The Patient in the Mirror

For the first week after his diagnosis, Dr. Juan Villagomez wasn’t sure exactly who he was supposed to be: a man who heals or a man in need of healing?

He didn’t see how he could be both.

He had been stunned by the lab report, sure that it should have said “ulcer� or “gastritis.� After all, he was just 38--thinner than he used to be, a little stressed, but fit, he thought, for a busy doctor with his own family practice and a long list of community commitments.

The report said “adenocarcinoma,� a cancer in his stomach. A doctor friend showed it to him on a June evening in 1996, hours after he arrived home, jubilant, from a 560-mile AIDS benefit bike ride down the California coast. He felt his spirits crash into a thousand pieces.

He was back at work the following Monday, still in shock, when a longtime patient--an amiable, elderly woman with a knack for telling off-color jokes--walked in. She had been fighting stomach cancer herself, with some success, for two years.

Villagomez did some chest X-rays, saw her cancer had spread and realized, with a mental thud, what it meant.

“There were all these metastases, all these tumors in her lungs,� he recalled. “I was looking at her, realizing: ‘This lady is going to die.’ And here I am . . . thinking, ‘I, too, will die.’ �

Death, for that first week, overtook his dreams--ghoulish images, skeletons, corpses. He awakened crying, walked to the room of his two small children and agonized: What would become of his family?

Three years later, he is still alive, and on most days, does not dwell on the subject of death. He’d rather trade “besitos� (little kisses) with his 4-year-old daughter, Gabby, when she comes home, wiggly and breathless, from preschool. He’d rather talk about his love of medicine, about what he has learned from being on the other side of the stethoscope, and most of all, about his faith in God.

His journey, as Villagomez refers to his illness, has forced him to navigate between worlds that society tends to set rigidly apart.

How to be both doctor and patient, both a man of medicine and man of God? He has struggled against these divisions throughout his professional life, but now, more than ever, he seeks reconciliation.

Doctors, of course, are not exempt from death, but most spend their careers trying to control disease. Losing control of his own health at such a young age is Villagomez’s distinct tragedy. His unusual reservoir of faith is what he considers his blessing.

He has cancer in its fourth, and final, stage. He was in remission for a year and a half--able, for 18 months, to return to his Santa Monica practice. Then the malignant cells ransacked his abdominal cavity.

In December, on his wife Alicia’s 38th birthday, he sang a Mexican serenade to her from a gurney as surgeons wheeled him into the operating room. They opened him up, surveyed the damage and then closed him again, helpless to do more.

Yet he continues to fight back. He’s getting intensive chemotherapy every three weeks, a regimen that steals his strength for six days afterward. He has outlived colleagues’ expectations and speaks longingly about resuming care, someday, of his elderly, mostly Latino patients.

“Who knows where my health is going to go?� he said one day when the morphine didn’t seem to be helping much. “There’s miracles that happen every day. I just hope God bestows on me his helping hand. It’s a big wish, but that’s the wish, that’s the prayer I send out.�

‘It Just Didn’t Seem Fair’

All his life, Villagomez has struggled to be a good man. He considers his illness neither a punishment nor a parable. But sometimes questions come to mind, uninvited.

“Of course, I have [wondered] ‘Why? Why did this happen?’ � he said. “Life was beautiful and I was doing all the things that were . . . gratifying to me. I was healing people, and I was involved in the community. . . . I was entering the prime of my life, and then I get struck with a terminal illness. It just didn’t seem fair.�

Villagomez, friends and colleagues say, is the kind of doctor who takes time to explain every concept, who calls late at night just to ask how things are going. He focuses his practice on older people; he loves to listen to their life stories.

His patients love him in return. “When [his children] were born, forget it . . . you couldn’t get into the office, there were so many gifts,� said Rita Esquivel, a close friend whose mother was Villagomez’s patient.

He is known for his community work, recruiting therapists to counsel Latino victims in the Northridge earthquake, helping to run an AIDS hospital ward, leading an effort to bring more physicians into underserved areas.

“He is the kind who had two or three seniors [as patients] that had no family . . . so he and the kids would go see them on Sundays at the nursing home,� Esquivel said. They brought armloads of pan dulce, Mexican sweetbread.

Esquivel was never his patient, but he saw her through the worst illness of her life.

She had met Villagomez briefly at a benefit, shortly after undergoing a mastectomy for breast cancer. Weeks later, after a “humdinger� of a chemotherapy infusion, she ran into him on the street. She looked and felt horrible.

That night, Villagomez called her at home, asking if he could come over. No, she told him, she didn’t want anyone to see her like this. It was all she could do to drag herself to the bathroom to get sick. She wanted to die.

