Commentary: The Promise of a Warrior

The Promise of a Warrior

By Arne Vainio, M.D.

News From Indian Country

I was in my residency training in Seattle and it was the first day of my surgery rotation. The surgery team was rounding at 6 AM and we were dividing up the patients on the service.

I was a brand new physician and uncertain of myself and constantly afraid of doing something wrong. The chief resident was in charge and there were three other surgery residents on the team. We covered rounds fast and we went from room to room to take care of post-surgical issues, draining wounds, cutting dead tissue from infected sores, managing pain, managing low blood pressures and patient fluid status and all the other issues that come up after surgery. We had over thirty patients on the service and there were new patients coming in through the Emergency Room and by referrals and there were patients to discharge to home or to nursing homes to continue their recovery once they were past the acute phase.

The team stopped in front of a room and the chief resident told the team, “Mr. Jensen is eighty years old and he has five fractured vertebrae from jumping out of an airplane. That was over a month ago and we can’t get him out of the hospital. He’s mad at everyone and all he wants is pain medicines and no one can talk to him. He won’t eat, he won’t get out of bed to work with physical therapy and what he was thinking when he jumped out of that airplane is anyone’s guess. He was too old to be doing something like that.”

We went into the room as a team of six and the chief resident asked him loudly, “Mr. Jensen, how are you doing today?”

“My back is broken. How the hell do you think I’m doing? I hurt constantly and I can’t walk and that physical therapist is trying to kill me. Get the hell out of my room!”

We walked out of the room and into the hallway. The chief resident looked at the assignment list and said, “Dr. Vainio, he’s your patient and you need to get him out of the hospital. No one has been able to talk with him. There isn’t anything surgical we can do to fix him, but he needs to be eating and he needs to start walking. Good luck.”

We finished rounding and I had other patients assigned to me and spent most of the morning discharging patients to home or to nursing homes, getting discharge medicine lists right, writing prescriptions and dictating discharge summaries. It was late afternoon when I got back to Mr. Jensen’s room. I knocked on the door and there was no answer. I opened it slowly and he was lying in bed glaring at me. “What the hell do you want now?”

I pulled a chair close to his bed and held out my hand. “I’m Dr. Vainio and I’ll be the doctor mostly working with you.” He looked at my hand, but didn’t shake it. “I’ve seen plenty of doctors and another one isn’t going to make any difference.”

“Fair enough,” I said loudly. “Is there anything I can do for you?”

“You can make my back stop hurting. I know everyone thinks I was crazy for jumping out of an airplane, but I did it and now I hurt all the time. You can’t change that, can you?”

“I can’t. Is there anything else I can do?”

“You can get me new batteries for my hearing aids.”

I put an order in his chart to get his batteries and the next day I went back to see him after morning rounds were done.

“How are you doing today, Mr. Jensen?”

“My name is Bill and you don’t have to yell anymore. My hearing aids are working fine. What did you say your name was again?”

“Dr. Vainio. What do we need to do to get you to eat? You need to eat so you can heal.”

“I get sick to my stomach and start burping when I eat anything. I haven’t had a good bowel movement since I’ve been here because it hurts my back when I try to have one. The nurses ask me about it, but it’s none of their damn business.”

“Actually, it is their business. If you don’t have a bowel movement, everything backs up. When you eat, it causes a reflex that makes your intestines move stuff out of the way. If your gut is really full and your stomach can’t empty that way, it tries to come back up your esophagus and makes you want to throw up.”

“So how do we fix that?”

“An enema to start and you should be on a regular bowel program with some fiber and a laxative.”

“I don’t want to be on more medicines. I wasn’t constipated before I came here and something here caused it. Is it the hospital food?”

“It isn’t the food. The most likely cause is the narcotic pain medicine you’re getting for your back pain. Those medicines cause lots of constipation.”

“My back is going to hurt worse if I stop those medicines. It’s the only thing that gets me through.”

“Your back likely will hurt, but those medicines don’t help as much as you think they do after the first few days. Most of the time people get dependent on them if they take them for too long and it’s really hard to stop taking them.”

The next day he was sitting on the side of his bed eating lunch when I came in. “That enema really helped and these hospital peas and carrots never tasted so good! My back hurts worse, but I’m trying to use less of the pain medicine. Physical therapy really hurt today, but I’m going to try to walk out of here if I can.”

