On some coastlines, mountains boldly march to the sea and form a battlefield of cliffs and foam. But the coast of South Carolina is more subtle and mysterious. The sea floor rises slowly here and makes a place of muted and changeable edges. Twice a day, land and water exchange places, exposing and covering oysters, sand dollars and discarded crab traps. In the Lowcountry, as it’s called, land isn’t always land; it’s something in between: green marsh grass poking through rising and lowering tides; black pluff mud gooey enough to suck off a wading boot.

Toward Beaufort, in a soppy region between Charleston and Savannah, the coastline is especially porous. Fingers of ocean probe inland and curl around islands with names like Lady’s, St. Helena, Edisto and Chisolm. Dolphins swim up the inlets and around these islands. Sometimes they drive schools of fish onto muddy banks, wriggle out of the water, make meals of the fish and wriggle back in. Bald eagles lift from branches of dead trees and circle about; deer bounce across marshy inlets, their white rumps moving like pistons. When a shovel sinks into the soil on one of these sea islands, the spade might slice through a pocket of beige sand, or hit clay or even a nodule of natural phosphate. Or that spade might hit fertile brown soil, as it did one warm fall morning in 1982 on Coosaw Plantation.

Mark Sanford, slender and 22 years old, gripped the shovel’s weathered wood handle and pointed the rusty brown spade toward a pile of dirt. His younger brother, John, and a friend who happened to be visiting the plantation had made the pile the day before after digging a trench between two massive live oaks. The soil below these grand trees was chocolate brown and colored by everything around it: flecks of fallen Spanish moss, grains of sand, seeds, decaying pine needles. Mark said nothing as John and their other brother, Billy, took shovels of their own. Scattered clouds gave way to blue skies. Wind blew through pine needles and moss above, building and subsiding, sounding like distant ocean waves. Mark and his brothers felt the soil’s weight as they moved it from the pile back toward the hole, which contained a cypress box and their father’s body.

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Dr. Marshall Clement Sanford had died three nights before in a side room in the plantation’s main house. By then, his arms and legs had withered, and his once erect spine curved under his declining weight. The muscles in his throat were gone too. He had nearly died a few weeks before as he choked on some food. Mark and his siblings had never heard their father even whisper a complaint as Lou Gehrig’s disease cut him down. They watched him accept his fate in the same workmanlike manner he performed surgeries and ran the farm. The poise he showed as his body failed was yet another example of his power. In their minds, he was godlike, the unquestioned authority of everything around them, the man whose hands mended sputtering hearts while they were at school and reached for a belt at home when they misbehaved, which wasn’t often because of the magical sway he held over them.

Doc Sanford was born in Mocksville, North Carolina, a small farming town near Winston-Salem, but left to become a doctor. After getting his medical degree, he did advanced training in surgery at Johns Hopkins University in Baltimore. In medicine’s pecking order, surgeons have long considered themselves superior to doctors who practice other specialties. Surgeons must be bold; when they see a threat, such as an aneurism or a tumor, they must act. Laziness, procrastination and anything else related to indecision can kill. A great surgeon “must have a driving ego, a hunger beyond money,” said Dr. David Effler, a contemporary of Sanford known for his pioneering work in open heart surgery. “He must have a passion for perfectionism. He is like the actor who wants his name in lights.”

For many surgeons, especially old-school ones like Doc Sanford, you found perfection by learning a procedure from a mentor, then doing it over and over until something as complex as a bypass was rote. “See one, do one, teach one,” goes the medical school cliché. Surgery programs are therefore known for their workloads, and Johns Hopkins was the original old school, the place where in the late 1800s, Dr. William Halsted required trainees to all but live in a hospital for six to eight years. These “residents” weren’t allowed to marry, were on call 362 days a year, and typically worked more than 100 hours a week. Halsted’s medical residency system became the national standard. As a result, surgeons, including Doc Sanford, led highly structured lives through their 20s and early 30s.

While at Hopkins, Doc Sanford traveled to the South Pacific with a medical team during World War II and treated combat injuries. After the war he operated with surgeons who invented new ways to save “blue-baby” infants with heart defects. In the early 1950s he moved south and set up a practice in the booming area around Fort Lauderdale, Florida, the first thoracic surgeon in that region. While sailing, he had met a young woman named Margaret Pitz, a pianist and Fulbright scholar who went by her nickname, Peggy. Together they had three sons, Marshall Jr., Billy and John, and a daughter, Sarah. Doc Sanford was 45 when their firstborn, Marshall — Mark — came along. “The kids were the prize in his life he had always been waiting for,” Sarah would say years later. And her father would make time to brand them with the values and high expectations that had brought him so much success.

