Lillooet, 2 km: Reflections of a rural GP surgeon

Nancy Humber

Now, more than a decade later, as a solo GP surgeon in a rural community in British Columbia, I can still remember that sign: LILLOOET 2 KM. I can remember thinking, “I could still turn around now. I could still change my mind.”

As I look at my house, my 4 children, and my accumulated belongings, the memory of my 27-year-old, freshly graduated self, with all my possessions in 3 boxes in the back of my car, seems surreal. It was sunny that day, a change from my past months in Prince Rupert, BC; nothing more complicated than that. Why had I chosen Lillooet? And who could have guessed what the next 10 years would bring?

Since I arrived, not much has changed in this quiet little village. To passersby, it still looks like there is nothing here. Medical students and residents proffer, “It’s nice. It’s beautiful. The people and the experience are great.” Then add, “But I would never want to work here.” What am I missing? Why did I stay? Why am I still here? Well, because of the mixed blessings of community life that were not obvious in medical school or residency. Because of the deep connection with patients that can only come with longevity of relationships and shared experiences as a physician, a friend, and a community member. These very things that medical school does not teach and society no longer seems to value are the very reasons that I entered into the medical profession.

“Can we have tea?” Thomas, the 4-year-old son of my best friend, asks.

“Absolutely,” I reply. I remember trying to relax over a similar cup of tea when this little rascal entered the world. I had delivered his brother without incident 3 years earlier. “The second will be easier,” I told my friend. “I would love to deliver your second.” That is, until the second stage of labour when there was unexpected fetal distress. The heart rate was at 60 beats per minute without improvement; the head was impacted, but too high for a vacuum or forceps.

“Is everything okay?” her husband asked.

“What do you want me to do?” my friend asked.

Seconds felt like minutes as I waited for the operating room team to arrive. I can still remember the enormous fibroid—underestimated in size at the ultrasound at 19 weeks—causing torsion on the baby’s neck, and the “squelch” as I delivered the baby by cesarean section. I held Thomas tightly as I brought him into the recovery room to see his mother—my friend. Her eyes were sleepy from the general anesthetic when her lips mouthed a speechless “thank you.”

It is not only a picture that can say a thousand words.

To be a friend and physician at the same time is to walk a fine and tangled line. One might say you should never treat your friends. You can’t see clearly. You don’t make sound medical judgments. But how do you do that in a community where you know all of its members on some level? Rather than withdraw from the community in order to limit any nonmedical interaction, I have decided to embrace it in trust, respect, and kindness, as part of the complexity of rural life and the richness of education a rural practice can offer.

I happened to be on call the night a friend presented with constipation and bloating. He had just returned from Mexico where he had visited a doctor for similar complaints and had received antibiotics to relieve his illness. When I examined him and felt ascites, I explained that we would get an urgent ultrasound the following morning. He was 42. He asked me if it was anything to worry about. Several days later, I sat at his kitchen table and told him he had diffuse peritoneal carcinoma and likely only 6 to 12 months to live. I rubbed his back as he vomited into the sink with the weight of the news.

Little did I know how the next year would change my own outlook on life. I grappled with the grief of caring for a friend who was also the relative of a colleague and a prominent member of the community. My own fragile mortality was made obvious every time I saw his family or drove by his house. The closer to home end–of-life care rests, the harder but more meaningful are the life lessons that are revealed. The relentlessness of the work prevents you from leaving; the opportunity to fully integrate into the community keeps you here.

I will never forget the faxes, cards, visits, and gifts from members of the community that arrived when I was pregnant and on bed rest at home and in the hospital, and later when, for 4 months, my premature twins were in the neonatal intensive care unit in Vancouver. Many were from people I felt I hardly knew. The support from afar was with me daily at a time when I was the patient, not the doctor, and all the knowledge of medical school could not help my 1- and 2-pound twins.

Two years ago, my 3-year-old daughter was admitted to our local hospital with unremitting seizures in the middle of the night; I recall the relief I felt when I finally went to our room. Where would I rather be than surrounded by the competent colleagues and hospital staff I knew so well? It was a welcome world compared with my previous “Ivory Tower” experiences.

When I tell my urban colleagues and friends about having dinners delivered to my house, with the community getting together to arrange child care on my on-call days, they are amazed. When I suddenly found myself a single parent, with 4 young children under 6 years of age, the community epitomized the old saying, “It takes a village to raise a child.” Friends and community members delivered coffee and muffins, cards, and words of encouragement. These were all actions of the heart, which continued over the next 6 months until I could get back on my feet.

In this day and age, when medicine has become a business and being close to your patients and community is so far removed from anything that medical school teaches, I feel we should all reflect on and share with students the diverse experiences that rural family medicine can bring. My experiences have not only made me a better family doctor but also have made me a better person, community member, and member of society.

As I pour tea for myself and Thomas, I wonder if I would change any of the stressful experiences I have had. Viewed on their own, it would be silly not to say yes. But they are part of the rich tapestry of rural family medicine, which I feel grateful to have as part of my life.