“He called me every half hour until six o’clock the next morning,� she said. “He got me through the night. That’s how we became friends.�

When he told her about his own illness years later, “there were tears,� she said, but she told him he would get through it. “Compadre,� she said, “I did it, you can too.�

At times, Villagomez isn’t so sure. But his vulnerability is blended, friends say, with a sometimes surprising strength.

Martha Hierro, his gastroenterologist friend, recalls the night she told him of his diagnosis. She waited, anxiously and respectfully, until the bike-ride celebration had died down and the champagne was emptied.

“I have some news about your biopsy results,� she recalls saying. Villagomez assumed that she had confirmed his suspicions about an ulcer.

“I’m afraid it’s more serious than that,� she told him, holding his hand. “The biopsies are malignant.�

Villagomez was quiet for a long time, then reached for his wife. Both cried.

“Then an incredible thing happened,� Hierro said. Villagomez walked behind Hierro’s chair, put his arms around her and said how difficult this must have been for her, to break this news.

“For me!� she said recently, still marveling. “He was worried for me.�

Leaving a Legacy

On this beautiful, blustery afternoon, Villagomez focuses his video camera on the couch in his West Los Angeles home and takes a seat where it is pointed.

He is creating a record of his life.

He started to film himself while in the hospital last fall, to make sure he told Gabby and his 6-year-old son, Bobby, about their roots. Maybe he and the kids will watch the movie together when he is an old man, he says--if God decides to intervene.

For now, the challenge is to collect his thoughts and keep them flowing, despite some boisterous interruptions--when Bobby, for example, bellows into a pretend megaphone and Gabby hoists herself up the side of the couch to bestow besitos.

“Otro, otro,� he says each time she kisses him. She dissolves in giggles at his pleas for more.

Today, in front of the camera, this tall, slender man with wide, brown eyes recalls his boyhood in Geyserville, Calif., where his family lived on the outskirts of a vineyard.

His parents, Mexican immigrants with grade-school educations, were hard workers who instilled the same ethic in Villagomez, their eldest son, and his six brothers and sisters.

Villagomez’s father worked for the railroad. All his children helped support the family by harvesting grapes, pears, apples, plums--whatever the land produced, whenever the time came.

“Harvesting season provided the extra money for clothes,� Villagomez said. “You had to get up early . . . rain or shine, hot or cold.� Three hours of work might produce a $12 to $15 bin of produce.

Villagomez had big dreams and no one discouraged him. First, he wanted to be an astronaut, then came his first hankerings to be a healer--actually, a dentist. He got the idea after he went to work in a local orthodontist’s office, sweeping floors for two years to pay for a set of braces.

A gifted student, he made his way to the University of Santa Clara, sustained by scholarships. There, his faith and his professional aspirations blossomed.

He grew more certain that he wanted a vocation, not just a job. But there wasn’t any epiphany about medicine. It simply came to him over time that as a physician, he could meld his interest in science with a growing spirituality, becoming what he hoped would be “a compassionate healer.�

“[I wanted] to help people, take care of people. . . . Religion was part of that--faith, and the Jesuit teaching about social responsibility. . . . All of these aspects are the fundamentals of Christianity, Catholicism, and they were meshed in with becoming a physician.�

Becoming a Professional

He struggled from the outset with the invisible boundaries that divide doctor and patient.

During his psychiatric rotation at UC San Francisco, he remembers being depressed about relationship troubles when an equally distressed young woman came to him for counseling. He felt conflicted. He was so in need of healing advice himself, and here he was, the supposed healer. “I felt the need to be in her chair,� he said.

Was it professional to empathize? How much? He wanted to keep a proper distance without abandoning patients to a lonely journey.

“It’s right to have a separation,� to maintain some objectivity, he said. “But you need to be able to join, at times, with a patient in [their] journey . . . to feel some of the things they feel.�

The experience prompted Villagomez to seek therapy to sort through his emotions.

Confronting death presented a more profound dilemma.

One day, during a grueling training rotation in which he got little sleep, a “code blue� emergency was called. He rushed to revive the patient. He pumped on his chest for half an hour, commanding himself to “keep going, keep going,� until he was soaked in sweat.

He was stunned when the doctor in charge called off the effort. The room emptied in slow-motion. He remembers stepping back from the body, dazed, and making his way to a restroom. There, he quietly broke down.

In time, he learned that being a healer means far more than sparing patients from death.

One of his memorable lessons came from a series of mostly wordless bedside visits to an 80-year-old matriarch from a large, extended Latino family. There was no drama, nothing much to be done medically; her breast cancer was incurable.