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Doc Sanford saw plenty of evidence in South Florida’s trauma wards about what happened to children who were corrupted by outside influences: gunshot wounds, limbs mangled in drunken-driving accidents, kids frying their brains with drugs. That wouldn’t happen to his children; he would give them plenty of freedom, but only in the world he created for them and only when he said they could be free. He sent them to Westminster Academy, a tiny Christian school, instead of Pine Crest School, the area’s larger and more prestigious private school. And every summer and available school break, they drove 500 miles north to the 3,000-acre farm he bought in South Carolina — Coosaw Plantation.

Coosaw is in the southern part of South Carolina’s coast, just over an hour south of Charleston. It’s on the western side of Chisolm Island, which overlooks St. Helena Sound. The land first had been home to the Coosaw Indians, who were wiped out in the 1700s, then a handful of plantation owners who raised cattle and grew indigo, cotton and rice. During the Civil War, one of the planters reportedly owned a drinking cup made from a Union soldier’s skull. After the war, speculators mined Coosaw’s seams of phosphate to make fertilizer. The Hurricane of 1893 and the discovery of new deposits in Florida put a quick end to the state’s fertilizer industry, and Coosaw eventually became a hunting retreat for financier E.F. Hutton. In the early 1960s, Doc Sanford consolidated several tracts to restore the plantation’s original Civil War boundaries and began farming the land for wheat, cucumbers, soybeans and tomatoes.

A brick gate with two pedestals marked the entrance. On the pedestals were two jockeys, each holding a lantern, their jackets painted red, their pants and faces painted white. From the gate, a sandy road cut through the grass to the main house. Old live oaks dripping with Spanish moss lined the road, creating a tunnel of shade that opened at the house’s front door. The house was two stories tall with single-story additions flanking each side. It had been built after a previous plantation hall was burned during the Civil War. When the phosphate mines were being worked, it was a bar and brothel named Alligator Hall. Later, a wealthy Cuban owner rebuilt it with bricks from a music school in Charleston that had been torn down. Walls inside were made of cypress panels, and the floors, perhaps the oldest part of the structure, were made of planks of heart pine. The house looked out onto the Coosaw River, which flowed to St. Helena Sound and the Atlantic. Winds bathed the house all day, keeping insects at bay. During the summer, the breeze typically moved like a sun dial, starting from the east as the sun rose and shifting to a westerly flow by day’s end. It was a peaceful place, but Doc Sanford would make sure it wasn’t an idle one.

His kids would learn the meaning of work and respect. They would answer “yes sir” and “no sir” to adults. “No grandstanding,” he said when they bragged. Boys had short hair. If long-haired friends wanted to visit, they were advised to cut their hair or face the Coosaw shears. In the morning, he drove his kids to one of the farm’s many fields, dropped them off with lunch pails and instructions on what grass to cut or fields to dig. They climbed aboard tractors and bush hogs as the Lowcountry summer sun cast everything in a haze of blinding white light. In the afternoon, thunderclouds often formed, softening the light a little and allowing the greens and golds of the land to fill out. They finished around five or so when their father returned in his pickup truck to collect them, tired and dirty, but not too tired to run full-tilt off the dock into the Coosaw River. They worked five and six days a week and didn’t even think about saying they’d rather do something else with their time, such was the power of their father’s authority. Somehow they got it into their minds that they wouldn’t get their next meal unless they finished their jobs.

And yet Doc Sanford had a gentle voice that he rarely raised. He didn’t have to. Mark and his siblings had seen how he felt about people who were lazy, like the worker who was sitting there one day flicking a cottonwood branch back and forth to keep the bugs off. “Gimme that thing,” he told the worker, grabbing the switch from his hand. As far as Doc Sanford was concerned, if you moved around enough, the bugs naturally stayed off; comfort wasn’t important, not in surgery, not in life.

In Florida they lived in an exclusive beachfront neighborhood, but their house had just one small air conditioner. On especially humid nights, the kids vied to get to that cooler room, sometimes sleeping elbow to elbow. They competed for everything. “A trip to the mailbox would turn into the Junior Olympics,” Sarah recalled. They were, as sibling rivalry expert Jeffrey Kluger once put it, a “team of rivals.” And Doc Sanford was the demanding coach. When you got hurt, you dealt with it and moved on, like the time Mark broke his nose playing basketball with his cousins. His father calmly ordered someone to find two plastic pens. He pulled the ink cartridges out, grabbed the back end of a spoon, and with Mark thinking he was about to have his nose cut off, inserted the pen tubes into his nostrils and taped it all together into something that resembled a giant beak.