The next day he took a few steps and made daily progress and a few days later I came into his room. I was really starting to enjoy our visits and he pointed to the chair when I walked in. “Sit down, Dr. Vainio. Where are you from?”

“Minnesota. Out in the woods up north.”

“Everybody thinks I’m crazy for jumping out of an airplane at my age. Do you think that?”

“I don’t, Bill. I hope when I’m eighty that I can even consider doing something like that. You’re the only one I’ve ever seen do that and I respect you for it.”

“Well, that will be the only time. My brother Randy and I were twins and he was born a couple of minutes after I was. He had polio when we were kids and it left him in a wheelchair. When we were in high school, I played football and he couldn’t. When I went into World War II, he stayed behind and I could read in his letters what he lost by not being able to do the things I did. He always wished he could have jumped from an airplane and he asked me to describe it to him again and again and no one was prouder of me the day I became a Major. He was diagnosed with colon cancer and it was too far along when they found it. The day he died, he asked me to tell him one last time how it felt to jump from an airplane. I did that jump on our birthday and I tried to see it from my brother’s eyes. Now I see that was the thinking of a foolish old man.”

“I see it differently than that, Bill. I see it as the promise of a warrior to a brother who always looked up to him. I see it as strength and courage and love. There isn’t anything anyone can do to fix your fractures and they have to heal on their   own. I have no doubt you’ll have the strength you need to get past this and I admire you for what you’ve done for your country and for your brother.”

“Thank you, Dr. Vainio. I think I’m about as ready as I’ll ever be to leave the hospital. I’ve taken a few steps and I know I’ll be able to walk again. Randy never had that chance and I’ll walk for both of us. I’ll be thinking of you when I do.”

“I’ll be thinking of you, Major Jensen. Is it proper if I salute you?”

“Normally, the correct etiquette for a civilian is to hold your hand over your heart, but a salute from you would be fine by me. Can you help me up?”

I helped him slowly rise out of his chair. I could tell it hurt for him to stand and I knew he was standing for a brother who never could. He stood tall with his feet together and his hands at his side and I hoped my salute was a proper one.

I helped him back into his chair and went to get started on his paperwork.

Gwayakwaadiziwin

By Arne Vainio, M.D.

News From Indian Country

One of our teachers, James Vukelich, posts the Ojibwe Word of the Day on Facebook every Thursday and I try to never miss it. These are beautiful lessons in what the words in our language mean, where those words came from and how our ancestors could see the best place to put some of our most important lessons so they wouldn’t be lost is in the language itself.

Gwayakwaadiziwin means honesty, but it means much more than that. It means to live a life so others can see your honesty and integrity and virtue. It means following through with what you say you will do.

The next day I was off work and I was thinking about living my life in that way and I didn’t take the first drink of my coffee. Instead, I remembered when George Earth was dying and he asked me to pour some of the spring water I collected on the ground at his funeral. Since then I make it a point to spill some of my coffee on the ground in the mornings before I take the first sip and I offer it to George and all of my relatives who have passed on. I offered my asemaa to the four directions and to the spirits in the water and to the earth and to the sky. It felt good to start my day in that way and I had lots of things to do and I silently vowed to do everything with integrity.

I had to go to the bank and the wait was long for some reason. I went to the store and I got into the line right after someone who had a full cart and she cut in front of me, even though she could see I only had three items. I needed to bring the rest of the liquid nitrogen I used for my mad science demonstration back to the welding supply place. I forgot to put it in my car and I had to drive back home to get it. I had to go to the tool supply place because I needed a new chain for my saw and I didn’t have the right part numbers, so I couldn’t pick it up. I ordered an antenna for my wife’s car from the internet and it didn’t pull in any radio stations and I had to go to the post office to send it back and I was third in line.

My hope was to work on one of my old cars and I hadn’t been able to do that for a long time. I finally got back home and realized I drove over 45 miles a couple of days before to pick up an engine stand and I didn’t bring part of it home. I had to drop everything and get into my rusty old truck and try to drive 45 miles again and get there before they closed.

I was trying to hurry and I came to a traffic light that is never green. This was a light that normally takes forever to turn green once it turns red and I was sure I was going to make the light and…

A pickup truck pulled out from a side road right in front of me and I had to slam on the brakes to slow down and I was sure he was going to make me miss that light. I could have let this pass, but instead I laid on the horn and stopped in front of him as he was pulling out from the side road. He stopped and I was able to go around him, but not until I got a good look at him. I was expecting a younger person who would maybe give me the finger or shake a fist at me and I wanted whoever it was to know they didn’t even look before pulling out in front of me and that this could have caused a serious accident. I thought maybe this was a beginning driver who might learn something from such a close call.