What he remembers was his unspoken kinship with this woman so like his own grandmother, her family’s quiet grief, and the peacefulness of her passing.

“I felt like I helped her,� he said. “You [can] still provide a great deal to someone’s life in ways that don’t necessarily involve a blood test or an X-ray.

“That technical part of medicine is certainly important,� but sometimes what’s more important is “learning how to listen, and how to be quiet, how to be with a family and appreciate the silence.�

A New Challenge

For all he learned about facing death among patients, it did not prepare him to face his own.

Just being sick left Villagomez profoundly disoriented. After his diagnosis, he found it unsettling when patients asked him how he was feeling. Wasn’t he supposed to be asking them that?

“He still wants to be independent,� said Carlo Weber, a psychologist friend. “I’ll say, ‘Look, I’ll help you down this incline.’ He’ll say, ‘No I can do it myself.’ . . . The guy is 41 years old, for heaven’s sake! He has always been the helper. It’s pretty hard to change course and be the helpee.�

He’s an optimist by nature, but this illness has yielded some dark days.

As a doctor focused on the mechanisms of the human body, he can explain with some dispassion why his stomach had to be surgically removed, how his intestinal tube drains away excess bile, how he is able to control the flow of morphine into his vessels with a small pump in his hand.

Yet his emotions take over when he considers his low prospects for long-term survival.

“He knows too much,� explains his brother, Manuel, a health care executive. “That [has] led to more doom and gloom.�

More than ever, Villagomez is leaning on his wife, the shy, lovely nurse who, upon their first meeting at a party 14 years ago, made him ask twice before she’d dance. “She’s been a rock,� one friend says.

But most of all, Villagomez takes strength and solace from prayer. He calls most frequently upon the Virgin Mary, the maternal presence who saw fit to intervene on behalf of believers in Fatima, Lourdes, Tepeyac and Medjugorje.

Just asking for her help fills him with hope. “Fear isn’t part of the feelings that are with me when I’m praying.�

Sometimes he goes to a high desert monastery, away from the distractions of the city. In late April, in the wooden chapel of St. Andrew’s, he stood with his head bowed, in the front pew, taking in the promise of the resurrection.

“[He] who looks at the Son, and believes in him, shall have eternal life,� went the Gospel, read by a Benedictine monk. “Him, I will raise on the last day.�

He had joined his fellow parishioners from St. Monica’s on a two-hour bus ride to hear Mass and stroll in the serenity of these grounds, a remote enclave with tall, swaying trees, expansive lawns, an apple orchard and a man-made lake.

But after lunch in the cafeteria, he could barely stand. He had left his morphine on the bus, and now was paying for it. He tried to suppress a grimace.

Outside, he reluctantly abandoned his plans for a walk. He made his way, with difficulty, up the bus stairs and to his seat. He attached his abdominal tubes to his morphine, then visibly relaxed. “It doesn’t take long,� he said, eyes closed.

The Mental Battle

In the days leading up to his chemotherapy appointments, dread and depression build inside him. He is anticipating the post-infusion nausea, the leadenness that overtakes his limbs.

“I get a lot of psychosomatic symptoms,� he said, though his knowledge of the mind-body interaction does nothing to forestall it.

He remembers his innocence at his first chemo session in 1996. After the nurse hooked him up to the intravenous fluid, he instantly felt sick from the metallic poison. It was worse than he had imagined.

An hour later, he learned the IV merely contained saline solution; the chemo had yet to be infused.

Dread, he has learned, can be far worse than whatever physical discomfort disease engenders. What is pain, after all, compared to “the primitive raw emotions . . . of fear and thoughts of mortality?�

At chemo sessions every three weeks, he thinks about his mortality a little more. He sits in a lounge chair in a small office at St. John’s Hospital in Santa Monica as fluid from a bag on an IV pole drips slowly into his abdomen.

He tries to keep himself busy. He uses the telephone to call his office and catch up with friends; he greets former colleagues. He says his rosary using plastic beads that Gabby lends him.

But he can’t relax. He bounces from despair to hope and back. “I feel sometimes, my death is so much closer,� he says. But “I don’t want to die! . . . I want to live!�

“I’m afraid to think of leaving my children,� he says, covering his face with a blanket.

How can he make Bobby and Gabby understand? He tells them Dadda is sick with cancer and his tubes are “owies.� He tells them he will get better.

Even on chemo days, he musters the faith that it could be true, he could be cured.

“There is that part of medicine that sometimes we can’t explain,� he says. “You hear stories of ‘someone suddenly became well.’ If you are a believer and you have faith, you attribute this to the healing grace of God. . . . Well, I’m a believer and I have faith. And faith is blind.