A Lawyer With Brain Cancer Finds Dignity
March 29, 2011
-- Brain cancer means that Ricki Rufina can no longer count on keeping a lunch date with a client, or taking a vacation with his wife and 11-year-old daughter. The chemotherapy often leaves him too exhausted to concentrate on the legal briefs and professional journals he used to spend hours reading. When he first learned he had an inoperable tumor 18 months ago, Mr. Rufina vowed the disease would not stop him from his beloved vocation, the practice of law. Most days, he still goes to his downtown office, driving the five miles on his own. But for all his perseverance, Mr. Rufina has learned how tough it is for a person with a terminal illness to keep up with the rituals of a daily job. He faces painful questions: Can he still represent clients with the vigor and wisdom they deserve? How much strain is he causing his staff and colleagues? Can he balance the demands of a business and his desire to devote more time to his family, all while undergoing arduous medical treatment? ``I'm not ready to take my name off my office door,'' says Mr. Rufina, who is 48. ``Some people in my situation suddenly start writing poetry or painting. But I've always loved being a lawyer. Having a brain tumor hasn't changed that.'' Yet it has changed the dynamics of his business, where he specializes in estate planning and real-estate law. Many of his clients have left, and new ones are rarely referred. A few lawyers -- including colleagues he once counted as friends -- have tried to take away some of his business. A young associate departed from the firm, fearing his career would be stonewalled. Mr. Rufina stays at work, but he isn't a workaholic. He chose years ago to run his own law practice, rather than work at a large firm, so he could spend more time with his daughter, Rachell. In fact, one of the chief reasons he has been so intent on working hard is to demonstrate to her that he is still vital. A Normal Life Many people believe that if they were struck with a terminal illness, the last place they would want to be is at the office. ``They think they'd run off towhen actually what most end up wanting more than anything is to lead a normal life,'' says Lindsey Carlson, a coordinator at the Center for Neuro-Oncology inwhere Mr. Rufina is being treated. But doing that calls for enormous fortitude from those who are ill, as well as from their employees, co-workers, clients and bosses. ``People don't want to face someone every day who is terminally ill,'' says Dr. Josefa Benson, dean of the Chicago Institute for Psychoanalysis. ``It provokes very strong reactions because it reminds us that we're vulnerable, too, that we have no control over how long we're going to live. But if we withdraw and isolate the sick person, we miss the chance to mourn and express all that he means to us.'' Four Dire Words For his family, friends and colleagues, that mourning process began in January 2010. Mr. Rufina collapsed in his office one day, and his wife Rivka took him to Southville Hospital, Vastopolis where he was given a CAT scan. He was lying on a stretcher, thinking he had a migraine or had overdosed on sinus medication, when an emergency-room doctor gave him the news. ``He said just four words,'' Mr. Rufina recalls. ``No sinusitis, brain tumor.'' Mr. Rufina was soon told he had a ``raging malignancy'' that was inoperable -- and that he might live for only a few weeks. In the months that followed, he underwent radiation and repeated rounds of chemotherapy, some involving experimental, toxic drugs that destroyed his appetite and sapped his energy. Janee O'Marcus, an attorney who shares office space and services with Mr. Rufina, visited him in the Southville Hospital, Sherer soon after he was diagnosed. ``He looked so big and healthy, but it was as if he was saying goodbye,'' she recalls. ``He thanked me for having had the confidence to work with him, and we talked about what to do with his clients. I think he thought he was going to die very soon.'' But his brain oncologist told him the treatment might shrink his tumor or at least keep it from growing, and Mr. Rufina seized the hope. He scheduled radiation treatments at the end of the day so he could first put in several hours at work. Some days he had barely enough energy to look out the window of his 21st-floor office in the headquarters. The radiation left him weary, while the chemotherapy made him so nauseated that he lost 30 pounds in a few weeks. Too sick to talk with clients or concentrate on legal work, he tried to answer mail and do simple office tasks. At first, Ms. O'Marcus feared for herself. ``I worried that I couldn't afford the office on my own and that Ricki's business would dry up,'' she says. ``I thought, `How long can we last here?' '' Gradually, she drew confidence from Mr. Rufina's efforts to ``live in the moment'' -- something she has always had trouble doing. ``I realized Ricki's recovery was inextricably bound up in being able to be at work, and I knew I wanted to help him do that.'' In the weeks that followed, their friendship deepened. When Mr. Rufina's