Mr. Braun was in bed when I first met him. An anguished face with practical wire-rim glasses atop his frail 73 year-old frame, he nodded when I introduced myself as Dr. Thorogood’s first year family medicine resident. “He’s a good man,” said Mr. Braun, “I’ve known him a long time.”
Mr. Braun presented to our emergency room with a two year history of weight loss, early satiety and fatigue. I didn’t know him from clinic but I was taking care of our practice’s inpatients at Norfolk General Hospital so I rounded on him that day. Rounding at a small country hospital looks and feels nothing like rounds at the tertiary care centres where I spent my undergraduate medical training. There are no huddled masses divided into pods of medical students and residents, leaping on every loose end deftly identified by self-assured attending staff. There is no scramble for CT approval from the radiologist in the basement in time for noon teaching. There is no nebulous hospital machine, lurching into action for hundreds and hundreds of people for whom I send up a wish and a prayer that community follow-up will actually happen.
At Norfolk General, I round alone, slowly and with intention. I take my time to thoughtfully check my labs, vitals, consider new differentials and conference with the nursing team about how things are going for my patients. The pharmacist comes to the floor to help me make good choices and get to know the hospital formulary better. If I know I am going to need a surgeon’s assessment, I go to the scope room or the OR to run my case by the surgeon on call. Everyone knows my name. When I think I have a plan, I call my preceptor and we review together. As I move through the patients, I am enmeshed in a supportive network of clinicians and staff. I know they are rooting for me but they also want me to feel alone enough that I push myself towards readiness for independent practice. I want to get it right for each patient because each one is part of my practice. And the practice is a meaningful part of the community.
I sat down on Mr. Braun’s bed. His gastroscopy and colonoscopy were normal. His labs were normal. His abdominal CT and swallow assessment were normal. His hands tremored from Parkinson’s, diagnosed several years before. I watched him try to eat his bagel. Each bite took minutes. I knew why he was losing weight. He sat back, exhausted. “I am so worried about where we go from here. I am so worried for how my wife will do without me. We get 70 or 80 years here,” he said, looking at me, “But I know I’ve got an eternity left in Heaven.” He went on to share that he is worried about money, his children and his home. Norfolk General is a bucolic terra firma for faith, fellowship and farming. The idea of an eternity in Heaven crosses cultural divides between the Mexican and Jamaican migrant farmers, the farming families of European descent, the Mennonites and the First Nations. Of course we face the same economic and social challenges as the rest of rural Ontario but it seems these challenges are weathered with stirring self-reliance and closeness.
I am technically an outsider. I am not a woman of faith. I am from the country too, but a different kind, farther north. My Low German is about as good as my Mohawk and my Spanish, which is to say non-existent. I don’t know anything about farming. But despite all of that, each of these communities has made space for me through my role as a provider of care. When I drive to work every morning, I drive through the Norfolk County hamlets, villages and fields, past the side roads, around the tractors and other slow, wide loads, to a new kind of home. Each one of my patients asks me if I think I could stay.
So it was not unexpected when Mr. Braun, an old Mennonite farmer, shared his existential sorrows with me. The hospital and its staff have a whole-hearted connection with this community and I am honoured to have been brought into the fold so openly. Mr. Braun was reassured that there was no tumour growing in his abdomen. I asked if he would like to go home and be with his family. He wanted just that. They were expecting a visit from their pastor, a man who could do for Mr. Braun what I was sure we could not. I called our practice’s administer, Mary, to see if we could get Mr. Braun in for an appointment around the holidays and discussed our plan for follow-up with the nurses. I will see Mr. Braun next week and we will continue our conversation, and our work together.
This essay was awarded the Society of Rural Physicians of Canada's Resident Essay award for 2016.