Patrick Coonan ‘86

Greetings fellow Barkan members,

Thank you for the opportunity to contribute to this newsletter section of the new Barkan website. This feature represents an opportunity for me, not only to express my gratitude to the Department of Ophthalmology, but also to share my experiences with others currently on this journey.

The discovery of Ophthalmology occurred late in my medical career. After eight years at Cornell University, I chose a general surgical internship and residency at the University of Colorado. During the second year of my residency, I joined a group of physician volunteers on weekends, providing general medical care, in a converted school bus, to migrant farm workers in the mountains of southern Colorado. Filled with inspiration and promise for this work, and questioning my decision for a career in General Surgery, I joined the National Health Service Corps to continue our efforts. This commitment allowed me to provide general medical services to an underserved, non-English speaking population, over a 3,000 square mile area in southern Colorado.

After two very successful and fulfilling years I was able to see the establishment of a permanent clinic facility, the development of a rotation for residents from Denver in critical subspecialties, and the purchase of an ambulance allowing me to drive patients the ninety miles to the nearest hospital. In addition, I discovered the satisfaction of providing primary essential care in all aspects of medicine from Pediatrics to Obstetrics to Psychiatry.

I left Colorado with only luggage, a horse, and a pickup and moved to a ranch in West Marin. After a brief sailing adventure to Tahiti, I returned with the determination to find my place in medicine. Without any financial savings, I joined a classmate from medical school to serve as medical director for three emergency departments in Marin and Lake Tahoe. There, I worked alongside all of the medical specialties, and I quickly determined that the Ophthalmologists that I met, as they saw patients in the Emergency Department, were the happiest and most satisfied physicians, a fact that was confirmed again and again throughout my career. I saw in this specialty the balance between clinical and surgical skills that I was seeking, a patient population benefitting from the precious sense of sight, and a lifestyle complimenting my other interests and family aspirations.

My conversations with Ophthalmologists introduced me to the emerging subspecialty of vitreoretinal surgery and I set out to investigate that potential field of interest. I sent a letter to five retinal specialists in the Bay area, offering to volunteer one or two days each week, carrying out research projects, collecting data or otherwise providing useful assistance, while allowing me to test my interest in the subspecialty. There was only one response: Dr. Wayne Fung at PMC picked up the telephone and invited me to meet with him in his office. He subsequently offered me space in his office to collect data for a research project that extended over a two year period. His generosity and kindness, and our work together over that period resulted in a residency appointment, multiple publications, an Academy presentation, a highly competitive fellowship and a lifelong friendship. More importantly, however, working in his office with Dr. Robert Webster, I discovered mentors who showed me for the first time what my calling in life was intended to be. As personal and professional role models, Dr. Fung and Dr. Webster represented the qualities in a physician that I wanted to develop and to incorporate into my practice and life.

Over my five year period in the Department of Ophthalmology, Dr. Fung shared with me his clinical experiences in his office practice and in the operating room, where each day he demonstrated extraordinary grace, humility and kindness. Seemingly never showing frustration, his sense of calm in the operating room, combined with his surgical precision and efficiency, set a standard for residents and colleagues that became my inspiration. In the office he was never rushed or hurried, offering every patient the time, kindness and respect that resulted in admiration, trust and loyalty – principles that guided my practice over the years.

Dr. Fung and I shared other common interests: our families, fishing, good food and vintage sports cars. After my fellowship, when I returned to the Bay area, we formed a dining club with other friends, shared meals at his home with his family, volunteered as clinical faculty and reunited socially at medical meetings.

The residency in Ophthalmology at Pacific Medical Center was an immensely challenging and rewarding three years. I had the very good fortune to have found a friend and mentor in Bernd Kutzscher, who had started the residency four months ahead of me and who also had taken time away from medicine. Bernd consoled and guided me throughout the first year as I struggled with an entirely new curriculum. Throughout the residency, he gave me encouragement and confidence in a field that was such a departure from my previous medical experiences.

Additionally, the head of the Retina Service at PMC was Dr. Everett Ai, who gave me instruction and invaluable advice as I looked forward to fellowship training. We co-authored publications, and together we created an Academy presentation and film on the pathogenesis and treatment of diabetic retinopathy.

