Monday, March 16, 2015

Eulogy (just my part) for Dr. Joan Barber

Joan graduated from medical school with honors in 1971.  The following year Patsy Mink, who was a congress woman in Hawaii, got Title IX passed in Congress, which gave women equal access to higher education.  Patsy’s dad was a doctor, and she wanted to become a doctor, but they wouldn’t let her into medical school, so she became a lawyer and then a very well-respected congresswoman.  JoAnn did not get any help from Title IX, but many later women doctors did.
I graduated with a degree in philosophy with honors in 1972, and was in the Peace Corps for 2 years.  When I came back wanting to become a doctor, the dean of admissions at UCDavis laughed me out of his office. So we had that in common!
I consider JoAnn to be the perfect role model,  from that vanguard of women in medicine— when there were only a few brilliant women in each class.
It is amazing that she wanted to be a doctor all her life, and was still sure at 18!   She was such a perfectly-built woman— compact and energetic, smart and cute.  She reminded me of a bright bird— I always remember her in good-looking, well-fitting clothes, which weren’t fussy, but showed off the physical fitness she built into her life.  It can hardly be emphasized enough that she was a role-model of how to be healthy, how to set oneself good goals and daily attempts to maintain fitness.  Her patients had chronic pain, chronic limitations and difficulty with movement.  But she always emphasized and modeled  what was possible and reasonable to do, to keep oneself as healthy as possible.
Also, I remember thinking that she and Milton seemed so “normal" and fun-loving a couple.   I once asked Milton about it, and he laughed and admitted he thought he had married a teacher!
But it says a lot about them both, that it was a great marriage, and that they both worked to raise good children who really are outstanding;  and that the work/life balance which is the Scylla and Charybdis of medical women’s lives, was something JoAnn mastered and carried out very gracefully.
Being a workaholic is not a good role model, although most of our early teachers were that.  (here I meant to add about time off— that women in medicine fought for maternity leave, and when Dr. Allari stood his ground with the Sutter administration and got his paternity leave, I knew we had fought for all doctors’ families, to be able to help the men doctors TOO, to have healthier lives)
One story from the early years of practice was from Becky— the office book-keeper— there was never any other item in the balancing of the checkbook except groceries— every few days on the way home JoAnn would stop to get groceries!  She hardly had time for any other shopping.
Another story from Becky is about the children— when they were young, if they got sick, she brought them to work in her van— kept them in the parking lot, doing their homework or sleeping.  NO secondary gain, no tv or distractions, and back-to-school as soon as they were healthy again!  To me this is very important;  about discipline and good boundary-setting, in raising children without self-indulgence.
Another thing is that JoAnn rose to that level of excellence as a clinician which made all of us doctors want to refer patients to her— especially if we weren’t sure of the diagnosis, because we knew she would do a thorough Physical Exam, and Differential Diagnosis, and in a very helpful and efficient way come up with the right treatment plan.  Our patients would rapidly improve, and also be eternally grateful! 
We both believed that estrogen helped decrease and smooth-out symptoms of arthritis in women, so we harmonized in our efforts to treat women for menopause and joint pain.
JoAnn was truly brilliant and insightful.  She cut through reams of articles and data and studies, to help us decide on what the Osteoporosis Committee recommendations should be, as to screening with bone densities, before standards were yet agreed upon.  Her sensible protocol has largely been upheld by the medical community.  The World Health Organization FRAX online tool has since made it easier for clinicians.  JoAnn was aware that rheumatoid arthritis does increase the risk of fracture, and she was vigorously pro-active in trying to reduce the risk for her patients.  
She was good at encouraging patients to increase weight-bearing exercise;  and because of her, I got interested and read the book by Miriam Nelson, the exercise physiologist from Tufts, called “Strong women stay slim”.  I started pushing my patients more to try to increase the walking; and to try to get to the goal of 10,000 steps per day.  
I always appreciated that she tailored theoretical and analytic knowledge to her patients, and her patients got copies of her notes long before I was willing to use the computer.  What was important was that her notes helped them understand their diagnosis and comply with her treatment plan.
On a personal note, my husband and sons got to go pick grapes in the Barber’s vineyard once or twice, but of course I was on-call and didn’t get to go.  They had a really fun time, and it was a community event, with good food and great wine! 
The last big event I got to attend at their home was for the medical society, especially to honor the earliest women doctors in Santa Cruz.  I remember Dr. Shorenstein, Dr. Korakas, and Dr. Meister there, and I think also Dr. Santora  and Dr. Baskerville came.  It was a lovely spring day, and we had a great time.  Milton took everyone on a walking tour through the redwoods, explaining details and interesting things about our special ecosystem, and it was a great educational event, which I still remember. ( The redwoods take up 16 times their weight in fog/water…)
I also saw JoAnn as her patient, and I echo what the other patients have said.  She emphatically encouraged exercise, and in easy-to-understand language, gave me some tips.  I was very encouraged when I saw her 10 years later, and she said I had actually improved my range of motion, so her notes were helpful, and one could assess progress and continuity from them! 
She took her own x rays, and read them— which was practical and there was no delay— she could get extra films if she needed them.  This is almost impossible for doctors now.

In every way she was an admirable physician, and her patients knew she was doing work she loved;  that she was not just trying to get paid; and that often she under-charged.  
Her staff said there were many times when she did not make money— and she always paid her staff first, before herself.  So again, it was lucky that Milton was there to back her up;
because he too believed in practicing in the most excellent and ethical manner. 

Finally— last lessons— Being Loved to Death.
Going to see JoAnn at their beautiful home that last time, a few weeks before she died, helped me know I should retire and try to find a better balance with my family.  
Watching Milton and Adelia care for JoAnn in that puddle of morning sunlight, when she was no longer speaking, and no longer walking, but still able to lean toward Milton’s voice, and his touch on her shoulder, made me think about how great it would be to be loved to death— to have such sweet and patient care.  Hospice was helping them;  but Adelia, who was nursing her baby, was watching and present, and helpful, as a person who was raised by a good doctor CAN be helpful.
And the reassurance of the loving touch and patience from Milton spoke worlds about what every physician hopes for, for our patients;  but may hardly dare to hope for, for ourselves.  

We live in a difficult age, and emotional support to help someone do a difficult and sustained job like being a practicing physician is hard to come by;  but this family, and especially Milton, have been a rock-solid base for JoAnn to be able to practice medicine in a beautiful and graceful way, and to meet the real needs of so many patients!