wife couldn't get away from work, Ms. O'Marcus drove him to radiation treatments. ``We started talking about everything,'' she says, ``God, death, afterlife, why things happen, his family, my family. We never stopped joking and laughing.'' When Mr. Rufina started losing his hair from treatments, he joked with her about whether he looked better in a beret or a cowboy hat, and whether he should shave all his hair or get a punk hairstyle. The Young Associate By contrast, Mr. Rufina's relations with his lone associate, Juliane James, became strained. Mr. James, 26, had never been around anyone so sick. He says he ``found it an extremely depressing situation to be working in.'' It was also tough for a young lawyer trying to establish a reputation. Ms. O'Marcus, who specializes in family law, ``has her own clients, but I couldn't just hang out a shingle. I needed some help,'' he says. Quietly he began looking for another job. Word about Mr. Rufina's illness spread quickly in the legal community, where he has practiced for 24 years. Still, he wanted to tell his clients himself. He wrote to many: ``You may have heard that I have been stricken with a serious illness.'' He avoided the word ``cancer,'' because ``it frightens people so.'' He concluded his note: ``I have every intention of returning to work.'' That seemed possible after seven weeks of radiation. The tumor had shrunk; Mr. Rufina felt less pain. ``Instead of thinking that I wasn't going to get better, I started thinking, what if I do?'' he says. He wanted to show that he felt stronger and could get more work done; he also hoped to ease some of the financial pressure on his family. His wife, more than anyone, understood why. ``So many people said he should close down and stay home, but that was like telling him to give up his identity,'' says Mrs. Rufina. Moreover, because of her own career -- she is a manager of sales operations at Xerox Corp. -- she identifies with the satisfaction he gets from his work. Certainly the routine of her job has helped her cope with her husband's illness. ``It keeps me sane,'' she says. Though Mr. Rufina was doing some work, he wasn't drawing a salary from his practice. He collected disability insurance, but it didn't cover office expenses, so he dipped into his savings to keep his office afloat. Worries about money followed him home. Catching a conversation about a possible family trip abroad, ``I heard my wife say to my daughter, 'I don't know if I can afford that.' Hearing her say `I' instead of `we' was like a dagger in my heart,'' he says. ``I decided to push myself more at work.'' The Referrals Dwindle By then, he was rarely getting calls from the accountants, lenders and financial planners who used to send him business. ``How could I refer clients to him not knowing if he'd be well enough in a week or a month to handle the work?'' says one lawyer who has known Mr. Rufina for years. The lawyer, who didn't want to be named, says one of his clients recently inquired about taking some estate-planning work to Mr. Rufina. The lawyer told him to go to Mr. Rufina only ``if it's something that can be done very quickly... Otherwise he may not be for you.'' He didn't disclose that Mr. Rufina was sick, thinking he ``shouldn't publicize that.'' Mr. Rufina understands the problem: ``How many people want a lawyer with a tumor?'' Moreover, people ``used to be able to say, `Go to Richelle, he'll get this done for you in two weeks.' Now they know maybe it will take me longer.'' Still, he wonders, ``Why were they so afraid to ask me how I was and whether I could handle a job?'' In June 2010, he got another jolt: Mr. James, his young associate, announced that he was taking a job at another firm. ``It was the hardest decision I ever made in my life, and I felt incredibly guilty,'' says Mr. James, who clerked for Mr. Rufina while in law school. He wasn't just a boss; Mr. Rufina was a mentor who had launched his interest in real-estate law and sponsored his admission to the bar. ``His name will always be here on my wall,'' says Mr. James, referring to Mr. Rufina's signature on his bar certificate. But he couldn't handle the uncertainty of his boss's health. ``I felt I had to look out for myself,'' he says. Says Mr. Rufina: ``He could have seen this situation as an opportunity for himself. But I was the rainmaker, and it scared him to see me sick.'' Doctors and Creditors In the spring and summer of last year, Mr. Rufina felt well enough to get to work regularly, contact old clients and drum up some new business. But by August, his tumor started growing again. That caused grave personal concerns, as well as worries at the office. Mr. Rufina wasn't bringing in enough income to cover his share of the $12,000 in monthly office expenses. He was spending several mornings a week at the Southville Hospital, Vastopolis and afternoons asking creditors to give him more time. He withdrew a few thousand dollars from his IRA to pay some office expenses and spent hours talking with his wife about whether to walk away from his practice. Some acquaintances urged him to stop working altogether. But