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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