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vendredi 22 mai 2009

A nice morning at the Native American Indian Clinic

One of the great pleasures of working with Indians is the pleasant encounter one can expect from the patients.

Two things was taught me from the beginning:

Always make sure that your patients leave happier than when they entered.

Show respect to each and every patient who sits in front of you.


For a medical student, a patient presenting with Vitiligo is an intellectual challenge since it makes him think of the various autoimmune dysfunctions one associates with that sign. I have looked after this patient for a very long time, and when he started complaining of atypical symptoms, I thought it was time to investigate other autoimmune failures associated with Vitiligo. Sure enough he had vitamin B12 deficiency which is easily corrected with monthly injections and the symptoms were relieved. He had a very responsible position within the tribe and many times, he would come with the stress of the finance management of the tribe which was his responsibility.


Today he comes to see me, not out of any medical necessity, but to check on the status. The first thing I noticed about him was that his face was radiant, there was a nice colour to his face and that there were fewer wrinkles on his face and his smooth face made him look much younger than his 69 years.


I am the greatest supporter of this clinic, he said. Years ago when I went to see a Specialist in the nearby town, he asked, how come you are so well aware of your health and know all the laboratory measurements. He proudly said, we have dedicated people running a clinic at the tribe and they come to your office and tell you what is happening, they call you up and make sure that you keep your appointment, and they don’t just focus on your medical problem but talk about other aspects of life of interest to me.


I was looking in the Electronic Health Records, under what category shall I record this visit?

His fasting Blood sugar and 2 hour post prandial sugars are below 100, thus ruling out Diabetes from biochemical point of view. His Blood Pressure today is 128/66 affirming the efficacy and frequency of intake of the medication prescribed. Hemoglobin A1C is 6.0.


I thought this would be the time to launch into my explanatory model for his wellness.

You look well, keyn eyn hora, I evoked a Yiddish prayer. Yes I feel well. I think you are well because of two things that come to my mind: the lack of stress in your life and the spiritual life you lead.

It is not up to me to talk about the Spiritual life, but it is up for others to say. A truly spiritual person knows that inside of him. I am not a man given to many words, and I don’t feel a need to speak at occasions when the community gets together. But I have noticed one thing.. normally at the end of a speech by a member of the community, it is followed by Aho.. the Indian equivalent of an applause.. but when I finish talking, it is followed by silence. I take it to mean that what I said, those words have had an effect and that the praise for them are inside of the listeners rather than in the open. If someone comes to speak to me about spirituality I would speak to them about it

To me, I said, when I saw you this morning, I felt a power, a connection to the universe and all the energies around us, and I told myself, here walks a man who is well connected with all that exists in this universe.


When you come to see me, this relationship we have, is not a doctor patient relationship but a relationship based on mutual respect and the exchange we have is based on that respect. There is medical and spiritual exchange between us without us naming it as such.


He then told me, two incidents. He had gone to see the Cardiologist in the nearby town and was subjected to a battery of tests at enormous expense and he was sitting there, not knowing what to ask since the doctor had not entered into any sort of discourse with him. He wanted to note down what to say, and what all the doctor was said that , here is a prescription for you, which will take care of the problem and that you can fill it at a Pharmacy.

He has had no conversations with the doctor, the doctor has not informed him of anything more than saying every thing is fine, and had not given him the opportunity to enter into a discourse about his health. He felt very disgusted and walked out, thanking all the time the fine service oriented health care he receives at the Indian Health Services.


We had a fine chat. This is what a medical consultation should be like, the patient is very satisfied, his questions answered plus he feels that he was able to enter and touch the human world that we all inhabit. The doctor feels good that the long trip has been worth while and that the Indians continue to teach him that connection to the Universe.. which many of us consider an essential part of Spirituality…