Ma’s story: Finding superhero power

Ann Loewen

I had been in practice somewhat less than a year when one of my patients was diagnosed with metastatic gastric cancer. A difficult condition in the best of times, this clinical picture was complicated by the patient, Ma, who was hearing impaired , and by a system that did not include any home or palliative care. The new hospital “up the shore” was regarded with deep distrust, and the local hospital had been shut down a few years before.

Mustering limited resources

Along with these complications was a doctor (me) with less than a year’s experience joining forces with a family that, albeit large and loving, was completely without clinical skills. Among her 10 or more adult children (I can’t remember the exact number), only one daughter knew enough signing to communicate complex information to her mother. All the others engaged in their own form of lip reading and gesturing.

The family’s concern for Ma’s well-being was such that they felt she absolutely must not be told her diagnosis, let alone her dismal prognosis. This left me in an ethical dilemma, even in a position of potential conflict with the family. Their love and respect for their mother was so palpable, however, that our discussions did not ever break down into conflict. Ma’s family and I simply saw things differently, and I was in no position to have my own way. We had our hands full keeping her comfortable at home until she died—for this was what everyone wanted, even Ma, who couldn’t communicate with me directly—so I didn’t need to look for additional battles to fight.

Despite the dearth of support services, the family and I managed to deliver intravenous fluids at home, organize family members to do subcutaneous injections, and enlist local nurses to drop by on a volunteer basis to help with care and support.

Where the power lies

Whenever I came by for a housecall, the kitchen was always filled with Ma’s family. It was through this family that I came to appreciate fully that I was a family physician not because I was capable of being a doctor for each family member, but because I was capable of being a doctor for the family itself. We worked together as a rather loosely structured team, making decisions on the fly, holding impromptu meetings around the wood stove at the far end of the kitchen, and crying as Ma slipped away.

Ma herself was stoic and smiling through it all, passive in the way many of her generation were about the vagaries of bodily functions and fate. Did she know what was coming? I suspect so, though I couldn’t ask to know for sure. She knew she had what she needed: the comfort of her family and her home. And she did die there in her home, the family around her in the kitchen sickroom.

The Crash Test Dummies’ “Superman’s Song” was on the radio a lot at that time, and after my last housecall at Ma’s, I sat in my car listening to it. I thought about how a physician can easily be misled into feeling like a superhero, swooping in to fight the forces of sickness and pain. But we are really just ordinary Clark Kent types, without superhero alter egos. The real power lies with those people who surround the suffering and the dying with the strength of their collective selves.