Mashkikiwinini: Thanking Sylvester, for his unconditional smile

by Dr. Arne Vainio

News From Indian Country

It wasn’t easy becoming a physician. But I didn’t do it by myself. I’ve had help and guidance all along from well educated people and teachers who spent their lives helping others advance.

I’ve had lots of great teachers and would like to publicly thank them, but was told I may not be able to use names without written permission and a release form. This may complicate things, but I’ll get it done somehow.

Sometimes teaching comes when you aren’t looking for it or even have the time to think about it.

Recently, one of my partners was off and I was seeing one of her patients in her absence. I was behind and rushed (as usual) when I stepped into the exam room and introduced myself. I had gone over his records enough to know he had metastatic (spreading) cancer, but his records were sketchy and I didn’t know much beyond that.

One of the nurses commented that she thought he was in denial about his prognosis before I went in, and that’s the expectation I had as I walked into the room.

I expected to see a man desperately holding out for a cure and a miracle. Instead, I met a smiling man who welcomed me into the room. His eyes were bright and clear, his smile was sincere and real. In spite of that, he was pale, gaunt and clearly sick. He had dark circles under his eyes and his words came in short, labored sentences. His belly was huge, even under his baggy shirt. He was clearly short of breath just sitting on the exam table.

“I would like to know if my cancer is worse. Last year I was told I had 5 months to live. This year I’m going to plant tomatoes.” He had no illusions about his cancer and his prognosis, he knew this was a bad cancer and was spreading.

I went through his records again in the room and found a CT scan report from 6 months ago. This was from a different medical system, the report stated “interval worsening” since his last study, with spread of cancer to multiple areas of his liver, into his abdominal wall muscles and into the mesenteric area (where the intestines attach inside).

His cancer was a GIST (gastrointestinal stromal tumor), which is a rare cancer. It can either be slow growing, or aggressive (very bad). Unfortunately, his was a very bad cancer and spreading rapidly. He had already asked to be DNR (Do Not Resuscitate) and this was in his records. There wasn’t much to do at this point except to make sure he was comfortable and didn’t suffer.

On exam his lungs sounded clear in the upper portions, but decreased in the lower right side. He lifted his shirt and I could see the massive tumor under the skin on the entire right side of his belly. It was tented up at an unnatural angle and as hard as wood. As I felt around the edges of the tumor, I could feel that it went deep inside his abdomen and I could feel other smaller tumors.

Sometimes diseases that involve the liver cause ascites, which is fluid collecting inside the abdominal cavity. I could not really appreciate this on exam, but was hoping for it as draining it could help his breathing. A chest x-ray showed part of one of his ribs eaten away and a mass inside his chest. He accepted this without complaint. Through all of this, he was smiling and planning his garden.

There was a social worker with Sylvester. I asked her “Is he always like this?”

“Short of breath?”

“No. Is he always this positive?”

“Always.”

I knew as soon as I met him that Sylvester had a gift. Not many could look death in the eye with his grace and dignity. I asked him if he would consent to go to the Medical School with me if I could set up a day so medical students could meet him and learn from him. Not just from a cancer standpoint, but from a spiritual standpoint and a lesson in the beauty of life.

We can all learn that lesson. He agreed immediately.

The following week was spring break at the Medical School. The week after that the medical students had preceptorships and were going to be staying with doctors in rural communities. The earliest time to get him to the Medical School was 3 weeks away. I was able to set this up and he was happy for the opportunity.

Early the next week I got a call from the social worker. Sylvester’s breathing was worse. He lived over 100 miles away and came to our clinic primarily so he could get his medicines from our pharmacy. The distance and getting rides for him was a major complication.

I set up a procedure to try to drain fluid from his belly under ultrasound. Unfortunately, there was no fluid present to drain. I then ordered a CT scan of his chest, abdomen and pelvis to see if the cancer was causing his shortness of breath. His kidney function tests were abnormal and he couldn’t tolerate the contrast dye needed for the scan, so he didn’t get it. He got up at 4 a.m., rode over 200 miles and wasted one of his few precious days for nothing.

Later in the week, I got a call from a hospice nurse.
Hospice is end of life care and is usually done in the last 6 months of life. This is wonderful care and allows those with terminal illness to spend their remaining time at home with comfort and dignity. He wasn’t necessarily any worse, but had finally accepted hospice care to ease his final days.

The next week I got a call from a doctor in the hospital in the town where Sylvester lived. He had been admitted to their hospital with a fever, but there was no source found for it. He became increasingly short of breath, confused and less and less responsive.

I had talked with the social worker the week after my only visit with Sylvester. She told me that on the drive home he was so excited to be going to the medical school. “I’m going to teach doctors! I always worried that I would be forgotten, now I get to have people remember who I was.”

She told me that sometimes he would play a harmonica for her in the car. “It was quiet and haunting, sometimes I could barely hear it. It was beautiful.”

As I wrote this article, Sylvester was in the hospital and was not expected to survive the night. He was not responsive and has family present. I wanted to be there and to hold his hand, but I was on call and I could not leave.

I wanted to thank him for teaching me the beauty of life and making me realize the things we take for granted won’t always be there.

I wanted to apologize for wasting one of his last days trying to get tests. I wanted to let him know that I’ll plant the tomatoes this year. I wanted him to know that he will be remembered. Always.

He will be some small part of whatever I do from now on. I wanted to say I was sorry for taking so long to get him set up to teach the medical students. His schedule was more important than ours. I wanted to thank him publicly. But I did not have a signed release, but maybe, I can get his family to allow me the honor.

Sylvester LaDuke

February 14, 1942 - April 9, 2007

Thank you, Sylvester.

Arne Vainio, MD (Ogimaabines)

 

 

Arne Vainio, M.D. is a Family Practice Physician at the Min-No-Aya-Win Human Services Clinic on the Fond du Lac Ojibwe Reservation in Northern Minnesota. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

 

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