beautifully, and we'd cruise west down Sunset Boulevard, weaving through traffic, hugging the turns, until Hillcrest Drive forked into Westwood. Our ritual was always the same -- the news on the radio, the running account of our days, and Diddy Riece, the best ice cream shop in West L.A. My father got pistachio, and I, butter pecan. We would sit on the outdoor patio, dwarfed by fashion boutiques and cinemas, and chat and people-watch in the sunshine. The complexities of life would melt into each lick of ice cream. "This is a small good thing," he would say. It is still my favorite childhood memory.

As long as I can remember, my father has loved sugar. He takes two heaping spoonfuls in his morning coffee, a sprinkle on top of his Thanksgiving pecan pie, and a pile for dipping his strawberries. "Sugar tastes good," he tells me. The corners of his mouth turn upward in an easy, unplanned smile. His eyes glint behind his gold-rimmed bifocals. He makes it sound so simple. But all that while, our Friday ice creams were drowning my father's pancreas in syrupy pools of sugar. The thought still makes me cringe.

My father was diagnosed with type II diabetes in June 1987. "I still remember the day we got the test back," my mother recalls. Her eyes, heavy-lidded and long-lashed like mine, well up with tears. "That was the day your father got life insurance."

My father has always known that diabetes runs in his family. His uncle, a World War II soldier in the British army, had had diabetes. His grandfather, the headmaster of a New Delhi prep school, did too. And so did his cousin, a Scottish architect, and his brother, a banker in New York. None of them, however, knew a thing about medicine. None was a well-to-do American surgeon like my father. None knew better than he how to manage the disease.

"I have sugar poisoning," my father told me when he broke the news. It was a breezy summer night and the kitchen windows were open. I was 8 years old. "I'm like the ancient mariner," my father said. He used to read the story to me before bed -- it's because of him that I like Coleridge. "…Glucose, glucose everywhere..."

In the early stages of his disease, my father was insulin resistant; his body didn't respond to the sugar-metabolizing hormone even though his pancreas produced it. As he got older, my father progressed into the more troublesome late stage of diabetes -- a combination of insulin resistance and insulin insufficiency. And now, 16 years later, two weeks after his 64th birthday and a year before his retirement, he is saddled with bottles of statins, ACE inhibitors, aspirin, vitamin E and insulin. He carries syringes, a blood glucose monitor, and hard candy.

It's not that my father doesn't make an effort. Indeed, there is a whole shelf in the refrigerator devoted to nonfat salad dressing and fresh fruit, and an entire drawer in the kitchen filled with packets of Equal. But the running shoes I gave him for his birthday sit in a corner of his closet, barely used, and he still eats tiramisu for dessert.

"I've tried to change, you know," he half-protests, half-admits. "But I'm a creature of habit. It's part of the human condition." He runs a hand through his thinning white hair. "I don't know what the future holds," he says evenly, "but I know I like sugar in my coffee." And for a moment, his resistance to change seems decidedly life-affirming.

But my father knows better. He is an ear, nose and throat surgeon, board-certified on four continents, and I grew up watching him read medical journals and textbooks. With a disease that is so profoundly improved by healthy lifestyle changes, his inertia represents the ultimate self-destruction.

He bares a zippered scar down the center of his chest from a double bypass that has permanently altered our fragile family. His legs are hairless because of poor circulation, covered in scrapes and bruises that don't heal. His toes are gnarled by calluses and corns. His broad shoulders have withered. His eyes are sunken. His cheeks are recessed. His fingertips are numb. His vision is failing. And while my father's degeneration is covered over by burgundy wingtips, neatly belted slacks and collared shirts, beneath his stylish L.A. clothes lies a very sick man.

"I'll die of a heart attack," he says calmly. We are sitting in a Starbucks on the corner of Montana and 15th in an upscale Santa Monica neighborhood. Christmas music is playing in the background, and a line of fashionable people waits to buy Frappucinos. My father notices the anguished strain that has come across my face and hesitates, his voice softening. I clench my teeth and choke back tears as two blondes in a BMW drive by.

"Everyone dies," he tries again. "What I have, you know, diabetes, just makes it more likely why.…" His voice drops to the register of husky whispers. His emotions have been lost in the realm of clinical probability and medical likelihood. His sadness and guilt and fear have been abstracted away into mechanical blips on computer screens. But a devotion to scientific accuracy is a hard thing to stifle, and the words spill out of his mouth.

His mannerisms remind me of myself -- the way he tilts his head back when he's burdened, the way he taps his fingertips together when he's thinking, the way he looks steadily into my eyes. "I'm an old man," he says, sipping his coffee. "I was born in a different era. I've lived through World War II, Vietnam, the Civil Rights movement. My father died while I was on my honeymoon, my best friend had leukemia, my children have grown up and moved out. I lived through that, and I promise, I'll live through this." He waves around his double-cup latte as if toasting a life of suffering.

There is a small sign in my father's office, framed and mounted, that reads, "This too shall pass." It has always struck me as the most cynical bit of optimism I have ever encountered, the kind that resonates with people who bear crosses that are too heavy. I have always hated that sign. I have always hated the prefabricated romantic martyrdom it represents. My father's stoic Starbucks toast reminds me of both.

I cup both hands around my chai tea to keep them warm, and my father slowly drinks his latte, which he has sweetened with a packet of Equal to make me happy. He beams me an entry from the journal he keeps in his Palm Pilot.

