We Made a Deal

2015
Buchan, Susan

We made a deal. She would call me every other week from Fort McMurray. That was the agreement I finessed, the only viable option she would have for connection with someone in this world. Someone who knew where she was and what she was doing. There was no starting fielder, no pitcher, no team for her. Alone and poor implied sadness and need. This was my early understanding and I felt compelled to assist in what I assumed was her search for elusive health and happiness.

Brenda had been one of those patients who had drifted in and out of my practice on the waves of circumstance. She first came to see me ten years ago for back pain, a likely consequence of years of driving tour buses. I remember admiring the strength and vigour she must possess to be able to drive from one destination to the next only to be greeted by the loads of luggage to be unloaded off the bus. She had undergone a remote lumbar discectomy and the combination of prolonged sitting and heavy lifting provided constant painful reminders. We would discuss her current symptoms and pain management options before getting to her social history which began as superficial conversation and progressed to deeper inquiry.

Those early questions about her past, her family, her lifestyle were initially met with guarded evasive responses. But ensuing visits unearthed more revealing answers and the construct of a life slowly took shape. I learned that Brenda was adopted by a Pastor and his wife when she was an older child. That prior to her adoption she had endured sinister abuses, forever incarcerated as unspeakable memories. I learned that she was married for too many years to an alcoholic. That she had had three kids. That she knew where two of those kids were but could not account for the third. That she was alone in the world with no gravitational pull to anyone or anything. There were short term friends that had come and gone and a daughter in Edmonton who she might hear from twice a year. Visit by visit the story of her life unfolded. Somehow Brenda was able to fracture this canvas of sadness and pain as she described a life that was also peppered with joy. There was an old boyfriend who was kind and she had loved for one luxurious moment. There was a sweet friend she shared laughter and secrets with that one summer on the edge of eighteen. And there were her adoptive parents who took good care of her for a short time. Remarkably, I began to see the happy hopeful woman sitting before me.

Unfortunately, her arthritic hip progressed to the point whereby she was unable to lift over sized tourist’s over stuffed suitcases. She was going to figure something else out, something better. Adversity seemed to invoke new and exciting possibilities for Brenda. The escape plan would seduce her to Fort McMurray where she accepted a job driving workers to and from the oil sands. A job that promised great pay, room and board and no lifting. One last visit to say goodbye. I did my best to try to convince Brenda that I could refer her to an orthopaedic surgeon for consideration of hip replacement surgery and that she would very likely qualify for long term disability if she chose to stay. She made her point congenially clear to me that a disability pension was no option for her and that this was not the first time she had to pack up her life and move to a remote place for work. Work and independence defined Brenda and guided her path through the world. She promised when she was back in town she would stop by for a visit. And then she was gone.

And then she returned. Two years later on a busy Tuesday afternoon I opened the door of the examining room to find Brenda wearing an expression of pride and accomplishment. Her teeth were ‘fixed’, meaning she now had some. Her dignity restored, never really left her. And she was accompanied by a cane as she was now the proud owner of a new hip. She had undergone hip replacement surgery in Edmonton six months prior. There had been no post operative physiotherapy, no follow up with the surgeon, no comfort or meals from family or friends. She was now home for a nebulous while. Despite no viable job opportunities, no savings or family support she remained confident and expectant. Again exuding the implausible hopefulness I’d come to recognize. Brenda explained that she was looking into the possibility of driving school buses locally. So what if she would be paid about a quarter of what she was making in Fort McMurray she’d figure it all out. Here she was reassuring me with her impossible infectious hope.

My assessment of Brenda’s hip revealed that she had been left with very poor residual strength and precious little range of motion. The expected consequences of post operative neglect. Appropriate therapy under the supervision of a physiotherapist was financially precluded so I printed out post hip replacement recovery guidelines with exercises to carry out at home. Unfortunately home was not clearly defined as she was staying on the couch of a cousin’s friend. As I had worried, the school bus work did not pay the bills and so when an opportunity came up to go back to work in Fort McMurray, she made plans to leave. Again she seemed eager and happy to shift her circumstance. And again I had to question how she could be happy.

This time we made a deal that she would call me every two weeks.

The first phone call came exactly two weeks following her departure. She described her room, the bus she drove, the progress of her hip. The room was clean but a little too small. The bus had seen better days as had the boys she drove to work daily. She had faithfully been carrying out her exercises and she had been able to wean herself off of the cane.

The next phone call came exactly two weeks after the first one and lasted twice as long. Further details of her daily interactions with other driver’s and with the “oil patch boys” were expanding into amusing vignettes. She had managed to make more friends than enemies, she had won more card games than any one else and she was positioning herself for a bigger room. These little victories were all adding up for Brenda.

I looked forward to her call every two weeks, soaking up the carefully rationed accounts of her current life in anticipated intervals.

Her last call was to tell me she was moving in with her daughter in Edmonton. Excited to make a new start, a new life and happy to have another chance with her daughter. She promised she would call me every now and then to keep me updated.

I still get calls from Brenda. They are few and far between but she has stuck to the deal and forever altered my vision of hope and happiness.

Theme: Patients | Patients
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Relationships | Relations 

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

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