Even up to the end, Jeff was thankful that he had had such a good run with the prostate cancer that eventually took his life on November 14, 2014. He had been able to live with the disease for 12 years, thanks to fabulous medical care, the support and prayers of many friends, and the love of his family.
Jeff was born on June 11, 1947, in New York City, the son of Edmund O. Piehler, M.D. and Martha C. Piehler. He grew up in Worcester, Mass. with his three siblings Edmund Jr. (Ned), Jennifer and Lisa, to whom he stayed close throughout his life. He graduated from Phillips Academy, Andover, Mass. in 1965 and from Williams College in 1969, having received highest honors in physical chemistry with a minor in art history, an apparent intellectual dichotomy that served him well throughout his life.
Growing up in New England, he was an accomplished downhill and cross-country skier, and he spent many days sailing with friends around Cape Cod as well as offshore. One of his most enjoyable summer jobs was running the launch at a yacht club on Buzzards Bay. After college, he landed a job in an industrial chemistry lab in Sydney, Australia, where he found himself at the time of the first moon landing in 1969, “It was fabulous, I didn’t have to pay for a drink for a week!”
Following his lifelong aspiration to be a surgeon, Jeff attended Cornell University Medical College in New York City, graduating in 1973. His surgical career took him to the Dartmouth-Hitchcock Medical Center in Hanover, N.H. for general surgery training and to the Mayo Clinic in Rochester, Minn. for training in thoracic and cardiovascular surgery, finishing in 1980.
In 1980, he was asked to join the staff of the Mayo Clinic, where he was the sole surgeon to aggressively practice both general thoracic and cardiovascular surgery. His work schedule at Mayo was legendary, frequently running three operating rooms from 7 in the morning until 9 at night, resulting in many ‘busiest surgeon at the clinic’ designations – a workload that seemed reasonable to him at the time, but which was subsequently described by his wife Jean as ‘the dummy award.’ With the passage of time and presumably the acquisition of some maturity, he came to see that she had indeed been correct. During his six years on the staff at Mayo, he performed thousands of operations, published over 100 papers in peer-reviewed journals, and was a regular presenter at national and international meetings in his specialty. He was elected into all the major societies for cardiothoracic surgeons. Jeff was committed to the education of young surgeons, and he was a favorite mentor of the residents in the Mayo system.
But the pace of life at Mayo did weigh upon him, and in 1986 Jeff accepted an invitation to come to Kansas City and join the staff of The Mid-America Heart Institute. He assumed the head of the residency training program in thoracic surgery at St. Luke’s Hospital, and thereafter a significant proportion of his work was dedicated to resident teaching, both in and out of the operating room. His surgical practice remained divided between cardiac and general thoracic surgery. He was the first in the area to implant cardiac defibrillators and to perform lung volume reduction surgery for emphysema. In 2000, he received the St. Luke’s and the University of Missouri-Kansas City Faculty Award for excellence in teaching.
In 1986 Jeff had the fortune of marrying Jean Malles, who loved and supported him for the next 28 years. Despite the challenges presented by Jeff’s disease and treatments, she was unfailing in her presence, her encouragement and her acceptance. He simply could not have endured the hard times without her unfailing devotion. As his disease progressed, their love became stronger than they had ever imagined possible.
Jean and Jeff were blessed by Benjamin and Elizabeth who completed the family with Jeff’s older children Britton and Timothy from his earlier marriage. Some of Jeff’s greatest joys were the reunions of the whole family where the closeness of all his children – there was no such descriptor as ‘half-brother or half-sister’—was celebrated. The family was blessed by the additions of Britt’s wife Rebecca and Tim’s wife Sarah, and subsequent grandchildren Henry, Owen, Lola, and Alice. Jeff loved caring for his family. After retiring, he made a bag lunch for every day of his daughter Elizabeth’s last two years of high school, never leaving out a note of love or encouragement and a small surprise. And he loved his dogs, particularly his little Maggie in whom he seemed incapable of seeing the faults that were so obvious to others. He made up stories of a superhero dog named Spot that delighted all the children, and he went so far as to carry dog treats in his car for any hungry looking friends. “God did his best work when he made dogs!”
