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Volume 12, Number 1
Short Story
Martha
Ted Osmun, MD, CCFP
The phone rang.
"Ted, your patient is here."
"How is she?"
"Doesn't look too good. She is having trouble breathing, and she looks a little blue."
"I'll be there."
Sarah, the nurse from Shelly Bay, had phoned earlier. She was flying out with Martha Temela. Martha had arrived at the settlement health clinic short of breath.
Martha was an elderly Inuit lady. She wore an amoutik, the traditional parka, her feet clad in sealskin mukluks. Her chest heaved with the work of breathing, her lips were tinged blue.
We struggled to get her amoutik off. The nurse started oxygen. I listened to her chest. There was no air moving on the right, the left was a cacophony of wheeze and whistle.
"Is she worse than before?" I asked Sarah, the nurse who had brought her. Sarah stood at her side, parka still on, boots puddling the floor. She nodded.
Oleepeeka, the translator, came through the door.
"Martha," I said, my hand on her shoulder, "we are going to give you some medicine to make you feel better, and do some investigations to find out what is happening." Oleepeeka translated, my words transformed effortlessly into the staccato of Inuktituk. Martha smiled wanly and nodded.
Bathed in the cold light of the X-ray box, I studied Martha's X-ray.
"Doesn't look good, Dr. Osmun. Looks like the big C." Bob Harding, a veteran doctor, stood behind me.
"Yeah, I know." Her right lung was a whiteout, no air and massive atelectasis. Her left lung bore the streaks of a chronic lunger. "Well I guess we'll have to fix her up and send her to Montreal to know for sure."
Harding pursed his lips and raised his eyebrows, "It looks pretty definite to me. Still, maybe it's T. B."
With intravenous antibiotics and Ventolin, her left lung gradually cleared. She could breathe comfortably and was no longer cyanotic. Arrangements were made to transfer her to Montreal for definitive diagnosis. She smiled at me as she was wheeled down the hall to catch the jet.
Later, Martha returned from Montreal. The news was as expected - she had inoperable cancer. She had come home to die. Her family was there on her return. They suspected the worst. I could read it in their forced smiles, unable to hide the worry in their eyes.
"Does she know?" I asked. Oleepeeka shrugged. "Well, I guess we had better go and find out."
I dreaded the interview. Through Oleepeeka I broke the news as gently as I could. Unable to find an interpreter, no one had told her in Montreal. Martha took the news calmly, smiled and thanked me. She had suspected she was dying and was glad to know the truth. "She did not like thinking about it, not
knowing for sure," Oleepeeka explained.
I was younger then, not familiar with carrying bad news. I found her stoicism disconcerting. I left the room, grateful for her strength.
She stayed in hospital at Frobisher Bay for a week, awaiting transfer to Shelly Bay. I visited her daily, often with my infant daughter on my back. Martha would smile and hold Anneka's hand over my shoulder. There was nothing I could do, only visit.
Her daughters, articulate and attractive, came to me alone to talk about their mother. "How much time?" they asked. Controlled, but obviously saddened, one daughter said her mother had always been so strong, it was hard to believe she was dying. Later, the daughter returned to let me know that her mother felt she must be doing well because "her doctor had smiled at her today." I got the point, gently given. Thereafter I made a greater effort to accept Martha's illness with the some of her own cheerful forbearance.
The day of Martha's departure came. I met her in the corridor, her daughters clustered around her wheelchair. I stopped, said goodbye, and told her I would visit on my regular settlement trips to Shelly Bay. She smiled and thanked me, her daughters translating our words effortlessly.
Four weeks later I was at the airport, waiting for my flight to Shelly Bay. My flight called, I joined the shuffling line to the plane. Breath frosted in the frigid air as we slowly climbed the stairs and settled ourselves in our seats. The plane's engines powered up, a few children began to cry. We slowly rose above the town of Frobisher Bay, banked and headed west over the low monotonous hills of southern Baffin Island. Then we were above the endless ice of the Arctic Ocean, its surface broken by pressure ridges. An hour and a half later we descended into Shelly Bay. The settlement sat lonely in the white of the landscape, the heat from the buildings shrouding it in mist.
I visited Martha in her home. As was the custom I let myself in; my Southern upbringing made me knock first, although by Inuit ways this was unnecessary. Martha, dressed, on a bed in the living room, smiled at seeing me. The room was warmed by the light of the Arctic sun. The air was heavy with the smell of seal. In the immaculate kitchen, two raw ptarmigan sat on cardboard, the unfinished remains of a meal.
Martha was pleased to see me. She looked well. Unable to completely surrender the role of physician, I listened to her chest. I asked if she had pain, she assured me she had none. Martha told her daughter how I would bring my child to work, miming how Anneka was carried in my backpack. Her daughter relayed Martha's regret at never getting a chance to hold her. Coming from a culture where children are viewed as necessary impediments to the smooth functioning of our lives, it had never occurred to me to take my child from my backpack and put her on a patient's lap. As it was, I felt ambivalent even taking my child on rounds, fearing I was transgressing an unspoken boundary.
As I took my leave, Martha smiled and thanked me for the visit. She expressed surprise that I had come, when there was no more I could do. I assured her I would come again on my next visit. Six weeks later, the sun circled the horizon, never setting. I visited Martha. Thinner and paler, she again reassured me she was pain free, and again sent regards to my infant daughter. I took my leave and walked back to the clinic.
Two days after my return, Sarah called to tell me Martha had died quietly in her sleep. I would not need to visit her again, listen to her chest, ask about her pain.
On my next visit to Shelly Bay, the short Arctic summer was over, the sun dipping behind the distant hills for three hours a day before reappearing. It snowed, whirling about my trailer, rattling the windows and the doors. I walked by Martha's house, saw through the window that her bed was gone. The door opened and three laughing children spilled out.
In another's death, we must confront and question our own lives. Martha empowered me to feel and to learn. I learned that to die well one must live well. I learned the importance of openness and truth. I learned to be there. I learned that there is never a time when "nothing more can be done."
Correspondence and reprint requests to: Dr. Ted Osmun, Southwest Middlesex Health Center, P.O. Box 219, Mount Brydges, ON NOL 1W0
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