June 21, 2009

2,800 babies
The first OB/GYN in The Dalles, Dr. David Mack bids farewell to a prolific career

By Kathy Gray
of The Chronicle

     OK, Dr. David Mack hasn’t exactly kept a running tally of the number of babies he’s delivered.
     “On average I probably delivered, overall, about 100 a year, plus or minus,” Mack said.
     Over 28 years, that’s a lot of babies — and a lot of nights on call.
     “I love my daytime job, but I can’t do nights anymore,” Mack said. “I figured out that I’ve been on call for the equivalent of 17 years.”
     That meant he had to stay within 30 minutes of the hospital; he could seldom enjoy parties and social activities; and he had to be ready at a moment’s notice. It also meant 28 years of chronic sleep deprivation, which can affect the memory over time, Mack said, and is not recoverable, even with rest.
     “It really cramps your lifestyle. It’s a constant, if subtle, pressure. It was onerous,” he said, as was the load of chart work that comes with a medical practice. Every hour of seeing patients, Mack estimated, requires a half-hour of chart work.
     So all the rewards of participating in a women’s most intimate and important moments came with their share of hard work and long hours.
     “It came down to making a choice: continue to do it or say enough is enough.”
Mack will be retiring at the end of June.
     Mack’s colleagues at Columbia River Women’s Clinic filled in some of the details of his life and character.
     “He is a very serious physician when it comes to the care of his patients,” said receptionist Linda Toda, who has worked with Mack throughout most of his career.
“He does not accept the status quo,” added Dr. James Faherty, who has worked with Mack since 1996. “Together, we’ve constantly tried to really maintain the cutting edge so the care delivered here in the community — although we’re small — is essentially the same as you get at the big ivory towers.”
     He’s also what Faherty describes as “an early adopter,” which is why Columbia River Women’s Clinic was one of the first practices in the area to adopt electronic medical records.
     “It was basically on his urging,” Faherty said.
     Mack grew up a small town boy in Oakridge and Sweethome, and initially was not a very serious student, as Toda tells it.
     “One of his favorite stories is that his dad told him when he was 18, ‘Now that you’re graduated from high school, where are you going to be living next year? Are you going to school? We’ll help with that. Are you going in the service? Well, get going.’ So he went to college and buckled down. He found a big interest in the sciences and kept plugging away at it. Actually, I think he felt that calling [to be a doctor].”
     And that calling has drawn other doctors to The Dalles.
     “He’s a great teacher and a great doctor; he’s always willing to help out,” said Dr. Analene Pentopoulous. “Part of the reason I came here was to work with him and Dr. Faherty. I thought I would continue to grow and learn with them.”
     That expectation has been borne out, she said.
     Now Mack is looking at how he will redefine himself in his retirement years after decades as a physician.
     “I think the road to physicianship is so arduous and so hard, it easily consumes people,” he said. “I’m currently into recommitting myself to fitness. And I’ve taken up photography.”
     Like many men of his era, Mack was the point-and-shoot documenter of family life, “without the appreciation of the artistic side of photography.” Then, a couple of years ago, he took a photography class at the community college.
     “I saw a whole new paradigm of the artistry of photography and the creativity,” he said.
     Work won’t be out of the picture very long for Mack.
     “Like many people, my 401(k) has become my 101(k),” he said. “I’ll take three to six months off to redefine who David Mack is.”
     Then he’ll be back at work, probably as a locum tenens, a physician working short-term assignments. He’s also looking at the VISTA (Volunteers in Service to America) program.
     Mack’s image of society has been shaded by the work he’s done as a gynecologist and obstetrician. During development of plans for the new middle school, for example, he strongly advocated for new schools that reduce dark corners where students may risk molestation. He also advocated strongly for a “2-2-2” system of a two-year middle school, followed by two-year junior high and two-year senior high to keep the various age groups segregated. And he’s been a regular supporter of HAVEN from Domestic Violence.
     “Dr. Mack is frequently perceived as paternalistic and gruff, but he’s hugely big-hearted,” Faherty said. “As an example, when my wife was pregnant and needed to be on bed rest, he purchased her a new bed so that she would be more comfortable.           He’s also incredibly philanthropic in the community. A lot of people don’t realize that he’s generous beyond most people’s expectations.”
     Mack has been a sponsor of scholarships at the high school, the university and the nursing school.
     “He specifically directed that his high school scholarship not necessarily go to the best student, but to one who’s overcome the most to achieve,” Faherty said.
Mack has gleaned some strong views of society from his lengthy career.
     “The greatest crisis has been the failure of our social system to be adequately supportive and expectant of responsible behavior,” Mack said. “For all the good things that came from the revolution of the 1960s and early ‘70s, the cost has been a loss of accountability for personal behavior. It’s been devastating to society.”
     Sixty percent of the mothers Mack has seen in recent years are single mothers, he said.
     “The cost to society is huge when we become a society of victimhood,” he said. “We don’t celebrate success and independence as desired goals anymore. It’s OK to do your thing and not be accountable for the consequences.
     On a more positive note, Mack said he has lived through a period of revolution in medical care. Ultrasound imaging, for example, was in its infancy when Mack started practice, producing blurry, hard-to-see images. Today they produce highly detailed “four-D” images.
     “The next level will be to scan the abdomen one time and regenerate the baby in the same position, slice by slice, much as in a CAT scan. It’s very exciting.”
     Mack also looks back on a career he describes as having less than average adverse outcomes.
     “I think every obstetrician is always concerned about the safety of the patient,” he said. “We do enough elective operations and take care of enough babies, it’s inevitable that some bad things happen, but they’ve been of minimal frequency.
     “But at the end of the day, Mother Nature bats last.”
     Mack originally envisioned practicing as a rural physician in family practice. He did an internship in a small hospital in Portland, similar to The Dalles.
     “After looking at Heppner and Vernonia, I realized that I was undertrained for the complicated issues of rural practice,” he said.
     He looked at various residency options, including family practice and obstetrics.
     “If I was going to spend time doing a residency, I wanted to be really well-trained in obstetrics, surgery and internal medicine,” he said. “The programs were three years each. I decided for the time spent, obstetrics would give me much better training than family practice for high-risk obstetrics and gynecological surgery. It turned out to be true.”
     However, his early family practice leanings have carried over into his obstetrics and gynecology practice, which he describes as acting as more of a “super-private care doctor for women.”
     Mack looked at an urban practice, but found the environment hostile for someone interested in rural life.
     “I found urban life stressful, impersonal and not very satisfying professionally,” he said. “I came to The Dalles to have a better quality of life. You know people here.”
     That’s the philosophy he’s followed in recruiting other doctors to Columbia River Women’s Clinic, including Doctors Faherty, Pentopoulos and Miriam McDonell.
     “One thing David has taught me, coming from the city during my training, was the power and importance of community,” Faherty said.
     When Faherty was considering the move to The Dalles, Mack wrote him a letter.
     “It said, ‘Don’t come for the windsurfing. Don’t come for the skiing. Don’t come for the nice views. Come here if you want to participate and be in The Dalles, participate in the community.’ That’s something that’s difficult to understand when you live in the city and from a residency where you are just one of hundreds of gynecologists in the city. You don’t appreciate that component.”
     “I wanted them to live in the community and become involved in community organizations, and be a part of the community,” Mack said. “It works well for the community and the physician. The only physicians to leave the community from our office have been taken away by their spouses for their careers.”