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Teachings

“It’s not like what they taught you.”

It is the winter of 2013. I am a second-year family-medicine resident, with big ideas and small experience. Brian is a staff physician, maybe three or four years into practice—years that might as well be decades. The two of us huddle in one corner of the little airport departure lounge in Sioux Lookout, Ontario.

The Sioux Lookout physicians provide fly-in medical care to the dozens of tiny Indigenous communities scattered around the northwest of the province. An email application I submitted on a lark from the comfort of my little apartment in Hamilton has brought me to this place. To learn “rural medicine.”

Perched on our hard wooden chairs, wrapped in winter coats, we bow our heads and confer. Brian is teaching me culturally sensitive interview techniques for the Ojibway communities.

“It’s not like what they taught you in medical school,” he says. “Lean back, keep your eyes on the floor. Keep your voice quiet. You don’t want to come on too strong.”

Wide-eyed, I take this in. I feel a long way from home. Then our flight is called, and we start out across the tarmac.

Two white doctors off to save the world, I think ruefully.

The January air is crystalline, punctuated by little eddies of condensed breath from the passengers lined up ahead of us. On our little Beech plane, the faux-leather seats are frozen solid. The pilots, several years younger than me, exude a questionable bravado. Under a merciless winter sun, the plane pops and sputters its way into flawless azure sky.

The engine rattle makes conversation impossible, and I turn my attention to the window, watching miles of forest and lake pass beneath us. Northwestern Ontario, stretching in every direction. On the provincial map, it’s the empty upper-left corner, seemingly an afterthought; in real life, it’s overwhelming in scale.

I try to imagine the French explorers bracing against the cold as they forged through endless trees; I picture their awe at this alien landscape. Then my thoughts turn to the people who were already here, who felt woven into the seasons and the animals. Those who’d made their home in a societal hourglass that had suddenly tipped. Not yet aware that, with the first appearance of these strangers, their own time might be running out.

It’s not like what they taught you….

We swoop down into the Indigenous community. From the air, it’s a small town like countless others. A school, a hockey arena, a water plant, a town dump. The plane’s tires bite the gravel airstrip, and we taxi toward a little shed where a few trucks wait.

Brian leads the way. We lug our bags and cardboard boxes of Health Canada-issued provisions across the snowy parking lot. A few tough-looking policemen stand at the chain-link fence, wearing bulletproof vests under uniform jackets. They wave people over, rifle through their luggage.

Brian follows my inquisitive stare.

“Looking for liquor and drugs,” he explains.

A rusted-out Dodge Caravan idles nearby, and the large driver lopes out and clasps Brian’s hand. He offers me a weak smile, then loads our bags into the back, beside a makeshift stretcher.

We drive along without talking. The community radio station plays gospel songs and traditional ballads. We pass rows of simple, unfinished houses couched among evergreen trees, windows still covered in branded plastic. Plumes of thick smoke from wood stoves. And mean-looking, energetic dogs, maybe half-husky half-wolf, dart toward the van and follow in our wake.

The nursing station is a weird oasis of artificial sterility in the midst of wintery nature. It’s a relatively new building, with crisp, clean walls and floors, and soulless fluorescent lights. Plastic chairs. Cheerful primary-colored posters advise: “Don’t drink in pregnancy.” “Get your flu shot.” “Call if you have a gambling problem.” The waiting room looks like a kindergarten classroom designed for adults.

Our apartment, down a long hallway at the back of the building, resembles a basement bunker kitted out for the Apocalypse. I take a blanket and a pillow from a cupboard, then claim a bunk in the back room. Brian sets about microwaving mini-pizzas.

“A Northern tradition,” he says, without irony.

We plunge into the work. It is a week of encounters that feel at once strange and familiar. A wheezy kid. An early pregnancy loss. An elder with disabling arthritis. A young man, barely my age, with new kidney disease. A middle-aged man traumatized by childhood sexual abuse, who can barely stand to stay in the examination room to speak with me. There is depth and nuance to their stories, but I am mindful that they’re not my stories to tell.

After a week of newness, I am tired. The nursing station is hosting one of their regular banquets, a low-key community celebration. Brian and I drift in after packing for the trip home.

There’s a contented buzz in the room, where twenty or thirty people have gathered. Heaps of bread, bannock, fish and deer meat. No vegetables; who can afford vegetables? The mark-up at the local Northern Store is scandalous.

People mill about. I feel like a tourist—or worse, a voyeur. Out of place, conspicuous, unsure of the customs. Immersed in my clinical work, I put these feelings to the side all week, but now they settle heavily on me.

Brian has been coming here for years, and there’s palpable warmth toward him—handshakes and backslaps. He is presented with a plaque from the Band Council thanking him for his service. I clap politely. Someone runs off and fetches a coffee mug that they give me for my week’s work. I’m touched, but also feel disingenuous. These people have let me into their lives, into their world, all to further my education. It doesn’t seem like an even trade.

Our early-morning flight home is a milk run through a half-dozen little communities. At each stop, the cabin door cranks open, and the air inside turns instantly frigid.

