No goodbyes, only thanks

Gresham breast cancer surgeon Mary Barnhart has retired, ending a 25-year career

Leave it to Gresham resident Mary Barnhart to host one of the most unique estate sales East Multnomah County has ever seen.

There’s the unusual setting. Instead of a house, it’s in a suite of medical offices in the Gresham Station Medical Plaza on Northwest Council Drive.

There are the for-sale items. In addition to the Victorian furniture and chandeliers that add a homey feel to her offices at Rose City Breast Care, people can buy pink-and-white pompoms and cuddly teddy bears.

It’s just stuff, Barnhart said. Stuff used to fight cancer. Stuff used to keep patients’ spirits up. The stuff of a medical career.

“The fabric, the wood, the lamps,” said Barnhart, 61. “It’s the background. The bittersweet part is the patients. … I will miss my patients dearly. That’s the heartbeat of what you do.”

Increasing demands on doctors make it harder to care for patients from the heart. Independent solo practitioners are being swallowed by paperwork and insurance dealings, taking up time once devoted to patient care.

It’s not the way Barnhart wants to practice medicine.

So after a 25-year career, including eight years in Gresham, Barnhart is retiring. She’s selling off her offices’ furnishings and locking the doors behind her.

An estate sale, she calls it.

For that last week of November, fellow doctors, nurses, medical staff and patients stop by. They check out the dark wooden furniture, couches and chairs in the cheery, rose-themed floral prints that became Barnhart’s trademark.

They don’t say goodbye.

Instead, they say thank you.

“There’s going to be a huge void in the medical system, not having you in it,” said Tina Arcouette of Oregon City, dropping off a card. She’s been a patient for 10 years, ever since being diagnosed with breast cancer in 2002. “You’ve touched our lives in special ways.”

“The medical profession will miss you, and so will the patients who won’t get you,” said Elaine Kristensen, a Gresham resident and a local teacher who was diagnosed in February 2010. “You made a journey that was not easy so much more tolerable.”

Her life’s calling

The medical profession nearly missed out on Barnhart all together.

Born in Michigan and raised in California, she was the oldest of three daughters and thought she’d follow in her dietitian mother’s footsteps. She studied at Pacific Union College and taught organic and biochemistry labs to pre-med students to work her way through school.

“Oh Mary, come to medical school with us,” they’d say.

“I don’t want to be rich, famous and arrogant,” she’d reply.

She had physicians in her family. Her maternal grandfather was one and she had uncles and cousins in the medical field. But they were all men.

Her grandfather was encouraging. Women made good doctors, he told her. “But it takes a very special woman to make it through medical school,” he said.

She transferred to Loma Linda University, where a fellow lab instructor from Pacific Union College ended up.

He invited her to an anatomy class with him.

“I was afraid of the sight of blood and I knew cadavers would be there,” she recalled. She was so nervous she was shaking and the smell of formaldehyde flooded her senses. But once the class began, she wasn’t afraid. She was fascinated by all the intricate ways the body is put together. “I wanted that knowledge base.”

Barnhart earned her bachelor’s degree in nutrition and dietetics in 1975 and worked as a dietitian for a short time while applying to medical schools.

The next year, she was back at Loma Linda, this time to the university’s School of Medicine. She planned to integrate preventive medicine and primary care with her nutrition degree. That plan changed in 1980 during her family practice internship in Orlando, Fla.

She thought she’d get her patients to change their lifestyles, diets, get them to stop smoking.

“See if they could get to a smaller bag of medicine,” she said.

They weren’t interested. And she was discouraged.

Then she had her surgical rotation.

And she discovered a whole new world of immediate results with willing patients. Surgery offered a quick way to change a life.

“It was magic,” she said, only with scalpels instead of wands. “Opening up an abdomen in surgery is like opening Christmas presents. You never know what’s going to be in there.”

Intrigued, she returned to Loma Linda University Medical Center for a residency in general surgery. It meant five more years of training and overcoming unbelievably condescending treatment as one of only two women in the general surgery program at that time.

At least once a month, sometimes once a week, she was told, “There’s 100 guys waiting for your position.”

Surgical residents endured constant digs, but women were given extra ones.

One instructor — the chief of vascular surgery, no less — thought it was fun to let a clamp off an artery during surgery and squirt blood into her eyes.

“That’s where I learned there was water-proof mascara,” she said.

Years later, as the nation was transfixed by a young woman named Anita Hill who testified about terrible treatment by a fellow named Clarence Thomas, conduct that infamously involved a can of soda pop and a hair, all Barnhart could do was laugh.

It paled in comparison to what she saw as a surgery resident.

Welcome to Portland

Of the 18 students in her surgical residency, six finished. She was one of them.

As she began the last year of her surgery program in the fall of 1985, two top-notch surgeons in Portland hired her. Not only was she the first hire outside of their family, she was the first woman. She was to start in July 1986.

But during that last year of training, which was her chief residency year, Barnhart met a patient who changed the course of her career.

Lillian Smith.

Just talking about her brings tears to her eyes.

“She fought so hard,” Barnhart said, swallowing her tears.

She wasn’t Barnhart’s first breast cancer patient, but she was the first one with whom Barnhart stepped over that invisible line of attachment.

