The Best Lesson My Father Ever Taught Me

By Thomas A. McNally, MD

As the anniversary of my father’s death approaches, I have been thinking about him as both a father and a surgeon. Those two parts of his life were never entirely separate, at least not for me. My surgical education began long before medical school, residency or fellowship, because I grew up watching how he approached his work, how he treated people and how seriously he took the responsibility that came with being a physician.

I could speak for hours about the things I learned from my father, as I expect many of the students, residents and fellows he trained could. Some were universal principles that I still use every day, the most important being, “Always put the patient first. It makes all decision-making more straightforward.”

My father was a plastic and reconstructive surgeon at Rush University Medical Center. He spent his career caring for patients with serious injuries, burns, cancer and congenital conditions. He was also a teacher, although I do not think he separated teaching from the rest of his work. If a resident was standing beside him in the operating room, then teaching was simply part of taking good care of the patient. He wanted the people training under him to understand not only how to perform an operation, but why they were making each decision and what they would do when the operation did not proceed exactly as expected.

The advice to put the patient first sounds simple, and that was part of its value.

A great deal has changed in medicine since my father began practicing. The technology available to us, the procedures we perform and the information we can gather before an operation have all advanced enormously. The basic responsibility has not changed. A patient comes to you with a problem, often at a vulnerable point in life, and trusts you to listen, exercise judgment and recommend what you believe is best.

My father understood that if you began there, with the patient, many difficult decisions became clearer. Should you operate? Is there another treatment that may be more appropriate? Putting the patient first does not guarantee that every answer will be easy, but it gives you the right place to begin.

One of the stories that best demonstrates who my father was began under circumstances that had nothing to do with medicine. In 1972, members of our extended family were killed when a bomb destroyed a Cathay Pacific flight over South Vietnam. My father traveled there to help identify their bodies and bring them home.

The recovery process took time, and there were periods when there was nothing he could do but wait. My father was not inclined to sit in a hotel room when there was work to be done, so he went to a hospital and offered to help.

At that hospital was a young girl named Kim Phúc, who had suffered terrible burns in a napalm attack. Most people know her from the photograph taken as she ran down a road after the bombing, an image that became one of the most recognizable photographs of the Vietnam War. My father knew her as a patient who needed reconstructive care.His care of Kim did not end when he returned home. They reunited years later after she came to North America, and they remained close over the years. In the final days of my father’s life, Kim called him to tell him she loved him, to thank him for the care he had given her, and to tell him she would see him again in heaven.

Dr. Randall E. McNally and Kim Phúc together during a reunion more than forty years after he cared for her in Vietnam

He did not go to Vietnam intending to practice medicine. He was there because our family had suffered an unimaginable loss. While waiting for the bodies of people he loved to be recovered, he found a hospital, asked where he could be useful and went to work.

I do not remember him speaking about that decision as though it were extraordinary. He was a reconstructive surgeon, there were patients with severe burns and he had the ability to help. From his perspective, that may have been all the explanation required.

Always put the patient first.

My father also understood the importance of listening. When he listened, you could tell he was really listening, and he often offered some observation afterward that made clear he had understood more than the words themselves. He did not rush people, and he did not appear to be preparing his answer while the other person was still speaking.

That is an important skill in any part of life, but especially in medicine. Patients do not usually describe their problems in the language physicians use. They tell you that they cannot sleep, that they have stopped walking, that they are afraid to pick up a grandchild or that pain has gradually taken away the parts of their life they value most. An MRI may show where a nerve is compressed or where a disc has deteriorated, but it cannot tell you what matters most to the person sitting in front of you.

For that, you have to listen.

My father listened carefully, although the advice that followed was not always what the listener hoped to hear. The summer before my senior year of college, one of my friends came to visit us at our family home in Lake Geneva. He was taking a year away from school, and my father asked him, in what seemed like an entirely innocent manner, what his plans were.

My friend explained the various possibilities he was considering, most of which sounded like the kinds of things a college student with the resources to take a year off might find appealing. None sounded remotely productive.

My father listened attentively until he was finished and then said, matter-of-factly, “You are what you do, and if you do nothing … well, you can figure it out from there.”

