Martine and Evie

Minde, Thomas

I wept with deep sobs. How could this be? It was not her time!

The e-mail had been unexpected. It was from Jocelyne, who had explained it with simple devotion last week - Martine was her Elder.

A brain hemorrhage, and maybe a heart attack. Would she die? Was she in a coma? Would she be able to talk, to think, to bless others with her prayers and her presence as she had last week at our meeting, where she set the tone of the whole evening with a beautiful sacred sage smudge ceremony?

The scented smoke had risen in the room, as she circled to each one of us in turn. For some, she waved the smoke over us with her feather, as if caressing our aura. I sent my aspirations and prayers out with it, that this gathering of healers could be supported and that it might unfold and grow in the best way.

An auspicious first meeting, I thought, as I considered those who had accepted my invitation. Two dozen healers of all stripes; osteopaths and chiropractors, energy workers, yoga teachers, therapists, and a few physicians like myself who were tired of the constraints of the regular medical system and wanted to find a broader, more inclusive way of working. All of us seeking, somehow, a group of colleagues to share with and to explore the role of the spirit in healing.

* * *

Evie’s daughter and grand-daughter were there first, alarmed and worried. What was the problem, they wanted to know.

I explained that our small northern nursing station did not have much equipment, and that her symptoms were not that specific. It had begun with abdominal pain that morning, with nausea and vomiting. She had eaten a healthy Inuit meal of raw seal meat the night before, but no one else had become ill from it… I mentioned the various possibilities, and we prepared to arrange for the plane to come and pick her up to transfer her to a larger centre. She might not make it, I warned them.

Shortly we got the news that the plane could not land, as it was too windy. It was true; at lunch I had played a bit in the wind, seeing how far I could lean against it without falling. Quite far! Last night my entire apartment, a small transit house, was shaking and shuddering, as my mind thought of The Wizard of Oz and The Shipping News! Luckily we did not get blown away into the tundra after all.

Her pain was getting worse. After a while, she began having particularly foul smelling dark coloured diarrhea, and it became apparent that she was bleeding into her intestines somewhere. Her blood pressure started dropping, and she became more and more lethargic.

I started getting organized with the team of nurses for intubating her, to do a ‘code’ on her if her heart should stop beating. But I was getting more and more worried, as there was no back-up available. We were on our own.

The corridor started to fill with people. The other grand-daughters. Great-grand children, who were soon playing with abandon in the hallway. Friends. A minister, who said a solemn prayer as we all stood around her stretcher. Her sister, wailing with great distress. Another minister, who also said a prayer. People crying, hugging, supporting each other. A low hum of Inuktitut filled the air.

I sought out her sister. I explained that she was getting worse. I tried to give a context for what was to come. I asked if they really wanted us to do CPR on her sister. Struck with grief, she broke out in sobs, unable to think straight.

I found her two daughters and asked them. They tearfully asked me what I would suggest, and I had to admit that if it were my mother I would not wish to have her subjected to CPR and all that might follow. The one in red kept wringing her hands. We offered Kleenex, and I waited. But still no decision.

Her blood pressure was dropping further, and we started intravenous medications to try to help prevent that. Normal saline fluid boluses. Antibiotics. Intubation meds were prepared, and I checked the light on the laryngoscope. Her pulse climbed as her blood pressure fell.

* * *

My mind railed against the injustice of it. I thought of Martine, a wonderful grandmother, face shining with brightness and wisdom. She had told me a few days ago as we sat in her garden, after she had introduced me to some of her plants as she would sometimes do, of how she was continuing to grow. Now her way of ‘seeing’ things was evolving. Her awakening was in full swing, and it was a thing of beauty to behold. Spirit in action! The blessings of the lineage, of the Algonquin grandmothers, could be felt in her garden, in the cup of tea we shared. The flowers in their lively colours basked in the sunshine and in our presence, and we in theirs. We were in the presence of the divine, we were the divine. Our respect and love was in the air, as we shared our reflections and our hopes. She had finally put some chairs in the garden, so for the first time she would not only experience it bent over digging weeds and collecting plants for her tinctures. She admitted that it was good to sometimes just sit and enjoy her friends the plants! Each one had a voice, she would say. If one listened well, one could hear what she said. As we walked she gleefully discovered one that had self-seeded and was back again, in spite of not having thrived last year.

