For my dad

{Dad, third from right, breaking ground at the site of his clinic, ~1987.}

On June 24, I graduated from family medicine residency and became the fourth family physician/general practitioner in three generations of Dorwarts. A week later, on July 1, our family gathered in Sidney, Nebraska, to celebrate my dad's retirement after 35 years as a family physician there. I couldn't be prouder of the work my dad has done throughout his career, his dedication to our hometown, his persistence through difficult times, and his unwavering insistence on doing the right thing even when it's not the easy thing. Even though I considered forays into surgery and gynecologic oncology (among other things), I am happy to have found my way to family medicine and to my father's footsteps.

Although my dad worked long hours throughout my childhood, I never felt like I was missing out because I appreciated the importance of what he was doing. My perception was that he was spending his days saving lives; my brothers and I went through a phase of asking him every day when he arrived home from work, "How many people did you save today?" Now that I've experienced life as a doctor, I know that the notion of "saving lives" seems distant when you're getting home late after spending the last few hours of your work day documenting everything that happened and signing prior authorization forms. But however he felt at the end of long days and whether or not he had "saved lives" in our juvenile understanding of the phrase, the fact is that he dedicated his life to his community and worked tirelessly to improve the lives of the people there.

I got to spent my family medicine rotation (a two-month period during my third year of medical school) working with my dad and his colleagues in Sidney. I learned more (or at least more that I still remember and use in my day-to-day practice) in those two months than I did in two years of preclinical coursework. I loved having the opportunity to witness the ways in which my dad practiced the art of medicine. Unlike some teaching physicians, he's not really one for pithy one-liners about his philosophy of patient care. What I learned from him I learned by watching and listening as he interacted with patients.

Some stories...
(Note: These stories are based on real situations, but I've changed details and diagnoses both to protect patient privacy and because this happened over five years ago...which means that I don't remember the details anyway!)

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On one of the first days of my rotation, I met an 80-something farmer in the hospital. His wife had brought him to the emergency room the night before because of shortness of breath in the setting of progressive lung cancer. He and his family had been my dad's patients for years. Dad knew all about the man's farm (he's prone to lengthy conversations about such things as irrigation systems and lawn mowers) and had even delivered the patient's grandchildren. When we entered the room he introduced me, as he did to all patients during my time there, by saying, "This is our student doctor, Michelle." When he knew the patients well, he'd pause a moment before adding, "She also happens to be my daughter." Almost invariably, the patients would say something like, "Oh, I thought so!" or, "Of course! She looks just like her mother!"

After a brief discussion of the previous night's rain (an eighth of an inch, probably), the conversation turned to the patient's illness. It had become clear to the patient and his wife that the end of his life was approaching. They wanted to try to treat any reversible problems (infection, specifically) and to focus on getting him back to the farm. We discussed the next steps in the man's care, including planning a conversation with the hospice team, before carrying on with hospital rounds and heading back to clinic for a busy afternoon.

That night, after dinner at home, Dad asked if I wanted to go with him to check on our farmer. We hopped on bikes and rode back to the hospital where we found that the patient's room was filled with his children, grandchildren, and great-grandchildren. They greeted us warmly, and Dad joined them in telling stories about the patient's life while he (the patient) laid in bed with his eyes closed, smiling and interjecting occasionally. We spent about a half hour with the family before wishing them a good night and heading home. As we pedaled up the long driveway to my parents' house, I realized that we had not done anything "medical" during our visit--no reviewing of labs or entering of orders, no discussion of medication changes.
But then, that hadn't been the point.

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Several weeks later, Dad and I took another evening bike ride to the hospital--this time because one of his patients was in labor. This was the woman's third child (Dad had delivered the others), and the nurse who called had said that the woman was 8 cm dilated, so we hurried to change into scrubs before heading to the delivery room. The patient and her husband were visibly reassured when Dad walked into the room just as another contraction started. As we prepared for the birth, I stood nervously behind my dad; this would be my first time participating in a delivery. (I had done an OB rotation about 10 months prior but the only hands-on experience I had gotten was holding retractors during C-sections.) Dad prodded me to move in front of him, and as the baby was being born he took my hands and placed them on the head, guiding me in my first delivery.

Later, when Dad was out in the hall doing paperwork, I stayed in the room to examine the baby and talk with the parents. As I was handing the newborn back to his mother, I told her that this had been my first hands-on delivery. She told me about her previous childbirth experiences and how she was so happy my dad had been there with her for all of them. The nurse added, "You know, I've worked with Dr. Dorwart for a long time. He may act like a tough guy, but the look on his face every time he delivers a baby...it's pretty special. Like he's witnessing a miracle."

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There are many other stories I could tell about my rotation or about other times from Dad's 35 years working in Sidney. Of course, there were rough times, days when the hours of work exceeded the hours available, years when the "damn computer" got in the way of just taking care of patients. There may have been a few patients who didn't appreciate his candor, a few medical students who were intimidated by, "Are you asking me or telling me?," and a few nurses who didn't love hearing, "What's your big emergency?" when they called...but he has always been unapologetically, unabashedly himself. And that self committed more time, energy, integrity, and love to his vocation than any other doctor I've met. My dad is, to me, the consummate family physician. For that example, I am endlessly grateful.

{With my parents at my residency graduation, June 2016}