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For his family’s good, Doc Sanford had created a sense of scarcity amid the riches around them, but he also filled this vacuum with love. Their father was forever concocting new recipes that he tested on his family, and when Mark, in his middle teens, ran well in a track meet, Doc Sanford proudly announced the creation of “Mark Sanford’s Championship Hash” or “Mark’s Track Meet Success Eggs.” At twilight on Coosaw, their parents sat on chairs in front of the house and had drinks. Sometimes Doc Sanford summoned one of the children to stand before them, then launched into a thorough account about what the child accomplished that day. Even three decades later, Mark’s younger brother, John, would get goose bumps remembering the joy of listening to his father’s praise.

Doc Sanford was also quick to brag about the kids in front of his hunting buddies, who often filled the house on holidays, their heavy Lowcountry accents echoing off the home’s cypress walls, their heavy boots shaking the pine floors. They carried shotguns and cigars. They included lawyers who ran Charleston and people like Brantley Harvey, a lieutenant governor from Beaufort. All this masculine energy created gravity that drew in the boys and made them want to be like them someday, make them proud, especially Mark.

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Mark Sanford was tall and wiry, with hazel eyes and a splattering of freckles. He inherited his father’s gentle voice and had an earnest streak as wide as the Coosaw River. He was the eldest, and with that position came expectations to lead. As a Boy Scout he worked diligently on his merit badges until he made Eagle Scout. In the fields he worked hard on the tractor and grew to like solitude and independence. In high school he ran cross country and track. His event in track was the half mile, which suited his nature. The half mile is too long to be an all-out sprint and too short to be an endurance run; instead it’s something in between. When the starting gun fires, you run just below a sprint until your lungs start burning; then the lactic acid builds in your legs and you can barely breathe by that final turn and the straightaway to the tape. He posted times of about 2 minutes, 7 seconds, average overall but good enough to put him in the state championships for small schools. He knew his father would be there at every meet watching, the great surgeon who arranged his schedule to put his kids first. “It was a happy little nest,” Mark would recall decades later.

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But even the sturdiest nest can get blown from a tree. When Mark was a junior in high school, his family gathered at Coosaw during a holiday. And it was here where he heard the words “Lou Gehrig’s disease” and “father” mentioned in the same breath. As usual, his father’s friends were in the house. One came over as he stood in the living room near a wall of family photos. He put his right arm on Mark’s left shoulder, and Mark could feel the weight of the man’s hand as he heard him say, “You’re in charge now.”

Doc Sanford was tough, yes, and even Lou Gehrig’s disease would take time to fell him. He would move from Florida to Coosaw and live out the rest of his life. Mark would attend Furman University, a small Baptist college in the state’s foothills, close enough for Mark to visit Coosaw on weekends. Even at Furman, his father’s hold remained firm. He abstained from sex, alcohol and drugs, he would say years later. He wrote a 20-page history of Coosaw with a $1,453 grant from the National Endowment of the Humanities. He was comfortable with nerds and athletes, helped organize a Christian fraternity, and in his senior year, ran for class president and won.

You’re in charge now. That’s what Mark told himself when his father finally succumbed on Thanksgiving eve 1982. And that life is short. And the nail that holds everything together can come undone unless you pound in more nails.

He would help make his father’s casket. He and a friend found planks milled from Coosaw’s cypress trees and nailed them together to form a box. Mark chose the place to bury his dad, whose only instructions had been, “Bury me someday under an old oak tree.”

Mark found two huge oaks about a mile from the house in a field within sight of the Coosaw River. After a service in Beaufort, Mark and his siblings placed Doc Sanford’s body into the casket and loaded it into the back of the pickup. They drove it out to the two old oaks where John and a friend from Canada had dug the grave. They placed the coffin in the hole. The air was warm, which is often the case in the Lowcountry in late fall, and clouds were beginning to give way to blue. Their mom had gone back to the house to help make food for visitors. Sarah, in her dress shoes, said she wanted to walk back to the house alone. Mark and her brothers asked if she was OK to do that. Yes, she said, she needed to be alone.

Three rusty shovels were next to the hole. The moment called for something, and Mark said they should say a prayer. The Sanford brothers took each other’s hands, said a prayer and peeled off their coats and ties. Into the chocolate brown dirt went three shovels. They said nothing to each other as they filled the hole and Coosaw consumed their dad.

Schuyler Kropf and Robert Behre contributed to this story.