“Regarde!”, “Look!”, she said, her French still echoing with a trace accent of her native France, as she bent over and gently touch the new leaves. “Oh, I am so happy you are back! You will have such beautiful flowers in a few weeks! I will bring you some water later”, she promised.

Rana lay in the cool grass at our feet, gnawing on a bone I had brought her. When she looked up her eyes were full of sunshine and of contentment, at peace in her dog’s life and with her mistress. She was a wonderful companion for Martine since her husband had died, and would even come when she called her with her thoughts. She had even learned to close the door behind her after she came in from outside!

* * *

I found the daughter in red among the throng of family and friends. I asked again about their wishes, and she indicated that they had finally decided. No CPR, no intubation. I breathed a sigh of relief. I knew that the chances of this intervention having a positive impact were virtually zero, and the potential for harm was significant. Apart from possible broken ribs from the chest compressions, there was the indignity of dying with people putting shocks through ones chest, and stiff plastic tubes being forced down ones airway and lifeless lungs being forced to breathe, all the while surrounded by frenetic activity, and family and friends kept out of the room.

Thus it became an unusual type of care. We had to use significant doses of intravenous medications that were usually used in an intensive care ward setting, to support her declining blood pressure. Medications to decrease stomach acid that are the mainstay of treatment for such a bleed. Antibiotics for possible infection. Morphine for pain. All this in a patient who was not to be intubated if she got worse.

Over the course of the next day, she slowly got worse, but she was able to clearly tell us that she wished to stay in the village. So we continued to support her as best we could. Her extended family arrived by plane from other villages. The nursing station was an ebb and flow of people. Old-timers like her with weathered wrinkled faces, eyes concerned but smiling. Young mothers with their babies in their amauti hoods, who nuzzled the little ones into the old lady’s neck as if to get a last kiss or blessing. Young tykes full of energy, at times wide-eyed and awed as they got close her, then full of life and playing with their friends. Gangly teen-agers, feeling out of place but somehow in their place at the same time. Her daughters, full of quiet dignity, even through their tears.

Slowly the mood shifted. A quiet strength was palpable, as the community gathered around. Organic, it breathed and flowed naturally in and out of her room, in and out of the corridor. Amid the sorrow there was a kind of solidarity, a presence, an appreciation. All were there to bear witness to the passing of a respected elder.

Finally, in the evening it became apparent that the supportive medication was no longer helping much. With the family, we decided to stop her IVs and just to give medications for comfort. The nursing team had been split about this, and there was general relief in the passing to a more known and usual type of care. How difficult it is to meet a situation as it is, rather than trying to force it to fit our usual concepts of how things should be!

The late evening summer solstice sky was bursting out with gold and red as I left the nursing station. The wind had settled, and the long long sunset seemed to change from one magical display to another, each one more spectacular than the last. Finally it settled into a deep crimson red, which slowly slowly became muted with the blue-grey of dusk. As I contemplated that perfect sky my heart just seemed to break open, and I wept. For the beauty of the sky, and the beauty of the moment. For the fleeting nature of life. For the sadness and the truth touched by Evie’s family and friends. For the perfection of that very loss, the passing of everything. For the joy of everything that is existing. The great perfection. There it was spread out before my eyes and before my mind, the fjord below reflecting the perfect sky and the sky reflecting my perfect mind. All was as it should be.

* * *

Jocelyne’s next e-mail was more hopeful. Martine was able to talk, but was weak, she wrote. Her family was requesting that we not visit for a couple of days. Perhaps she just needed a bigger sign, to learn to start slowing down more. She would probably be around for a while yet.

My heart sighed with relief.

* * *

People drifted out of the new white church into the chill grey evening. The service had been long. First a son had told her story, the story of Evie’s life. Where she had come from, about her husband and children, and her years in this village. Many prayers, and a long homily by the minister. All punctuated by hymns and songs. Most of the village had been there, and children ran and played with abandon in the aisle.

With the strains of Amazing Grace still floating in my mind, I made my way with the others to the little outcrop behind the water storage tank where the cemetery was. Again some prayers, and the earth thrown onto the plain plywood casket. Near the end, my on-call telephone rang, and I had to quickly withdraw to take care of that situation, walking back home. Another patient. Another village. Life goes on.

All was as it should be.

Theme: Community | Communauté
Theme: Death and Dying | Décès et le mourir
Theme: Family | Famille
Theme: Patients | Patients

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




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