What I didn’t expect was an old man who was at least 90 years old. The skin on his face was thin and wrinkly. His eyes were blue and his hair was white and his head had a steady side to side tremor. He was alone in the truck and I could tell he was used to being alone. He didn’t look at me with anger or apology and he didn’t look at me at all. Instead, he threw his hands into the air and I could see him start crying. His hands were in the air in a gesture of giving up, of complete surrender and he slammed on his brakes and I went around him and I made it through the light and I left him behind.

Who else left him behind? His wife? His brothers and sisters? All of his friends from work? He most likely outlived all of them.

His vision and his hearing and reflexes were not what they used to be and I sensed he was isolated and alone and his long life had allowed those things most important to him grow old and die or to simply fade away.

In my hurry, I could see I was the straw that broke the camel’s back for him and I couldn’t stop thinking about him on my 45 mile drive. I thought about him as a young man, strong and with his entire future ahead of him. I thought of him finding love and raising children who inevitably found lives far away and only saw him occasionally and had a hard time talking to him on the phone. I saw a 90 year old man holding on to the last of his independence.

I saw the fragility of that independence and no doubt he had been seeing signs of it for a long time. Now his hearing and vision loss almost caused an accident and he would be too well aware he was the cause of it.

I picked up the rest of the engine stand with about five minutes to spare before they closed. I noticed my own strength as I picked up the steel frame and lifted it over the side of the truck and thought about what it would mean to have that strength taken away from me.

On the way home there was a rock outcropping on the top of a hill. I stopped my truck on the side of the road and I climbed until I was overlooking a small valley. I put my asemaa out for that old man. I had never seen him before and had no reason to think I would ever see him again. He would never know I climbed this hill for him and maybe he wouldn’t even see it as important.

I saw it as important. A light breeze picked up and it took my asemaa and it carried it out over the valley. I asked forgiveness from those who had gone on before me. I asked forgiveness from the old man.

On the first day of my new way of life, gwayakwaadiziwin, I didn’t live up to the lessons our old ones put into our language. My brief moment of anger had a lasting effect on someone else.

A moment of kindness would have lasted forever.

Arne Vainio, M.D. is a physician at the Fond du Lac Reservation and he was awarded the Association of American Indian Physicians’ Physician of the Year Award. On the Fond du Lac Band's website, Doctor Vainio relays his, "primary role is that of a teacher" and he hopes to accomplish that "in a series of articles," with the goal of addressing "complicated medical issues in a way that makes sense, and to empower people to take part in their own health care." 

 

What Do You Want to Be When You Grow Up?

By Arne Vainio, M.D.

They were late to the appointment and I almost wasn’t able to see them. A five year-old girl missing one of her top teeth and her mom, single and taking the day off for this appointment. She was in college getting her general requirements done and one day hoped to go into nursing. She worked at the casino and had been there for several years.

The girl had a cough for the last week and her mom thought it was getting worse. She was coughing off and on as I was getting the history from her mom, but she was also singing songs from one of the animated princess movies and she was dancing and doing pirouettes and wearing a billowing blue princess dress.

She had a beautiful singing voice.

I showed her the ophthalmoscope and let her look into my hand with it and showed her how it magnified my fingerprints. She turned her head so I could look in her ears and both of her eardrums were fine. I looked in her nose with the scope and could see some puffiness in her nasal passages and the back of her throat looked fine. I checked the lymph nodes in her neck and told her how they were part of her immune system and how they can get bigger when they are fighting an infection. I listened to her lungs in four different places on her back and told her how her lungs move air in and out and how they sounded normal without any wheezing or sounds to suggest pneumonia. I listened to her heart and told her as I was listening to each of the four valves how her heart beats over 100,000 times per day, every day and it never stops. I checked her abdomen and told her as I followed along her large intestine and palpated her left kidney, then her spleen and her stomach and her pancreas, then her liver and gall bladder and her right kidney and then her appendix, then her small intestine in the center of her abdomen and she listened to every word.

“You have a cold. Antibiotics will not help this and it just has to run its course. Cough syrups are fine and it’s OK to take medicines to help with fevers and achiness. Chicken soup and a mother’s love are what you need most and the chicken soup is optional. You have a beautiful singing voice and I don’t know when I’ve seen someone who could stand on their toes so gracefully. I’ve known you since you were born and I know that you’re bright and I know you’re a good reader. What do you want to be when you grow up?”