"Thanksgiving Day. I try to leave loved ones with loving words because I am afraid that every day will be the last. So much to do and so little time left. I still have not become the person I wanted to be."

I feel a wave of nausea wash over me. I hate my father for being a martyr. I hate myself for watching him die. Hot tears roll down my cheeks, but no one in Starbucks seems to notice. They are whispering about the former sitcom actress who has just walked through the door.

It is not uncommon for good doctors to be bad patients. If you walk into the medical center where my father works, you'll probably stumble upon the internist who chain-smokes, or the cardiologist who drinks like a fish, or the general practitioner who eats hot dogs for lunch.

"The doctor's life is a dog's life," says one of my father's colleagues, a young pediatrician who moonlights at the medical center. "Doctors are just people. You see in them what you see in everybody else -- smoking, overeating, drugs. Doctors not following their own advice are like cops not driving the limit."

Doctors have an element of self-subordination fundamentally built into their personalities. "You put yourself last, she goes on. "You've got sickness and suffering all around you -- that's your first priority." Besides, "there's the person you are in front of your patients, and then there's the person you are."

For a man living with a disease so easily camouflaged by a well-tailored suit and a smile, my father has no problem letting his patients see only his public persona. "You'd lose all your credibility otherwise," my father points out. "Why do you think I stopped going to all those doctors? Half of them can't even take care of themselves. Why should I let them take care of me?"

I found out about my father's heart attack a few months after I graduated from Yale: It is a balmy, beautiful summer, and I am living in New York with friends, writing during the day and drinking at night. I have no money, no car and a new Ivy-League degree. Everything smacks of possibility: The skyscrapers, the subways, the Saturday brunches, the Sunday Times, the Met on Wednesday mornings, the Washington Square Park on weekend afternoons.

I cry quietly into the phone when I hear the news of my father. I'm not sure who the tears are for. I take the first flight from JFK to LAX the next morning. The morning after that, my father complains of chest pain. I drive him to the hospital in his Volkswagen, speeding wildly and trying to act calm. When I drive him home six days later, he has already begun to recover from his emergency bypass. He looks so much older. I wonder what will change.

My older sister Sue has always taken a hard line about our father's diabetes. "It's about personal discipline and self-control -- the willingness to change," she says, with an irritated edge to her voice. "When you realize that, it's kind of liberating because then you can stop banging your head against the wall. After all, no one can save you but yourself."

Sue is honest in a way that I have always wanted to be, and her frustration with our father, like mine, runs deep. Doctors have an invincibility complex, she tells me. "If he's going to be so cavalier, then what can I do?" she asks pointedly. She has her own life to live, her own job, her own struggles, far away from California. "People have to take care of themselves."

My mother says my father is in denial. Life is short, though, and so she understands his predicament. After growing old together for the past 36 years, both my mother and my father feel the anxiety of aging. "Sometimes doing what you like -- even if it's self-destructive -- makes you feel like you're young again. It helps you hang onto a past that's not there anymore."

She looks around at the photographs and books and mementos that clutter her bedroom. She and my father have filled this house with so many dreams, and she is afraid that they will die when he does.

"Never get old," she says to me, looking at the yellowed photographs on the wall. She tucks a wisp of hair behind her ear with French-manicured fingertips. Her eyes look vacant and sad. She has been watching her husband of more than three decades grow sick and fragile, and she has been watching him do it to himself. Over the years, her frustration and anger with my father have waned, and settled instead into a complicated blend of anguish and hope.

My father's diabetes looms over her, working its way into her dreams and nightmares alike. She talks about him lovingly. "It's like the shadow under the candle," she says. "There is always darkness under light.Your father gives off so much love and care to others, but that warmth comes at his own expense."

My father drives me to Los Angeles International Airport in his new black Passat. It is not yet 6 in the morning, and the usually heavy 405 traffic has yet to materialize. We watch the sun come up against the backdrop of downtown skyscrapers, admiring the refracted glints of pink and orange light. "What can I say?" he asks me, over the low hum of NPR. We have been talking about his diabetes for the good part of almost a week, and I sense the emotional exhaustion in his voice.

He is driving me to the airport so I can fly back to medical school, to a journey that he once took, to a future as uncertain as his. Everything I learn about comes back to him. Every molecule, every organ, every failing of the human body that I commit to memory over late nights at the library -- it all gestures back to him. Last month I held a human pancreas in my hands. I cradled a human heart. I ran my fingers across the left anterior descending cardiac artery and palpated for beta cells I couldn't see. I want to tell him. I want him to know what it is to be his daughter. I can never find the words.

LAX is two exits away. It is hard to sit next to him, a portrait of so much that I admire and detest, with such calm. He is so much a part of me that seeing him fall apart makes me want to cry, scream, bang my head against the wall. His heart is so weak. His blood is so sweet.

I once read that love is just an excuse to look deeply into another human being's eyes. He looks over at me, sadly, lovingly. His face is wrinkled with the lines of a million apologies and excuses. "What can I say?" he asks again, his voice reduced to a tentative whisper. I don't have the words to answer him, even when our eyes meet.

The L.A. skyline that frames his face looks beautiful, lyrical in the background. I have been straining to see into my father's soul all this while. The weight of daughterly love bears down on my shoulders, and the only thing I know anymore is that I want to ride in this car with him forever. As we drive into the morning light, he tells me something he knows, something that can redeem him. "It's hard to be the person you want to be."

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