Monday, July 21, 2008

The intersection of faith, family and survival

Bill’s daughter Mary is worried about him again. He is elderly and she fears he is over-committed in the community, considering his multiple medical problems.

She hasn’t approached me this time with her concerns, but it seems I cannot escape them, it being a small community. On Sunday at lunch, I am sitting at the corner table of the “Chinese-Western Diner,” feasting with my family on wonton soup, grilled cheese with ketchup, and buttermilk pancakes. A mutual friend approaches and asks me, as Bill’s physician, whether I think he should slow down, and in particular, cancel a bible study group that meets Fridays at 7 a.m. at a tiny local church.

I weigh my words carefully, wanting to protect the dignity and confidentiality of all involved — but particularly my friend, mentor and patient. “Well, I think Bill is in the best position to decide how he wishes to spend his energies, and I’m sure he’ll consider (well, consider, then happily ignore, judging from prior experience) his family’s concerns.”

“Great,” she responds with a smile; “See you Friday at seven.”

I turn back to my husband Paul, who stifles a chuckle. “It must be hard for Mary to sleep in when Bill is shuffling around the house at 6 a.m. on Fridays,” is his only comment.

Paul loves Friday mornings as much as I do; after bible study at church, I drive Bill back to our house, where Paul reads to him for an hour or so over tea. Bill still subscribes to his favorite magazines, despite losing his vision to macular degeneration, and Paul enjoys the excuse to read archaeology, history and international news with a good friend.

During residency, I was frequently warned not to serve as a friend’s physician, but my perspective shifted after moving north. It has been said that in a small community, physicians who won’t treat their friends have either no friends or no patients.

Yellowknife is large enough to balance these approaches, depending on the situation; and Bill has always preferred to be under the care of someone he knows and trusts as a friend. At times I have distanced myself from his care, insisting he also have a family physician and stepping out while a colleague on call prepared for a transvenous pacemaker insertion.

The hardest area has been discussion of code status. After a particularly difficult year — punctuated by repeated hospitalizations and a few medevacs — we addressed the topic in the comfort of my clinic.

I felt foolish outlining the question to a minister who traveled 3000 kilometers per year by dogsled in “the early days,” witnessing Inuit families torn apart by tuberculosis treatment and conducting funerals for infants who died on the trail during Arctic migrations. Bill understands human fragility far better than I do, and has had 50 years in the Arctic to reflect on the intersection of faith, family and survival.

He nodded slowly, and smiled.

“Yes, I understand what you are asking. I trust you and your colleagues to make the right decision, and I hope that the physicians looking after me would contact you and speak with my family as well.”

In his own wise way, he sidestepped the easy questions — tube or no tube? CPR or not? — and yet provided exactly what I needed to know.

Clinical situations change, but the guiding principles of his life – which he knows I share – will ensure that he lives and dies with grace, dignity, and hope. The best I can do for his code status is to advise: “Be sensible, be compassionate, and please call me.”

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