“I don’t know.”

“It’s not too early to start thinking about it. Those big movie studios that make the princess movies want you to buy dresses and clothes and they want you to buy dolls and all the things that go with them. They want you to want all those things. But they also want you to think that your greatest value as a girl is how you look. When you go to the mall, look around. Everything there is telling you that you need to be thin and you need to be pretty and you need to be giggly and superficial. The songs you listen to are telling you the same thing. Everything around us wants you to be a helpless princess and it wants you to be saved by a prince who rides in on a high-stepping horse. Almost all of the shows on TV are trying to tell you the same thing.

Right now you like to read and I know you understood when I was telling you how many times your heart beats. Someday, someone will try to tell you reading is hard and math is hard.

It isn’t. Math is rules and learning the rules isn’t hard. Science is mostly noticing the world around us and wanting to know how it works. All those things that want to turn you into a princess are meant to make it harder for you to do what you want to do.”

“But I like being a princess.”

“It’s OK to be a princess sometimes, but you need to be a doctor. You need to stay smart and you need to make sure your mom studies and makes it through college. Have you seen how hard she works at it? She needs you to believe in her.”

“Sometimes she cries when she isn’t ready for tests.”

“Everybody cries when they aren’t ready for tests. The important thing is that she’s working hard to make a better life for both of you. Good parents always want their kids to do better than they do and that’s why she works so hard in school. She wants to be a nurse so you can be a doctor.”

“Is that true, Mom?”

Her mother was crying. “It is true. I just want the best for you and I never thought about you being a doctor. I’m always proud of you and I would really be proud if you were a doctor.”

My pager went off and it was time for me to see another patient. I turned to the girl and said, “Remember, this cold is going to get better. You keep reading and getting good grades and I will do whatever I can to help you be a doctor. One day a frog is going to tell you if you kiss him, he’ll turn into a prince. He’s going to be very convincing and they always are. Do you know what you need to do?”

“What?”

“Leave him in the swamp. He’s just a frog.”

She was laughing and she started singing as she pirouetted toward the door. Her mother reached up and squeezed my arm as she walked past.

“Thank you, Dr. Vainio. It’s hard doing this alone and sometimes we barely get by. I’ve thought about dropping out and I have cried when I’m not ready for tests. But this is important and she needs to see me finish. Thanks again for talking to her. I think I needed to hear that as much as she did.”

Arne Vainio, M.D. is a physician at the Fond du Lac Reservation and he was awarded the Association of American Indian Physicians’ Physician of the Year Award. On the Fond du Lac Band's website, Doctor Vainio relays his, "primary role is that of a teacher" and he hopes to accomplish that "in a series of articles," with the goal of addressing "complicated medical issues in a way that makes sense, and to empower people to take part in their own health care." 

(From News From Indian Country)

Do you believe in dreams? 

By Arne Vainio, M.D.

"Dr. Vainio, I’m not so sure I want to live anymore."

It was early in my residency in Seattle and Victor had lived as a fisherman all his life. He and Genevieve raised their children on the water and he knew the islands and he knew Puget Sound.

He knew the best places to fish and he knew what time of year was best for any given fish. He’d been close to pods of whales and he watched the sun rise and set from his boat.

I never met Genevieve and she died a couple of years before I came to Seattle. The first time I saw Victor was for an infection in his hand after cutting it on a rusty piece of metal when he was working on his boat. He was relatively quiet that first time and he didn’t seem to want to use any words that weren’t necessary. He listened carefully as I explained what the redness in his hand meant and the need to see me again after I started the antibiotic to make sure his infection cleared.

He did come back and his hand was better. “It was so swollen I could hardly bend it and now its fine. I’m glad I came in. This happened to me once before and it was a couple of months before it got better.” After that he only wanted to see me and for the most part, his life on the water kept him in good health.

Over several visits he opened up about what troubled him. He came home from fishing one day and found Genevieve on the floor. She’d had a stroke and he called an ambulance. She died after a couple of days in the hospital and never fully woke up. He told me how he stayed with her the entire time and how after she died he was lost and alone.

“Her funeral was awful. There were so many people there and all I could think was she would have been alive if I was home when she had her stroke. I knew her since we were kids and I never wanted anyone but her. We were married forty years and she was too young to die.”