During these quiet pauses, Brian opens up about the year he spent working in a pediatric hospital in central Africa. About the death and suffering he’s seen. About his impatience with the steady flow of “volunteers” who come from the West to pitch in, only to stop turning up after a few weeks. About the importance of continuing in the face of overwhelming odds, if only to say that you were there, and that you saw.

I sink lower into my seat, wondering about my own takeaways. I’ve learned a lot, but I’m not confident that I’ve seen the whole picture. I’ve been standing on the outside, seeing the lives in this community as though through frosted glass, or a sheet of ice.

If I come back again, I tell myself, I’ll be ready. My mind will be open, and I will be prepared to be useful.

The trip home makes my head spin. My morning has started in a shed on a deserted gravel airstrip, stomping my feet to stay warm. By evening, I’m walking the halls of Toronto Pearson International Airport, suddenly awash in the cosmopolitan. I feel disoriented and slow, trying to parse how these two worlds can exist in the same country at the same time. How all these people—these glamorous-looking tourists and suits at the airport bar—can go about their business, unaffected by my experience.

Then I find a seat at the bar, and slowly my allegiances start to shift. Lulled by the comforts and familiarity of city life, I feel myself stowing away these memories and feelings.

But the seed has been sown. In due time, I will start to plan my next trip North.

Family doctor Rory O’Sullivan is a staff physician at the Toronto Western Family Health Team and a clinical lecturer in the University of Toronto department of family and community medicine. His work has appeared in Intima: A Journal of Narrative Medicine and in the anthology The COVID Journals (University of Alberta Press). In 2022 he received the College of Family Physicians of Canada Mimi Divinski Award for History & Narrative in Family Medicine for his short piece “Traffic Patterns,” published in Canadian Family Physician. “I have had the opportunity to live and work in four Canadian provinces and to collect extraordinary stories along the way.”

Comments

9 thoughts on “Teachings”

  1. In the early 1970’s the US had declared a “war on poverty.” As a young college graduate nurse I wanted to use my career as a way to “make our world a better place. “ So I started working for the Visiting Nurse Service in Central Harlem, New York City. As a white girl raised in the suburbs, I had a lot to learn. It was a terrific job, hard work and the biggest lessons I learned were from my patients – long time residents of Harlem. It was life changing for me and influenced my career and more importantly my perspective on life. To this day I can say “My patients helped make me a better person!”
    Keep going Dr. O’Sullivan …

  2. Louis Verardo, MD, FAAFP

    Enjoyed your story, Dr. O’Sullivan. In 1981, my first practice post-residency was on a small island off the New England coast, and I will tell you that I experienced culture shock there on both a personal and a professional level. The personal was because I had grown up in a suburban community 30 miles outside of New York City and knew nothing of rural life. The professional was that instead of a 300 bed community hospital with a full medical staff, including specialists, what I had at my disposal consisted of an excellent public health nurse, a great rescue squad, an air ambulance service (plus access to the Coast Guard rescue boat on poor flying days), and me. Oh, and a supportive community solidly welcoming to a newly-minted attending physician and willing to trust that doctor with their health. I learned so much about Medicine and life in those years, and I have remained in contact with many of those former patients to this day.

    Thanks for sharing your memories and also helping me relive some of mine.

  3. Your story reminded me of conversations I had with an architect about whom I was writing, who had designed a hospital/clinic for an indigenous population in Alaska. At their first meeting with the Elders, the design team bombed completely: the Elders were silent, stoic, implacable; they gave absolutely nothing back to the architects. The latter went home, did their research, and returned. This time, they brought a complete model, sat down on the floor before the Elders, and gave a culturally-sensitive presentation. Success. One of the things they learned was that the seams of an outer garment were critically important, as that is where the cold–and potential death–could enter; the embroidery and decoration along the seams marked their importance and the care of the maker for the health of the wearer. Similarly, in the final hospital design, special attention was paid to the joinings and transitions, representing the care and affection with which the staff attend to their patients and their families.

    I’m not an architect, and I’ve never been to Alaska. But the meaning of this story has stayed with me, as a way I try to approach encounters with the new and different.

    1. Rory O’Sullivan

      Hi Erika, thanks for your comments. It’s amazing how much we can learn from each other when we get past the shock of having our most basic assumptions challenged; we don’t know what we don’t know!

  4. PETER MCCONARTY MD

    Rory, did you ever go back to that community? What does continuity look like in such an isolated place?

    What would you think of bringing canned fruit and vegetables along with the medical equipment? You know, prescribing food. Or maybe the people who live there wouldn’t wany fruits and vegetables ( unless someone leveraged their credibility , established through continuity, to discuss including plants in one’s diet
    Thoroughly enjoyed your piece. Much to think about

    1. Hi Peter,
      Thanks for reading. After residency I went back to the region, and practiced as the staff physician in a neighbouring community for three years. It probably took the best part of a year to build trust as people there are so used to fragmented care and providers dropping in and out.

      You’re right about fruits and vegetables – I can’t say we tried anything like that but I suspect interest would be low.

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