Room for a view: Racing away

In she marched, her granddaughter a step behind, and started before she even took off her coat. “Ay Doctorcito, tengo dolor en todas partes.” My young doctor, I hurt all over. “Grandma, sit down,” Maria said. Ana began describing her son's busy work schedule, her embarrassing flatulence at church and the pain in her knees. I interrupted to ask a clarifying question, but on she went. Maria shrugged helplessly as my eyes pleaded for assistance. I found my chair edging farther away with each new complaint. “?Me entiendes? ?Me entiendes Doctorcito?” Do you understand me? The repeated question unsettled me. Although I understood her words, I felt that I was missing their meaning. Eventually I learned that Ana, originally from Argentina, suffered from diabetes, high blood pressure and arthritis and that a cancerous lesion had been removed from her breast three years earlier. “Look, my young doctor, my sugar is fine,” said Ana, “I just need more aspirin for my knees so I can get out more.” “But your sugar readings aren't fine, you have sky-high blood pressure, and don't you think we should do a follow-up breast exam?” Progress was painfully slow in those early visits. At some point, I began to see Ana as a South American version of my talkative Acadian grandmother. As an adolescent sitting beside my grandmother, and now again with Ana, I found my spirit drifting off as the awkward conversation continued. I remember thinking: so what if my grandmother looked after half the Acadian community of Halifax; so what if she had given birth to three priests and a nun; so what if my father adored her? She still had no right latching onto my arm and holding me so close that I had no choice but to inhale the overpowering breath that accompanied her incomprehensible words. So, deep down, I just wanted to get away, and I figured Ana sensed this. But Ana returned, and several years later so did her cancer. Her office visits became more frequent and my interruptions less so. Finally I had started to listen. Ana, cane in hand, now spoke affectionately to staff and patients alike, whether or not they understood Spanish. Her smiles and embraces cut through all barriers. Maria would blush apologetically in the midst of her grandmother's uninhibited affection. Office visits evolved into home visits. In her upstairs bedroom, Ana's stories seemed to take on more meaning; photographs of her son, granddaughter and extended family, carefully placed between religious icons, spoke clearly of her life commitments. One afternoon I received an urgent call from Maria: “Dr. Pottie, my grandmother is very sick! Can you come right away?” This home visit was different. Ana was no longer talking; she was struggling to breathe as though drowning under a heaving chest. As I propped up her frail body her cracked lips turned blue and her chest crackled with fluid and infection. Ana's impending death was undeniable, for both of us. But Ana held my arm with all her strength, refusing to say goodbye. Within the hour we had oxygen to go along with morphine and diuretics. While we waited, the family invited me to join them in the kitchen for coffee. They told me how Ana had journeyed to Canada to care for her two young grandchildren, responding to a call for help from her son. She made the one-way trip without a word of English or a moment of hesitation. We all laughed as each member of the family told a story highlighting her unyieldingly talkative nature, both in Argentina and, more remarkably, as a Spanish speaker in English Canada. That day, the medicine worked and Ana revelled in the lively respect of her loved ones. Two weeks later Ana died. Family and friends greeted me as I arrived at her home. This time Ana lay silent, a rosary in her hands. Maria sobbed at the foot of her bed. Ana's silence and the family's grief left me speechless. I pronounced her dead, completed the death certificate and abruptly raced away. Rain pounded on my windshield as I distanced myself from Ana and her family. I felt an unexpected liberation, as though I was fulfilling my childhood fantasy of racing away from my own tenacious grandmother. But the taste of freedom didn't last long. For the next few days I admonished myself for my actions, for failing to embrace Ana on that first urgent house call, and for failing to attend her wake. Three long days later, I called to follow up with the family. “Dr. Pottie,” Maria said in a radiant tone, “you should have seen the hundreds of people who showed up at her wake yesterday, even people who didn't speak Spanish!” This time Maria spoke in never-ending sentences. “I never knew so many people loved her; we cried, we sang, and the priest gave a 40-minute speech honouring her contribution to the community. They had to open extra rooms and although we were supposed to leave by nine, everyone stayed 'til one in the morning. She was not just my grandmother, but a grandmother to the whole community, especially my friends whose grandmothers are far away.” Maria had comforted me. She had shown me how Ana's affectionately loquacious nature had touched many lives, including my own, and how she had ultimately become a thread binding together her community, a thread that would now continue through Maria. And now, as I think back to my own grandmother, I realize she too must have felt my young spirit racing away. But, like Ana, she held tight, using that same binding thread to hold together my family and my Catholic Acadian community. A magical thread that makes racing away only another way to return home. Kevin Pottie Assistant Professor Department of Family Medicine University of Ottawa Ottawa, Ont.

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