In 2000 Jeff decided to focus his practice solely on general thoracic surgery, and he moved his practice with others to the University of Kansas Medical Center, where he felt he could best succeed in this goal, becoming Clinical Professor of Surgery. Giving up cardiac surgery after 20 years and thousands of open heart procedures was difficult, but Jeff was pleased to be able to focus his efforts on his true passion, surgery on the lungs and esophagus, particularly for patients with advanced cancer, who were referred to him from throughout the area. He continued to immerse himself in the training of the general surgery residents at KU, and his was one of their favorite rotations. Many residents became his close friends, which was a source of great pride.
Jeff always felt that his obligation to his patients and their families was to offer emotional support as well as to provide as perfect an operation as possible. A new patient in the office was always scheduled for one hour of his time and he frequently ran over. He was particularly engaged with his cancer patients and their families, taking time to positively present all treatment options and to stand with them regardless of outcome, even if surgery was not possible. Once, after leaving a patient who had to be told of her inoperable cancer, the resident, who had been observing, said, “If I ever have to be told I have cancer, I hope you’re the one to tell me.” Every patient that he operated on for cancer was personally followed by him for up to five years, a milestone celebrated with an enthusiastic hug. After every patient’s death, Jeff wrote a personal letter of condolence to the family, sometimes needing multiple revisions before he felt it acceptable.
In 2002, it was Jeff who was told he had prostate cancer. The next years were a complex weave of work and a variety of treatments for the cancer that kept recurring. Surgery, radiation therapy, chemotherapy, immunotherapy, and hormone therapy each brought their impact upon him and his family. Despite his efforts to continue his practice – he sometimes went to his own radiation therapy treatments between operations – the development of finger neuropathy as a result of the chemotherapy forced his retirement from surgery in 2005.
On many occasions, Jeff told his family that to live well is to never stop learning. “I don’t want to die dumb,” he would say. His intellectual curiosity never failed him, remaining wildly eclectic. A glance at his bookshelf of volumes read, and sometimes re-read, was testimony to his commitment to that goal: particle physics and quantum mechanics, number theory, sailboat hull design, photography, French grammar, American antique furniture and impressionist art are all represented, with some being the source of considerable bewilderment to his family. After retirement he re-learned French and became the grammarian in his class at La Causerie. Although he never viewed his French as being as good as it should have been, he was proficient enough to engage in an emotional political conversation with locals at an adjacent table after a dinner in a Paris restaurant. He was a passionate and knowledgeable collector of American antique furniture and art, and he loved explaining the fine points of construction that revealed the maker or artist. No interest was casually undertaken: his wine collection became epic in scope, and he was on speaking terms with winemakers at many cult west coast wineries. He loved sharing his wine, particularly with someone who said, “I can’t tell good wine from bad,” or, “I’ve never had a red wine I liked.” One of his well-aged pinot noirs would inevitably win them over, to his delight. While his cookbook collection became disturbingly large, he did become reasonably adept in the kitchen, though sometimes a slave to his perfectionist tendencies. He once spent three days making the perfect veal stock for a sauce, which, fortunately, was quite good. Assembling the ingredients for a guest dinner would require stops throughout the city, looking for the right olive oil, the freshest pasta, or the plumpest scallops. He was obsessed with knowing current events. He read five newspapers daily (one in French), and he insisted on reading two or three weeks of saved newspapers upon returning from any trip so as not to miss anything.
Me with my Nikkormat, 1968
Since his days in college, Jeff had always had an interest in photography, and after his retirement from medicine, he re-committed himself to this passion, which he pursued with his usual enthusiasm, particularly during trips to other countries. He took thousands of pictures during his and Jean’s many trips to his beloved France, and his appreciation of art gave him a reasonably good eye. His favorite pictures were those that emphasized the solitary dignity of man. But his true creative epiphany came in the spring of 2011 when he accompanied eight local photographers on a photographic and cultural trip to Bhutan, a tiny kingdom in the Himalayas. His colleagues on the trip were generous in teaching him new photographic skills, and he obtained some images of which he was sufficiently proud to work into book form. The trip, however, also proved to be transformative in other ways: through the sights, the people encountered, and the relationships created, he returned with redirected priorities and a better understanding of the paths toward happiness in life.
