By Blythe Sanders
Sometimes , you go through m edical s chool hoping you will develop the power to save. Surely, you believe, by amassing this enormous wealth of information you can fight disease and suffering to prolong the lives of those around you. Maybe you think only of saving patients, people who comprise a category of relationships with only distant connections to you . Perhaps you do not think you need to save those closest to you. They should be immune from any virus, bacteria, or disease. Friends and relatives are outside the sphere of pain, longing, and struggle you observe while on the wards. You learn how to evaluate a person with chest pain and manage complicated patients on a Medicine service, but you return home and phone your healthy family. And these two worlds of "future career" and "personal life" will never mesh. Right?
I was singing my heart out. "Yeah and he's tradin' in his Chevy for a Cadillac-ac-ac-ac-ac-ac you oughta know by now"...As I drove home from school, preparing to become the next American Idol, my cell phone scared me serious with its vibration. My m om informed me Grandpa had suffered a stroke. The awareness that s omeone so close to me had been shot down by affliction left me stunned. I was not ready for the integration of my education and person a l life. And how could Grandpa be sick? His name is Soldier, because he was born in the last year of World War I, and had two uncles in the Army. He spent eleven months as a prisoner-of-war when the B-17 Bomber he served as a gunner on was shot down. He suffered frightful weight loss and Nuremburg Prison Camp before escaping to face long hiking through Europe and the Danube River . Eventually, he stumbled upon General Patton's Army. This man , who has been awarded the Oklahoma Cross of Valor and the Air Force Escape and Evadee Society Medal , could not be ill. And yet, as I remembered how strong he is and how impossible it was for him to be sick, it had happened . It left him with sever e ly impaired short-term memory, and a droopy left eye. However, he had always been an avid golfer and tennis player, and had virtually no impairment to keep him from his natural atheleticism. He could still play "Pretty Woman" on the guitar, but he became a different person.
S hortly after his stroke he developed Alzheimer Disease. He began to wander, even during the middle of the night. Though everyone knows each other on my reservation, no one was willing to risk him getting lost. Throughout this time, I did my best to supply any medical information my family requested. I provided definitions, drug information, and descriptions of behaviors in an attempt to feel that, from a long distance, I was attempting to save. I gave my Dad The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life .
My Grandpa had good days and bad days. Almost always he sat in a large recliner, tucked in the corner of his living room, backed by a bookcase with a wall to his left bearing many framed plaques of his accomplishments. Initially, when I would st o p by he and Granny's house to visit , he w as always sleeping. My Granny would lean forward in her recliner from across the room and yell, "Grandpa, waaaaaaaake uuuuup, Blythe is here ." He would open his eyes, grunt a few times, and ask me, "How's school?" I would chat with him for a few minutes each time I visited , but my comments or questions were sometimes greeted with a blank stare. Could he not understand me? Had another CVA occurred? "Sheeee saaaaiiiid, howww arrre yooouuuuu doooing," Granny would belt, indicating I just didn't speak loud enough for my hearing-impaired Soldier. Ahhh, relief. Soon, when I visited and my entrance was announced by Queen Granny, Grandpa didn't ask me about school. In fact, he looked like he was searching for recognition of my face. When I talked to him the responses were nods or "mm hmmms" that never matched what I had said. Shortly thereafter, Granny's announcement was asking him who I was; this was her way, being a retired teacher, of quizzing good 'ole Grandpa to see how he was doing. Sometimes he got it right, other times he called me Faren (my aunt) ; the worst reply was silence.
Grandpa is now on an Alzheimer ward of a n ursing h ome. His initial placement there was, I believe, the most difficult thing my dad and Granny have had to do. My dad's bad back could no longer handle picking Grandpa up when he fell. He still wandered, and it was clear he needed more frequent care than any of my family could provide.
For a long time after he was admitted to the facility, he repeatedly asked when he could go home. All of us felt so much pain when w e imagined how he felt . He and my Granny are such homebodies, never taking lavish vacations or straying far from home. They took short trips, never by airplane, to see their other children. There was also the big yearly trip to the Cherokee National Holiday in Tahlequah, Oklahoma , where my Grandpa could see all of his family members of the Cherokee Nation.
His physicians said he would continue to have mini-strokes that would slowly debilitate him. Hopefully, they said, his last one w ill occur while he is sleeping and serve as a very peaceful death. He is 87 years old and is still on the same ward with a DNR order in his chart. His PTSD, a result of being a POW, manifests in combination with the Alzheimer Disease in tragic and difficult ways. I cannot disrespect him by describing the many events and struggles he has gone through while he has been there. Though describing these events may serve as clinically educational from my perspective, he is my family member and not the "87 year-old Native American male w/h/o multiple CVAs." It is very difficult for me to imagine what horrifying thoughts he sometimes has, and how it must be to drift in and out of the memory of who you are. My dad visits him every day, driving an hour to help him with dinner and the evening bathroom trip.
After asking in the beginning if a physician's two worlds will never collide , I know it is impossible. What happens, of course, is the slow or rapid realization that those you love may become the pain you have observed. They become the patients you tried to distance yourself from, so the sorrow and anxiety you felt about them would not filter through the phone and affect your non-inoculated family and friends . Medical school did not give me the power to save my g randpa. Until he became sick, my two worlds of medical education and personal life never touched. With one event, my perfect separation was destroyed.
Acknowledging the sickness of a family member led the rest of my family looking to me for answers. I have done the best I can as someone who has only completed medical school, and has yet to enter residency. Part of becoming a physician for me is serving as a source of information. I am the one who can tell my friends and family what a hemangioma is in plain English. I am the one they call when they have seen something on "CSI" they don't understand. I am the one they call for a second opinion, though I still have not figured out why a medical student should be able to give a better answer than a B oard- C ertified I nternist. Nevertheless, if you are an approachable person who will become a physician, friends and family will tell you the most personal details to get your help.
My full-blooded Indian g randpa would be horrified if he knew what his granddaughter knows about his clinical situation. These are details of his day-to-day life that are stressful and tragic. They are shared among the family members (only those who can handle it) so we remain updated on his care and health status . My Grandpa is a very stoic and prideful man. He has lived an extremely long life in the eyes of some. He is in a situation where he can barely feed himself now ; and though I am powerless to help him, I will do my best to make him proud. He would want me to become a physician who does not deny my roots, and respects the ways of elders like himself. When Granny tells me the way to cure an earache is to let a baby pee in your ear, I don't laugh any more. And I will go with her this summer to learn to collect bull nettle and make necklaces for infants who drool. I have seen for years how people come to her and request the necklaces that seem to be the only thing that keep their babies from slobbering all of the time. I am honored that she is ready to teach me how to make them. Hopefully, having traditional medical knowledge and tribal secrets will help me not to save everyone, but to heal many.
C. Blythe Sanders
UNC School of Medicine/School of Public Health