The day he told me he wasn’t so sure he wanted to live anymore was after a couple of bad months fishing. He made his payments by what he brought in and he thought luck was against him. Normally the rainy weather on the sound didn’t bother him and he liked the way the cries of the water birds were kept close by the low clouds and he reveled in the view of the mountains through the breaks in the rain.

Now it was just clouds and gloom. “I always think about Genevieve and you’d think I would be better by now. It’s been almost three years since she died and when the clouds are out it seems like the sun will never shine again.”

I talked to him about antidepressants and he was reluctant to try them. “I don’t want to get hooked on pills. I need to pay attention when I’m on the water.”

He wouldn’t see a counselor and “I only want to talk to you.”

He started having trouble sleeping and he started to gain weight. “It’s because I’m so tired all the time. All I want to do is sit at home and eat.”

His lab results were normal and I talked to him again about depression. He finally agreed to start an antidepressant and I saw him back in a couple of weeks. “I feel about the same. I don’t know if these things are making any difference.” I discussed with him that often the person taking the medicine isn’t the one who notices a difference, but the people around them.

He smiled the first smile I’d seen in a long time. “I’ve been having more dreams. Lots of them have to do with fishing and my dad was in one of them. I think the fishing is going to get better.” He agreed to increase the dose and we set an appointment for another month out.

One month later and the room was brighter when I walked in. “The fishing is getting better and I’ve been getting up early again and I can’t wait to get out on the water. My dad has been coming to me in my dreams and it almost feels like we’re fishing together.” He didn’t want to change anything and agreed to see me again in three months.

Residency is a busy time and the next three months were filled with clinic and studying. I was doing a rotation in emergency medicine and the days flew by. Suddenly it was three months later and Victor was in my schedule.

He looked good and I told him as much. “Dr. Vainio, you know those dreams I was having? Genevieve was in one and only one of them. I was on the boat and she was with me, just like we used to be. The rain was coming down and we were trying to get back to shore and the boat was working hard. It seemed like that went on for a long time. Then the clouds broke and the sun started to shine through. Genevieve turned to me and she said, ‘Victor, I want you to be happy.’”

“Then she was gone.”

He went on to tell me that not long after that he stopped in at a small café and the woman there was running it by herself. She was there at 6:30 in the morning when he stopped in and she was there at 6:30 in the evening just before it closed. He said she never complained and she was nice to everyone who came through the door. “I never thought I would see anyone work as hard as Genevieve and there she was.”

I finished my emergency medicine rotation and then a medicine rotation and an orthopedics rotation and I was getting ready to start a rotation in obstetrics. I loved Seattle, but I wanted to get out of the city for just a day and I got up early and I drove. I got off the freeway and I drove along the sound as much as I could. The water sparkled and the sun was bright and it was a beautiful day to be just driving. I drove past some expensive restaurants and tourist destinations along the way and I wasn’t following any planned route.

I stopped for lunch at a small café with a gravel parking lot. There were mostly trucks parked in the lot and I could see this was a place where working people stopped. I walked in and Victor was behind the counter wearing a white apron.

“Dr. Vainio! I’ve been meaning to stop in and see you, but things have been pretty busy. It seems like this place never slows down and I don’t know when I’ll get a chance to get that way again.”

There was a woman in her mid-fifties taking orders from one of the booths and she walked over and stood next to Victor. She could see we knew each other and she looked at me, then looked up at him.

“Dr. Vainio, this is Elizabeth. I have never seen someone work as hard as she does and I’d put her up against any man in this place, including you. We were married about a month ago and it was a small ceremony. I still fish when I get a chance and we’ve been running this place together and I have to say I don’t mind working inside.”

She shook my hand and went back to clear a table. I ordered my lunch and Victor brought it to me at the counter.

“I stopped taking the antidepressant, Dr. Vainio. I didn’t figure I needed it anymore and I don’t know when I’ve been happier.

He slid the plate toward me. “It’s on the house. Do you believe in dreams, Dr. Vainio?”

Arne Vainio, M.D. is a physician at the Fond du Lac Reservation and he was awarded the Association of American Indian Physicians’ Physician of the Year Award. On the Fond du Lac Band's website, Doctor Vainio relays his, "primary role is that of a teacher" and he hopes to accomplish that "in a series of articles," with the goal of addressing "complicated medical issues in a way that makes sense, and to empower people to take part in their own health care." 

(From News From Indian Country)

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