During that same period, the Department of Ophthalmology was chaired by Dr. Bruce Spivey. Dr. Spivey had the rare gift of bringing together exceptional administrative skills with a successful faculty practice and innovative medical education. With his worldwide reputation in Ophthalmology and his ability to recruit and manage faculty and personnel, he led the Department to national prominence and to the distinction of attracting the most competitive applicants to the residency, fellowships and faculty. Equally inspiring to all of us was his ability to bring his administrative accomplishments together with warmth, kindness and generosity.

In 1986 I completed the Ophthalmology residency at PMC and moved to Iowa City for a Vireoretinal fellowship. With established patterns of referral from throughout the Midwest, the Retina service at the University provided exposure to a seemingly unlimited population of patients with rare and diverse clinical and surgical challenges. During the evenings I was able to duplicate thousands of slides from the extensive photographic library, which I used for teaching residents at PMC when I returned. With daily Grand Rounds, a world renowned supportive faculty, research opportunities and exposure to complex clinical and surgical patients, the fellowship provided me with the confidence that would bring success and fulfillment throughout my career.

When I returned to the Bay area, I studied the distribution of retinal specialists and determined that Sonoma County would be an ideal location for a practice. After interviewing all of the general ophthalmologists between Marin County and the Oregon border, I felt that there would be enough support for a successful practice. With only one employee, a card table reception desk and a single examining room, I opened my practice in a rented office building in Santa Rosa. The local hospital agreed to provide the necessary surgical equipment and nursing support. The initial pace of the practice was painfully slow and I often wondered if I should have joined Dr. Fung as we had discussed many times. Practicing alone, I was also realizing how important it is to have a colleague to discuss patient care in the office and assist with difficult cases in the operating room. After 6 months, however, the practice volume had grown and I was joined by a very good friend who had been in the fellowship program with me in Iowa. Together we grew the practice, relying on hiring excellent personnel, prompt and thorough communication with referring physicians and providing the highest level of medical care. Using our experience and teaching materials from Iowa, as clinical faculty at PMC, we were able to offer monthly retina lectures and workshops to residents. After two successful years we purchased an office building, and the practice today enjoys an excellent reputation with five retina specialists.

There was another very important reason that I chose to move to Sonoma County. I had always enjoyed farming and country life, having spent many years in large cities. After several years I was able to purchase a hilltop site where I built a barn and planted a vineyard. For three years I lived in an apartment above the barn and with my first harvest, began construction of a home on the property. After three more years I was happily married, with two children living in the house of my dreams, with a successful and enjoyable medical practice and award-winning wine grapes.

If lives are divided into chapters, as mine seemed to be, I had another chapter that had been a lifelong goal. After twenty years of practice in Santa Rosa, we decided to sell all of our possessions and move aboard a boat that we had built in southern California. For five years we lived on the boat, traveling over 20,000 miles, homeschooling our six year old son, and exploring the waters from Panama to Glacier Bay in Alaska.

On one of our trips to Alaska, we anchored in Eagle Harbor on Bainbridge Island in Washington. Going ashore, we discovered a unique community which reflected our values and lifestyle, good schools, essentially no crime, gorgeous landscapes and a small population of kind and welcoming residents. To process the idea of settling here, we secured the boat in a local marina, and moved to Paris for a year. There our son could attend a French school, and we could carefully make the decision for our next chapter. We returned, made one more voyage to Alaska, sold the boat, and spent the next two years building another home on the island, where we live very happily today. Our daughter lives and works for a nonprofit in San Francisco and our son will graduate in May from Michigan with degrees in mechanical and electrical engineering.

As I look back over the good fortune that I have experienced in these years, I trace all of it to the opportunity to complete the Ophthalmology residency at PMC. The initial inspiration and guidance from Dr. Fung, the camaraderie of my fellow residents, the extraordinary PMC faculty led by Dr. Bruce Spivey and the doors that opened throughout my career following those relationships, led me to enjoy a life and career of profound fulfillment and happiness.