“I got too involved with a patient and I’ve done it ever since,” she said.

Lillian died on Easter of 1986. Barnhart still can’t see Easter lilies without thinking about her.

“I felt personally responsible,” she said. “And I felt unprepared to treat breast cancer patients. I knew that as a female surgeon, there would be a lot of female patients sent to me because I was a female. So I wanted to be sure that was an area I was strong in.”

She asked the surgeons in Portland who hired her to hold her spot while she underwent a one-year fellowship in breast surgery — the only one of its kind in the country at the time. The surgeons agreed. Her medical career began in Portland on July 20, 1987.

The two surgeons she worked with focused on general surgery. She gravitated toward breast surgery and dreamed of creating a breast center for all breast-related issues. A place where a breast cancer patient could get any surgical treatment needed, including follow-up reconstructive surgery.

She teamed up with a plastic surgeon and in 1989 opened a breast center on the Adventist Medical Center campus in Southeast Portland.

In 1995, a second plastic surgeon joined the practice. And in early 1999, Barnhart went solo, opening Rose City Breast Care, also on the Adventist Medical Center campus.

Three years later, she stood with Fred Bruning, in a field in Gresham on the corner of Civic Drive and Burnside Road. Bruning had just built the Gresham Station shopping center in Gresham and had plans for a medical building to the north. Barnhart took in the view of Mount Hood and breathed deeply.

She was in.

On Dec. 1, 2004, she moved her practice into new offices at the Gresham Station Medical Plaza.

First-class treatment

Barnhart’s practice encompassed the one-on-one treatment of a family doctor with a surgeon’s skills and a dietician’s expertise — the latter of which was helpful when treating a disease for which diet, stress and lifestyle are thought to be factors.

“It was like all the passions in my medical training congealed,” she said.

She also made a point of allowing the patient to be in charge of his or her treatment.

“This is way too personal,” she said. One patient may want to jump in the deep end, while another will stick a toe in the water first. “We all have a different style, our own approach to life challenges,” she said.

Barnhart learned that first-hand in 2006 with a devastating diagnosis of her own: uterine cancer. Like many cancer patients, it provided a powerful lens through which to re-prioritize her life.

She took Fridays off, allowing time for her own cancer treatment while continuing to provide her patients with that personal touch she’s known for.

She beat cancer and kept the Friday-off schedule. In 2010, she began taking Mondays off, too, hoping for a more balanced life.

Instead, those days off became consumed with paper work and record keeping, which tend to take on lives of their own because of concerns over malpractice.

“All I want to do is take care of patients, but the business end and paperwork have eclipsed that,” she said.

It was just one of many sobering changes she’d adapted to over her years as a solo practitioner. The increasingly stringent regulations and restrictions, the dwindling medical reimbursements.

“It’s taken away the fun of medicine, the doctor-patient relationship,” she said. “When you see that being eroded little by little, it’s very difficult.”

She tried to sell the practice, but new doctors want guaranteed salaries and limited hours. Hospitals, with their large staffs, can offer that to hospital-employed physicians.

As a solo practitioner, particularly with her specialty, she couldn’t. Limiting a patient’s visit to 10 or 15 minutes might fly for a person seeing a primary-care provider about a persistent cough, but not for a woman who just discovered she has breast cancer.

“I give a new breast cancer patient a minimum of 90 minutes with at least three hours to talk about treatment options,” she said. “I don’t wear a watch and there’s a reason. When that patient is there, she has 1,000 percent of me.”

Solo practitioners are always on call, which doesn’t appeal to new doctors.

“You don’t schedule a crisis.” she said.

“It’s frightening where health care is going. It’s so sad to me that the personal touch is disappearing. New doctors have relationships with a computer screen.”

Unable to find a doctor to buy her practice whose philosophy aligned with hers, Barnhart decided to hang up her stethoscope.

“I’m not angry or bitter,” she said. “I am disappointed with where medicine has progressed to. In the next few years, solo practitioners will become extinct as they’re forced to sell out to corporate medicine, large hospitals and medical conglomerates. I hope I’m wrong. ... It’s just a progression. A wake-up call. A convergence of things personally and my idea of where medicine is going.

And the fact that I don’t want to go there.”

Instead, she thinks of her patients and the bonds they’ve forged, like soldiers who lived through a war.

“The grace and class that so many of them display under such painful circumstances,” she said. “What a privilege — to see the strength that some of them are aware of for the first time.”

Barnhart refuses to tell them goodbye.

“They’re like family. They’re my friends,” she said. So she set up a special email address for her to keep in touch with them — nogoodbyes4us@gmail.com.

She may no longer be their doctor, but they can still talk as friends — and without the burden of HIPPA laws or other legal limitations. “It’s the most freeing, liberating thing!” she exclaimed.

So is not having a schedule.

She’s free to go to the gym. Explore the Northwest with her husband of 22 years, Michael Skinner. In what they’re calling a joint retirement, he too retired last month from the Gresham Station Surgery Center, where he served as administrator.

Together they plan to relax on the Oregon Coast. Cruise the Greek isles. Take ballroom and Latin dance lessons.

“I’m going to make memories,” she said. “Enjoying the journey is what it’s all about.”