Editorial

Perspective Editorial

JOSEPH PAVIGLIANITI, MD

The Slingshot

Ihave been thinking about my legacy a lot lately. I’m not really sure why, but over this last year or two, I find myself reflecting a lot on what my legacy will be to my children and to my community, and perhaps, presumptuously, to the world. How will I be remembered? What stories will my kids tell about me to their kids? When I die, will anyone care? Did I make a difference?

The idea of “leaving behind a good legacy” strikes me as similar to the idea of funerals and wakes. Legacies and funerals are constructs “for the living” and exist for those left behind, as a way to comfort and begin the process of closure. When you’re dead, you really don’t care what kind of casket you are in or what they say about you. But those you leave behind do. Sim ilar ly, when I’m pushing up daisies, I won’t care about the legacy I leave behind. But while I’m alive, the concept of building up a strong legacy reassures me that when my time comes, I will die “at peace.” Whilst some of us might want to “go out with a bang” while doing something heroic, I presume that most of us want to die peacefully, with few regrets and many of our goals accomplished. We hope for the cinematic matriarchal death scene, surrounded by our families as we slowly slip into oblivion, knowing that our loved ones are cared for, and that we lived the life that we were intended to live and put to use all the gifts and talents we were given. We ran a good race and crossed the finish line before the finish line came to us.

About 12 years ago, while in my mid-40’s, I started reading The Last Lecture by Randy Pausch, a CMU computer science professor with terminal pancreatic cancer. He and his wife had delivered their third child just months earlier when he got the news of his cancer diagnosis; after some quick research on the dismal prognosis of pancreatic cancer, his priorities instantly changed. He needed to make sure his young family was provided for after he was gone. After that, he wanted a chance to be able to talk to his kids “from beyond the grave” and give them some fatherly advice when they were old enough to need it and understand it.

But life in your mid-40’s is busy: young kids, homework, chauffeuring to sports and school events, medical practice in full swing, “on call” responsibilities that take up what little free time you have, patients that need help after hours or late in the clinic day such that you miss (or are really late to) all those great sports contests, school band concerts, birthdays, etc. The list is endless. You will note I left “spending time with one’s spouse” off the list, because, sadly, spouses are often left off the list, or at least shoved really far down it. I could not be a successful physician and father without my wife filling in the many places where I fall short. The career we have all chosen takes us away from our families far more than the average parent. Our kids and our spouses get the short end of our time-stick. It’s tough being a spouse to a physician. In the old days, parents wanted their kids “to marry a doctor; I’m not sure I would give that advice to my own children. While I am generally happy with my choice to become a physician, by far the smartest and most important decision I ever made was not to become a physician, but rather to wait patiently until I found the right person to spend my life with…and to build my legacy with. I won the wife lottery.

Anyway, I only got a few chapters into the Pausch book before getting distracted with “life.” I got sidetracked and forgot about it. For years. But, it’s a decade later now and I’m clearly on the downward descent of the arc of my life. Hopefully it’s a long, graceful arc, but one never really knows, do we? So, now in my mid-50’s, I went on a mad hunt, found the Pausch book and started it again. And it’s got me thinking. If I were to die before my kids were all “fully cooked,” how can I reach out from beyond the grave and have a presence with my kids and dispense fatherly advice posthumously?

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There are many good points to the book, but the basic premise is: stop wasting time, focus on your life goals, figure out your dreams and work with single-minded focus to fulfill some/most of them. Show gratitude, stop complaining, suck it up and work harder. See your world half full, not half empty. Don’t give up. Well, that’s easy advice to give, but hard to put into action. While we need to work to have the means to accomplish some of our goals, if all we do is work, and never get around to goal fulfillment, what was the point? Admittedly, this is something that my wife and I are often at odds about. As physicians, most of us are experts at delayed gratification. Then, as we start our careers, it’s time to join the rest of the world on… living. New car, house, marriage…later some kids. Before we know it, we are on an incline treadmill of house, school, credit card, and auto payments. The “home treadmill” gets faster every year. Here come more kids. Here comes college tuition. So, we crank up our careers and our “work treadmill” speeds up. Add in some prior authorizations and EHR, and burnout eventually at work and at home. I sometimes feel like everyone gets a piece of me… except me. If you ask my patient wife, she feels as if she gets none of me, or maybe just a few crumbs. I haven’t found the off switch to either treadmill. People talk of slowing down the treadmill, but that is difficult to do.

In my garage, there is a 5-foot-tall tree branch that is shaped like a slingshot at one end. When my oldest son, Daniel, was 5, he loved reading Calvin and Hobbes. There was an episode where Calvin and Hobbes make a slingshot to hurl something at Calvin’s nemesis, Susie. For some reason, Daniel thought that was a great idea. Somewhat serendipitously, we found a fortuitously slingshot-shaped tree branch and we soon thereafter decided we were going to make a slingshot; his plan was to aim it at his 3-year-old sister, Anna, with some chocolate pudding, but pretend it was poop. Dan thought the plan was uproariously funny, and I have to admit, I enjoyed sitting with him while he drew up a stick figure battle plan. We waited for our perfect moment. The tree branch/ slingshot was propped up inside our garage waiting to take Anna by surprise.

A few months ago, we were packing up Dan, now 23, to move into his first “post college/first real job” apartment. He saw the tree branch / slingshot near the garage door and asked me why I had kept it, as we clearly never were going to fulfill the pudding/poop slingshot assault plan on his sister, especially since she had found out about the plan (five-year-olds cannot keep secrets). He knows I am a hoarder, but an 18-year-old tree branch shaped like a slingshot seemed a bit excessive, even to him. He had asked me why I kept it several times during those 18 years, but I never owned up as to why.

But now he was moving out, and I needed to confess. I admitted to him that tree branch represented all my many failings as a father: all the time I wanted to spend with the kids, but couldn’t. All the plans we would make to do things, but never get around to. All the good advice I wanted to give them, but couldn’t put into words at the right moment. All the trips to cool places we should have gone, but couldn’t. There were always things that got in the way: Work. Chores. The Lawn. Work. Obligations. Bills to pay. Work. Lack of funds. Work. Taxes or paperwork to do. House Maintenance. Did I mention work? Always seemingly more important stuff that got in the way of the father/husband I envisioned myself being when I dreamt about it as a starry-eyed teenager. The tree branch/slingshot has remained my reminder that I can always do better and that I am far from perfect. When I die, I want Dan to have the slingshot to inspire him to be a better parent than I was able to be. Or maybe they will bury it with me, so I can take my shortcomings with me.

So, as I sit here contemplating what sort of legacy I will leave to my family and to the outside world, I think Pausch got it right. Live as if our days are numbered and commit to trying to fulfill some life goals, for our time may be very limited. I am making “slowing down” a priority with a start date. I also am adopting the idea of beginning to keep some sort of written legacy of family history, quotes and bible verses that resonate, words of wisdom, etc., that the kids can refer to long after I am gone, when they might be facing problems I faced. Right now they don’t want to hear it…but, maybe later. Memory fades, but the written word can span generations. What made me tick? Why did I do the things I did? Why did I work so hard at the expense of fun? Why was providing for my family such a priority? Hopefully, they will come to the conclusion that there was much more to me than just an unused slingshot.

Dr. Paviglianiti is a pediatric ophthalmologist and associate editor of the ACMS Bulletin. He can be reached at jcpmd@pedstrab.com.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion

Continued on page 316of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

ACMS Bulletin / November 2021

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