By Arne Vainio, MD
I was looking for an old truck someone had told me about and I thought I had the right place. She slowly stepped out of the house into the hot summer sun. She was thin and pale and I didn’t recognize her until she spoke.
“I heard you’re going to medical school. I always thought there was more to you than you let on.”
As I was growing up I had worked lots of jobs that I liked, but they didn’t really lead anywhere. I was a skidder operator for years and worked dragging trees out of the woods so they could be loaded onto trucks and brought to the saw mills. I worked on a saw mill and I was used to hard and dangerous work with very little pay. There was no health insurance offered and going to see doctors was not anything anyone routinely did. I was in my late twenties and any thoughts of mortality were distant and didn’t apply to me.
I knew her, but she was much older than I was and I hadn’t seen her in a very long time. She knew my mother and she was easily a generation older than me. Her husband drank himself to death and I knew he was a mean drunk when he was alive.
When I made the decision to go to medical school, I was a professional firefighter and a paramedic and I loved what I did. Every time the truck or the ambulance went out, someone was in trouble and we had a chance to save another life. Most of the time we did.
I sometimes saw death and most of the time it came out of the blue.
She leaned against her cane and I could tell even that was an effort and she spoke in short sentences.
“I could tell you didn’t recognize me. I was getting sick and I couldn’t eat and I was constipated all the time. I tried drinking warm water and I ate prunes and that didn’t help. I went to see a doctor and he did some blood tests and said he didn’t see anything and I didn’t go back for a long time.”
I didn’t know what to say and we were both silent. She took a deep breath and went on. “I remember when you were a little kid. You used to read those science fiction books when everyone else would rather watch TV. Do you still read them?”
“I do.” I answered.
“I always liked that you did that.” She said. “I like to read and my husband and my kids thought it was such a waste of time. I always wanted to go to a tropical island somewhere and I wanted to swim in the ocean and watch the sunset from the beach.”
“Did you ever get to do that?” I asked.
“I never did.” She replied. “My husband never wanted to travel and said everything we needed was right here. Now I’ll never get to go.”
“Why is that?” I asked.
“I went back to the doctor.” She replied. “They took me to surgery to see what was causing my stomach problems. They found out I’m all full of cancer and there’s nothing they can do. They closed me back up and told me I have less than 6 months and they sent me back home. My kids are going to take turns staying with me for as long as I can stay here.”
“I’m so sorry to hear that.” I replied.
She took my hand and said, “I want you to feel my belly. All that cancer is inside there and I want you to know what it feels like so you never miss this.” She put my hand over her stomach and she pushed it down hard and she moved it to different parts of her abdomen and she kept pushing. I could feel multiple hard areas throughout her abdomen and I was worried her pushing so hard was going to hurt her. She could tell I was trying to hold back and she pushed my hand down harder and said, “I know you’re worried about hurting me and I want you to feel this deep inside. I’m an old woman and I don’t have anything left to pass on to anyone. My opportunity to leave something permanent is gone. I want to know the first time you ever recognized cancer was here. You’re going to feel this again and you’re going to have to tell someone what it is. You need to know what this feels like so you catch it earlier than they did with me. If you’re going to be a doctor, you can’t be afraid.”
I pushed deep into her belly and I knew where the major structures in her abdomen were. I followed along her large intestine, past her left kidney and up to her spleen in her left upper quadrant. I followed her transverse colon past her stomach and her pancreas and over to her liver in her right upper quadrant and her gall bladder under that. I followed her colon down past her right kidney and down to her appendix and over to the center of her abdomen by her umbilicus. All along I kept finding hard nodules and masses with softer, normal areas between. She winced occasionally as I palpated and she finally spoke again.
“You’re a reader. You know there’s a whole big world out there I will never see. All those beaches and sunsets will have to live in my imagination. I can picture them and I can smell the ocean and I can feel the breeze on my face if I just close my eyes. I know you get that and I know you can close your eyes and be by the ocean or on Mars or anyplace you’ve ever read about. You and I have that in common and you’re the only one who understands me.”
She was quiet again and then she spoke.
“I want you to be a good doctor. I want you to travel and I want you to dream. I want you to not listen when someone says you can’t do something or that something you desire doesn’t make sense. I want you to never miss anyone’s cancer. Someday when you’re watching the sunset with the ocean breeze on your face I want you to close your eyes and remember me.”
Arne Vainio, M.D.(Mille Lacs Ojibwe) a family practice physician on the Fond du Lac reservation in Cloquet, Minnesota. He can be contacted at firstname.lastname@example.org.