Tribute to my Father

Nathan Rifkinson, MD

May 23, 1912 - March 21, 2010

Delivered to those who came to pay their respects

On the occasion of my father's passing, I want to say some things about him &, frankly, it is hard to know where to begin as I have so many mixed emotions.

Yes, he was my father & I knew him better than he thought I did. But I also have to share this father thing with many of you in this room which is a great honor.
 

It is a sad day but I prefer to remember the more interesting things about my father. He was -- to say the least -- a complicated man who presented a number of mixed messages to all of us. And all of us had to get used to these and other contradictions to understand who he really was.

My father was an only child but he grew up amongst a group of cousins. He loved that life with his cousins. They played amongst the push carts in the streets of New York City & they traveled together to the countryside during the summers in a rickety model "A" Ford. They got into fights, had girlfriends and boyfriends, grew up and grew apart. But of that group of cousins, my father was the only one who became a professional.

His cousins knew him as Natie. His wife, his many friends & colleagues knew him as Nathan, He was dad for me, daddy for Stephanie, grandpa to the two young ladies sitting there in the front row & Dr. Rifkinson to some of you.

After working his way through college & medical school, finishing his internships & residency, my father wandered in his early medical years: first in general medicine then in public health, finally as a pathologist at the Bayamon District Hospital.

But the Government of Puerto Rico offered him the biggest opportunity of his life: a three year fellowship to Barnes Hospital in St Louis Missouri, to study Neurosurgery under the great Dr. Sachs, himself a student of Harvey Cushing, the father of modern Neurosurgery. So off he went, me & my mother, too.

When we returned from St. Louis -- by that time I was 5 & Stephanie wasn't....yet... the government   provided us a half a house to live in. The other half was occupied by Doctora Janner, a psychiatrist. The house was situated between the insane asylum & the prison in Rio Piedras, not the most picturesque location but my father was grateful.

I learned to drive down the long entrance to the insane asylum sitting on my father's lap & we had prisoners doing yard work.

In 1950, when the Independentista revolution broke out, much of the traffic from the outlying parts of the island was funneled onto a road that ran directly in front of our house and each car had to be searched for weapons at a road block, manned by very young & nervous National Guardsmen.

Frequently, gunfire would erupt & bullets went flying, some right into our home. No, this was not a Hillary Clinton sniper moment. This was for real & I remember the three of us hunkered down behind a thick cement wall that divided the living room from the dining room.

It was during one of these dangerous moments that the phone rang. There was a patient in need & it was the only time that my mother absolutely forbade her husband to leave the house, although that was his first instinct -- to go see that patient who needed him.

I grew up -- & then Stephanie grew up -- knowing that patients came first. That was my father's primary focus & responsibility.

He was very grateful to Puerto Rico & loved the people. He worked hard for them, for you, & for us. And I think he never forgot that large family of cousins because, through the years, he amassed a huge group of medical students, interns & residents, their spouses & their children, all of whom he considered family.

As a result, many of us in this room today share similar experiences & know that he could be as demanding as any dictator, as devoted as any priest or rabbi, as generous as any philanthropist, as self centered as any super star and still, despite it all, he was a humble man who never forgot his roots, loved to argue and had a theory about absolutely everything.

So all of you here today are part of our family, Stephanie and I know, appreciate & are proud of that fact. Like our father, we will never forget Puerto Rico, what it did for him, what it means in our own lives. We have both traveled the world but we always love coming home. It is after all, home, where we were born and where both our parents remain.

Towards the end of his life, many of you returned the love & respect he had for all of you by taking care of him in so many ways, big & small. Doctors who didn't make house calls, did. The nurses he had worked with for years, the residents he had helped train, all gathered around him when he was hospitalized in the wards he had helped design.

And when he came home, friends and colleagues stopped by to confer, chat, bring little gifts of food, photos & articles. And -- as the news spread -- the phone calls, the endless stream of phone calls, from people all over the world. Invitations to coffee, movies, ice cream, dinner, concerts, holidays filled his last years.

Stephanie & I know our father loved his life here, with and amongst all of you. You gave him a great & rewarding life & he truly appreciated it.

Thank you for demonstrating your love & respect for our father by coming here & sharing this time with us today. After all, in the end, we are all one big Puerto Rican family.

March 23, 2010

San Juan, Puerto Rico

30 minutes in a life

My father is dying. He is 97, comfortable, not in distress nor in pain, slowly slipping away. It could be a matter of days or weeks or maybe even a few months. He is the-little-engine-that-could, known on the streets when he was growing up on the lower east side as 'tough Natie', aka the state college boxing champion -- fly weight division -- circa 1930. 

He lives in Puerto Rico where he has been for more than 60 years & where his wife, my mother, is buried near a scrawny tree in the Jewish part of the cemetery off Route 1, the road to Caguas.

He is well cared for at home, 24 hours a day, 7 days a week by people who have known him & have cared about him for decades.

Over the past few years, I have flown to P.R. often to visit him, sometimes for weeks at a time, sometimes in emergencies, sometimes just to visit & to push him through the little park that fronts his condominium. During this period, I've had some very personal conversations with him; some about him, some about me, some about our strained relationship.

His decline in mental, as well as physical health, has been gradual but steady over the past two years. Through it all, he has dealt with it in a pretty realistic way. He is a doctor, after all, familiar with death, and says he is not afraid to embrace it when his time comes naturally.

I don't think he believes in an after life as such but sees it more as release of his life's electrical energy back into the universe. He's been quite dignified throughout this time.

The thoughts that cause me to write this are as follows: should I fly to Puerto Rico now & wait until the end comes or should I wait until I get that phone call announcing his passing, then fly down, help with the necessary arrangements, attend the ceremonies & return to Ridgefield, CT where I live. 

Is this issue about the 'show', about him or about me? 

I've never cared much about what other people think, i.e. the 'show'; "See?... his son has been here to see him every day... so nice.... to have been able to say good-bye." 

Since dad basically sleeps all day, is on oxygen constantly, can't move on his own even to feed himself, is easily confused, forgets the last sentence spoken to him and mumbles almost incoherently, it's hard to imagine that it would make much difference to him if I was with him on his last day.....or not.

That leaves me with me. How would I feel if I was down there on a 'death watch'. How would I feel if I got the phone call. I've been thinking about it for a while now.

A few weeks ago, when I was in Puerto Rico, visiting with my father, I went to his apartment at lunch time as this is the time he is most alert. Unable to feed himself, I volunteered to do it.

His eyes were closed & remained so as we moved him into a sitting position & I explained I had food for him. He mumbled something incomprehensible & I told him he would have to help me by opening his mouth, that the food was good & it would make him stronger. He nodded, eyes still closed. 

So I took a bit of food on a spoon and told him to open his mouth wide, into which I deposited what was on the spoon. I waited patiently as he chewed and swallowed. After a number of spoonfuls, I offered him water through a straw & he sucked it in (a good exercise). And so we proceeded this way for the better part of a half hour. When he signaled he had enough, I wiped his face, removed his bib & he nodded off.

After watching him sleep a bit, I kissed his forehead & left, returning to the hotel where I was staying. It was February 25th and I realized it was the same day that my mother had died 15 years previously. What more can I say?

I'm not sad. I'm convinced another visit with my father can't be better than what I've described. I'm content to just hold that memory  close...... and wait.... for that inevitable phone call.

78 mpg.....Oh YES. YES. YES