That was the end of the conversation.

A year or so later, I saw my friend again, and he expressed a fairly direct opinion about my father. I asked him what he meant, and he reminded me of their conversation.I am my father’s son, so I asked him what his plan was.

He said, somewhat begrudgingly, that he was going to medical school.

My father had a way of using very few words to make a point that became more difficult to dismiss the longer you considered it. “You are what you do” was one of those points. He was not suggesting that a person’s value depended upon a title or profession. He respected people who were good at what they did, whatever the work happened to be, because he appreciated the commitment required to develop real skill.

What mattered to him was the connection between intention and action. It is easy to say what we value or what we plan to do. Eventually, however, our lives are defined by what we actually do, particularly when the work is difficult, inconvenient or unnoticed.

My father spent his life taking care of people in need, providing for his family and teaching others to continue the work after him. He was what he did.

I came to appreciate the reach of his teaching when I traveled around the country interviewing for spine surgery fellowships. Whether I was in Boston, Baltimore, or San Francisco, if I saw a Rush diploma hanging on a physician’s wall, I would often introduce myself and mention that my father was a surgeon there.

It never failed that they knew him.

Then they would tell me a story. Sometimes it was about a difficult operation. Sometimes it was something he had said years earlier that they still remembered. Often it was about the way he taught, the standards he expected or the calm he brought into the operating room.

As his son, those conversations meant a great deal to me. Children know their parents in one way, while colleagues, students and patients know them in another. During those fellowship interviews, I began to understand how many physicians carried something my father had taught them into their own careers.

Every physician has mentors whose voices remain with them when they find themselves in the middle of a difficult case. One of my own mentors described this as the Green Tile Moment. A surgeon encounters an unexpected problem in the operating room and instinctively looks up, almost expecting the person who taught him to be standing there with an answer. Instead, there is only the green tile on the operating room wall.

Every surgeon eventually reaches that moment. The teacher is no longer standing beside you, and the decision belongs to you.

If the teacher has done the job well, however, you are not entirely alone. You remember how that person approached a problem, what details mattered, when to proceed and when to pause. You remember how to remain calm when the operation no longer follows the plan.

A good teacher shows you how to perform an operation. A great teacher prepares you for the moment when the operation becomes something you have not seen before.

My father prepared thousands of students, residents and fellows for their own Green Tile Moments. He could not stand beside each of them throughout their careers, but his judgment, his standards and the questions he taught them to ask continued into operating rooms he would never see.

I have had many Green Tile Moments during my own career. In those moments, I hear the voices of the people who trained me, and my father’s voice is among them. Sometimes I remember a specific instruction. More often, I remember a way of approaching the problem: slow down, understand what you are seeing, and remember that the patient is the reason everyone is in the room.

My father died in July, 2022. I still find myself wanting to ask him what he thinks about a difficult case or some new development in surgery. I also find myself wishing I had asked more questions when I had the chance, although I suspect that is true for most people who have lost a parent.

The lessons, however, remain. I hear them when a patient needs more time to explain what is wrong. I hear them when a difficult decision becomes clearer after I return to the person whose life will be affected by it. I hear them in the operating room when I look up and see only the green tile wall.

If someone asked me to name the best lesson my father ever taught me, I would answer, “Always put the patient first.” But that lesson was not limited to medicine. It was also present in the way he listened, the way he taught and the way he responded when people needed him.

When he was in Vietnam waiting through one of the most painful experiences of his life, he found a hospital, asked where he could help and went to work.

You are what you do.

My father was right.

Dr. Thomas A. McNally is a board-certified orthopaedic spine surgeon specializing in minimally invasive and complex spine surgery. He cares for patients throughout the Chicago area with offices in Chicago and Elk Grove Village. His practice is built on the same principle that guided his father’s career: listening carefully, treating every patient as an individual, and always putting the patient first.

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Historical Note

To learn more about the tragedy that brought Dr. Randall E. McNally to Vietnam and the extraordinary story that followed, listen to the podcast A Hazy Yellow Feeling. It tells the story of Cathay Pacific Flight 700Z, the Kenny family tragedy, and touches on the lifelong friendship between Dr. Randall McNally and Kim Phúc.