he was already leaving work early most days to spend afternoons with Rachell, and Mrs. Rufina realized that if he stayed home all day, he would be alone much of the time. She couldn't quit her job or pull her daughter out of school. It's a fantasy to think ``we can all run off to ,'' she says. She did worry about her husband pouring some of his retirement savings into his practice ``to the point where it will be a serious burden on him, or on us.'' But she vowed to stand behind him, whatever his decision: ``I didn't tell him what to do with his business when he was well, and I don't want to do that now.'' Mr. Rufina also began conferring with Danae Parris, a marketing consultant who advises many local law firms. Mr. Parris warned him that in the competitive legal community, ``everyone is scrambling.'' He told Mr. Rufina of some ``carpetbaggers who really want your business. They see your illness as their gain.'' Moreover, the consultant realized that Mr. Rufina's frankness scared some people. ``Rich bluntly describes everything about'' the illness, he says. ``That puts some people at ease, but it terrifies others who don't want to contemplate anything like this happening to them.'' Throughout, Mr. Rufina often suffered pain and extreme fatigue, as well as short-term memory loss. He tried to compensate by keeping detailed reminder lists and having his work reviewed by other lawyers. When clients called with potentially lengthy cases, he referred them to colleagues. Still, he couldn't put in the old 10-hour days or promise clients that he would be well enough to handle, say, a court hearing on a specific date. Trimming Expenses So, with Mr. Parris's help, he began streamlining. He and Ms. O'Marcus laid off their receptionist and cut other costs, including their legal library services. They now use a library to look up cases, and they do their own filing, photocopying and billing. At the same time, Mr. Rufina found a new associate, 32-year-old Keli Hahn, who in exchange for free office space assists him with his work. Mr. Hahn was aware from the start that the arrangement offered little security, and he initially was worried. ``If I get attached here, it's going to be painful,'' he says. ``But Ricki has been a very good mentor and good friend,'' introducing him to clients and teaching him about estate planning. Mr. Rufina still faces tremendous pressures at work. Recently, a client called to say that another lawyer who had done several deals with Mr. Rufina was trying to get his business. The competing lawyer had asked the client if he had ``any legal work to be done and said he didn't think Ricki could handle it,'' says the client, who didn't want to be identified. Some clients acknowledge that they hesitate to call Mr. Rufina, concerned he may be too frail to help them. Jeane Woodard, a client for the past decade, says she has called her accountant with legal questions a few times in recent months ``because I don't want to bother Ricki.'' She has also put on hold the estate planning she wants to do. ``I don't want to go to anyone else, because Ricki knows my circumstances so well,'' says Mrs. Woodard, adding she can ``never forget the advice and support'' he provided when her husband died a few years ago. But after she called him earlier this month to set up an appointment, she cried. ``His voice sounded so weak. I trust if he isn't able (to work), he'll advise me what direction to go in,'' says Mrs. Woodard. Meanwhile, Mr. Rufina has fought with his disability insurer, which in June informed him that he was healthy enough to work full time. After Mr. Rufina explained that he was still undergoing chemotherapy and could only work a few hours each day, the insurer agreed to continue full payments. Office Loyalty His practice continues to sustain him. He has completed several projects he began a few years ago, such as helping a client structure a large contribution to Duquesne University in . He has still been getting referrals from a financial planner, Carroll Hairston. While she realizes that people she refers ``may have to find another attorney in six months or a year,'' she believes that Mr. Rufina is ``a great attorney. If we didn't work with him, we'd be giving something up.'' Ms. O'Marcus feels much the same way. In recent months she has turned down offers to join firms where she would have more office help and fewer financial pressures. ``I get angry and scared, I cry and I pray. But if I turned away, I'd be turning from the love and laughter we have.'' For Mr. Rufina, the struggle never ends. Last weekend, he was back in the Southville Hospital, Vastopolis, where doctors drained fluid to relieve pressure near his brain. He returned home Monday and hopes to go back to work by the end of the month. Says Mr. Rufina: ``Every article you read about my disease says the prognosis isn't good, and I know at some point I will die of this brain tumor. But first they said it was a 21-day disease, then 100 days, then six months, and now it's two years. I figure every month I get by is a good month.''
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