Lost Cause

2013
Chirgwin, Juan Carlos Luis

Today I am going to save the world…again.  This is a standing joke I make to my wife, and if there is a “lost cause” to support, I’ll be there! I know I am not alone.

Like an automaton I march out of our wealthy neighbourhood Town of Mount Royal, open the wire-fence gate separating us from Park Extension and prepare to cross this socio-demographic border.  The Acadie Boulevard is busy with speeding vehicles, zipping by despite the notorious Montreal potholes.  Off to the left and high above me on the top of a dirty apartment complex, a massive and ugly “T”-shaped communication tower offers its satellite dishes to the people:  the airwaves bring dreams of prosperity to the residents of Park Ex.  I think of the Lou Reed song as this tower transforms into a symbol:

“Give me your hungry, your tired, your poor
I’ll piss on ‘em
That’s what the Statue of Bigotry says
Your poor huddled masses
Let’s club ‘em to death
And get it over with and just dump ‘em on the boulevard”

Harev is every doctor’s lost cause.  At the community health centre where I work, he came to my drop-in clinic to ask for his ear drops, drops in an ocean of need.  He spoke loudly in some words resembling bits of English (“Somebody!  Somebody!”) and made buzzing sounds as his fingers opened and closed by his temple.  Was this tinnitus?  Over numerous frustrating encounters, the pieces of the puzzle more or less began to fit together.  He was a victim of cranial trauma after being struck by a car in the late 1990’s.  He required urgent bilateral mastoidectomies, a long hospitalization with an unclear rehabilitation phase and then was lost to follow-up.  The social worker Andrew and I realized something was wrong when even the hired interpreter, who shouted Punjabi into Harev’s ears, was unsuccessful in crossing the communication barrier.  Apparently he spoke a dialect of Punjabi.  After Andrew, Harev and I crammed into the back of a taxi and secured the patient’s limited hearing test with the ENT specialist, no one could really know how deaf Harev really was.  

The years passed, and his chronic medical conditions worsened.  Deaf to most sounds, dependent on the peripheral vision of one eye, obese, diabetic, hypertensive and unilingual, Harev never threw in the towel.  He lived in squalor but somehow kept his apartment with occasional interventions by Andrew to appease the angry landlord.  Harev would navigate the streets using his sawed-off plastic mop stick.  He would seek me out at the clinic, grimace as he held his belly and make buzzing sounds while he touched his head.  One winter he was sitting under a bus stop shelter and a psychotic, skinny man was rifling through Harev’s plastic shopping bags.  Harev protested with words only.  I told the skinny man to leave him alone but to no avail.  A second threat to call the police finally drove the man away.  This incident was the beginning of the end for Harev’s autonomy.  Andrew and I could no longer keep him safely in his apartment because we felt he might not survive another winter.  We involved an ethicist and got him admitted for a global assessment.  Now he is living in a semi-independent care facility but is unhappy there.  It was never easy to follow him, so I should not expect this to change now.  The difference is I ended his free life, and I sense he knows this.   

Walk down Jean Talon Ouest, and the store front names reveal their nationality:  Village Grec Souvlaki, Halal 786, Sousmarins Nha Trang, Mode Shamu, Maison Afrique, Priyanka and Thurga.  The Salvadoran joint sold grilled pork sandwiches, then closed down and was later replaced by a halal pizza eatery.  Fast food nation feeds the economically deprived faster than I can detect and treat their diabetes and hypertension.  Immigration Canada Dream, one of many offices for so-called immigration consultants, promises asylum acceptance, family sponsorship and certain other below-the-table propositions.  Those who lose hope can always go drown their sorrows at Taverne Bar Pam Pam. 

The hopeful arrive at airports and borders, walk into my examining room and re-connect me to the world outside.  An elderly couple fears police reprisal if they are forcibly returned to their birthplace.  They went into hiding after the deportation order was delivered.  There are husbands who abandon their wives during the asylum claim.  Left alone or with dependent children, the woman has been “shamed” in the eyes of the community.  The minister of immigration calls their claims “bogus” and cuts their coverage for basic medical services, which are guaranteed to all Canadians on social assistance.  He insists Canada will not be taken for a ride and tells me whom I should treat.  Why do I practice medicine in this chaos? 

My father must have shivered down in the basement of the city morgue in Santiago, Chile.  That year in 1973 it was still winter, but fear, horror and disgust must have added to his chill.  His country had just experienced the first 911, a terrorist attack orchestrated by a foreign government and executed by our own armed forces.  The morgue was full of Chilean corpses, and he remembers their wounds, the blood and the impossible remains of what should have been faces.  The rows of dead went on and on.  Democracy was lying there at his feet, mangled and torn beyond recognition.  An elected government, elected and supported by the majority, had the audacity to bring food, education, health and employment security to those who had in the past only dreamed of such privileges.  Three years of success was too much for the few and the powerful cliques, who feared progress at their expense, and so the hounds of war were unleashed on its own citizens.  My father was looking for Eduardo, his brother-in-law, and was relieved not to have identified him among the cadavers.  In 2013 my mother and aunts will gather in Santiago to continue the search for his remains.  Three thousand dead and missing Chileans remind us of the cost of democracy.

So what is a “lost cause”?  Is it a futile option, which can be replaced by a better one with a better chance of success?  Is it something we can discard, skin we must shed as we mature and abandon utopian dreams?  Is it wisdom of historical experience which allows us to accept a polluted planet threatened by more wars, more crushing poverty, countless millions displaced and seeking refuge in our territories, and a stalemate of ideological giants with 20 000 nuclear weapons trained on each other’s cities?  How do we explain that to our children?  How can we kiss them good night and wish them peace if we adults allow our virtues to wither and die?

Truly, a lost cause cannot exist, only the lost hope, which yearns for justice and caring.  Dreams have materialized for thousands of people in this country and across centuries because of such sentiments.  Others have done so in other places.  I wish this to be true for my family and descendants, but only wishing will not make it so.

Theme: Community | Communauté
Theme: Health Care Delivery | Prestation des soins de santé
Theme: History | Histoire
Theme: Patients | Patients
Theme: Physicians | Médecins

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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