Jeff had little tolerance for hypocrisy, perhaps explaining his general disdain of politicians, but he had enormous respect for anyone who took pride in their work. “There is no job that cannot be done with elegance,” he would tell his children. Although more socially hesitant than many would have suspected, he was blessed with a large circle of friends from all walks of life. He was never “Dr. Piehler,” but simply “Jeff.” Within his family, he was the problem solver, perhaps on occasion excessively so, when others might have been better left to fend for themselves.
As do all, Jeff had both minor and major shortcomings, both of which wore upon him. His monotone singing voice and his meager dancing skills turned many a head in a variety of settings. He loved old Bob Dylan music, to the dismay and perhaps indigestion of many of his dinner guests. He had difficulty parting with material things – a possessiveness that was at conflict with Jean’s ability to toss with ease. Discovering Jeff in the midst of a “final verification” of a trash can’s content before bringing it to the street was not uncommon and was the source of considerable ribbing within the family. Much to the delight of local automobile mechanics, he owned only two cars in his last 28 years. Other vehicles in his past included a forklift truck during summer work, a VW Microbus, a 1929 Seagrave firetruck, a 1954 Dodge Powerwagon, and a Matchless English motorcycle.
More difficult was his merciless self-criticism, particularly if an operation did not come out as he had hoped. The perfect results were dismissed as “the way they should be,” but any failures weighed on him interminably. He was always jealous of colleagues who could better process the emotional ebbs and flows of his profession.
Jeff frequently expressed his view that an obligation of life is to progressively become a better person. Like most, he had his fits and starts in this endeavor. He was too absorbed in his work at the beginning of his career, to the benefit of his patients, but not his family. He set unrealistically high expectations for virtually every endeavor, and the inevitable failings weighed heavily on him and ultimately on those around him. With time, though, he came to understand these tendencies. He came to view his work-obsessed past as being part of a time when he had to prove to himself that he could “run with the big dogs,” which indeed he could. But he came to appreciate that a life should not be measured by a quantitative list of accomplishments, but rather by the softer, but greater standard of what one has done for others, family, friends, and strangers. Sometimes this would entail an expression of appreciation to a bagger at the supermarket, a gift of money to someone in a pinch, a conversation with someone met in a line. If you were ever held up at a tollbooth by a slow moving car, it might have been Jeff asking the toll collector how his day was going.
He adored his family and was humbled by their love for him. He felt blessed by the love of his many close friends who offered immeasurable support throughout his illness. But perhaps the greatest blessing in his life was the insight gained as he lived with incurable cancer; he found himself able to discard many of his old burdens and negative emotions – finding himself in an uncluttered world of beauty. He was known to tell people that every day he could see a handful of miracles between his front door and the morning newspaper at the end of the driveway. He felt overwhelmed by the grace that he saw in others, which he did his best to return. Of all the gifts that his cancer had given to him, the greatest was realizing that accepting his mortality brought him closer to the person he had always wanted to be.
In February 2014 the New York Times published an op-ed that Jeff wrote about making his own coffin with his friend Peter Warren. While many initially thought this project morose and defeatist, in fact, it was a positive statement of accepting his upcoming death and using this acceptance to experience a fuller remaining life. The topic struck a chord throughout the country, and the following months were filled with communications from friends and strangers alike who had read the piece. The message was simple: that embracing one’s impermanence opens a world where overwhelming beauty is found in each moment, beauty from loving and caring relationships, from seeing the majesty of the earth, and from feeling a part of the continuum of life. The responses were humbling in their kindness; several wonderful friendships were formed and maintained through e-mail. But most importantly, heartfelt conversations about his approaching death with his family and friends left all with a peace of completeness. All was said, and, while difficult, what was voiced was a graceful expression of mutual love.
Jeff’s life “did not work out the way I had the book written,” but it proved to be a complete story nonetheless. Some pages did have to be eliminated, some did have to be painfully rewritten, but others, perhaps the most important ones, ended up overflowing with joy into the margins. But the details should not detract from a simple conclusion: his hope to be remembered as a good husband, father, brother, and friend – someone who would readily give of himself for another. As his life unfolded, he came to realize his fortune of having received back from others far more than he ever offered. This brought him joyous appreciation to the last. Yes, it was indeed a good run.