Death of a Friend

“To die is poignantly bitter, but the idea of 
having to die without having lived is unbearable.”
-Erich Fromm

My friend Ulises Alvarez died yesterday shortly before 9AM.

I met Ulises soon after I started my medical practice in north St. Louis County in 1976. Together with Dr. Pascual Alonso, another Hispanic physician, he had an internal medicine practice located not far from my office.  We connected because a language in common binds together souls who live in a foreign land. When you hear Spanish being spoken anywhere away from home the foundation for a conversation is instantly poured. One may have nothing in common with these strangers; indeed one may never think of addressing them had one met them way back home. But let the setting change to Rome, or Beijing, and one feels the urge to relate.

Relate we did. We shared a love for sports; music; literature; family. And medicine.  Within minutes of our first meeting I understood that here was a man who worshipped at the altar of caring. He got to know his patients as people, not as a collection of symptoms. We had dozens of discussions about our interesting and challenging cases. He gave me insights on what it was like to practice medicine without CAT scans and MRI’s, in the times where to offer a caring hand was the best that we could do for a patient in distress.

My practice expanded. Christian Hospital wanted me to grow more. They suggested that I should recruit Ulises’s son, Juan, who was about to finish his medicine training at Jewish Hospital. Juan was bright; personable; a hard worker. When I approached him he made it clear that his dream was to join his dad in practice. I did not think that this would be a good fit, because my practice was in the mode of growing and acquiring new equipment and sophisticated technology. Ulises was suspicious of style over substance. He was content to examine his patients while they sat on exam tables that showed their significant age.

A compromise was reached. Ulises agreed to move to my practice with Juan. I agreed to allow the old exam tables into our shiny new office. Hundreds of pounds of paper medical records made this trip. We thrived.

My friend and partner Ulises Alvarez died yesterday morning.

We grew some more. New X Ray machine; new bone density machine. We collected a hundred samples of blood every day. Vendors of every possible gadget or drug lined up outside our doors. It became impossible to separate the practice of medicine from a significant, ever present concern about money.  Many times I was pulled in different directions by these two seemingly conflicting forces. The more bills and salaries that I had to look over and pay, the more money that came in. Employee salaries and benefits grew. I found myself seeking shelter in Ulises’s office during the moments when I was just not sure if we were doing the right thing. He always found a way to make things fit inside my brain.

My friend, partner, and moral compass Ulises Alvarez passed away Saturday morning.

Steve Baak became our fifth partner. Soon after we hired a nurse practitioner, then two; three. It was a lot. It is hard to describe how busy things can get; how little time there is for reflection and perspective.  My wife, the “everything in its place” freak, was hired as Ulises’s nurse. She tried to keep him organized, only to find out that it was him who organized her. My father, the overwhelming presence in my life, became ill. It was clear that he would not survive. I found myself traveling back and forth to Puerto Rico at the same time that I ran the office and maintained an elite level of service to my patients. I lost my place with my wife and my young son.

I moved out of our home. To a tiny, Spartan apartment a few minutes away. I made myself believe that I needed a new start. Ulises took me aside.

“I like both of you. But you tend to make instant decisions. It’s good for a doctor. Life doesn’t work that way.”

After nine months I asked for her permission to come back to our home.

My friend, partner, moral compass, and mentor left me just as winter approaches.

Time passed. I had to pass ownership and responsibility for the office to DePaul hospital. There were many benefits, not the least being financial, but things were not the same. Large institutions follow the numbers. Ulises was never about making a lot of money. I could sense that the hospital felt that he was a drag on our practice. That they would not mind if he retired. He saw the same picture that I did. A new young physician, Cami Watkins, was hired. Ulises left our office. Overnight, what had for two decades been our temple, became an office.

His health slowly deteriorated. The tall, strong jock began to have trouble ambulating. He moved to a retirement community. He was forced to move about in a wheelchair.

I got a few members of the Hispanic community together. I printed copies of many of our memorable poems, and the lyrics to our most touching love songs. We went to his “home” and spent the evening singing and reading poetry, eating Spanish sheep cheese, and drinking wine. One of the last times that I saw him smile.

My friend, partner, moral compass, mentor, and lover of beauty is gone.

Juan sent me a text on Friday night. “My dad is at DePaul. Not doing well.”

I called my wife. We met at the hospital early in the evening. The Alvarez clan was there. Juan’s children, who grew up in front of my eyes, all of whom I would be proud to call my own. Ulises Jr., the spitting image of his dad, every bit as calming a presence as his dad always was. Patty Alvarez, the incredibly capable mother and businesswoman.

Ulises, our guiding light, frail and agonizing, at the center of all.

We told stories. We laughed. We held his hands. In a snapshot: the essence of his life. 

The many years of school and training; the hardships of being an immigrant; the difficult work of being a doctor; the agony of losing a daughter; all of this incredibly rich life boiling down to the snapshot of family and friends at your side during your last moments.

He would have been proud.

I signaled to my wife that we should leave. She bent over Ulises and kissed his head.

“I love you.”

I gave him the traditional Hispanic hug. “Siempre pa’lante.”  Always look forward.  We walked away.

Everybody’s friend, partner, moral compass, mentor, lover of beauty, and beacon of family togetherness has moved to a new home.

God bless his soul.