A walking resilience

Cherinet Seid

She wants my opinion. I lend her my ears, putting myself in a listening position. In my son’s karate class they talk about 6 different listening positions. I don’t know if mine is among them.

She continues. “It is about my neighbour. He was recently in court.” She is convinced that he is innocent and a good family man. She thinks he would have a good chance of turning the decision in his favour if he appealed his case at the Superior Court of Justice, then asks me what I think. Now, I am staring at her, a little stunned: How on earth can someone be so concerned about her good neighbour while in the midst of fighting terrible troubles of her own? Isn’t that ability a wonderful gift?

The list of her adversities is long. But she keeps beating them, one by one. I have believed in her through all her fights. And who wouldn’t, given how difficult they have been, and how clear her wins. She had bilateral mastectomies and beat breast cancer. She had serious arteriosclerotic disease—carotid artery stenosis, peripheral artery disease, and cerebrovascular accident—and underwent successful bilateral carotid endarterectomy and bilateral iliac artery angioplasty. Appendectomy completes the list of her previous surgeries.

All interventions for these issues were very successful. But she was now struggling and close to giving up with another one. The removal of an infected periurethral cyst had left her with complete urinary incontinence. Maybe we could not beat this one. Still, I reminded myself that I believed in her, no matter what the circumstances might be.

Many specialist visits followed. It began to look as if she would have to learn to live with the incontinence—she was not ready to consider urinary diversion via ileal conduit or supravesical catheterization. The idea of carrying a bag around did not sit well with her, at least for the time being. However, the chance of successful surgical repair without diversion seemed slim.

I don’t try to fix my plumbing issues at home. I just don’t think it would be fun to get my home flooded if something went slightly wrong. Her plumbing problem was far trickier. Who would dare to undertake the repair that she wanted? Her specialist contacted expert after expert, and finally found one man willing to dare. My patient and her husband, Bill, drove to the big city, Toronto, 600 km away, for a consultation with this surgeon.

Hoping and daring

Back home, she had to decide: Should she go ahead with the surgery or “just continue living with it”? She asked for my thoughts. I fully supported her decision and signed it off with a hug. It seemed natural to keep believing in her.

Another trip to the big city followed, this time for the operation. The surgeon would take a small amount of tissue from her abdominal wall to reconstruct a new urethra. At the same time, he would repair the urethrovaginal fistula. The tissues involved were in good condition—a fact to hang on to and keep the hope for success alive.

Awaiting her surgery, she stayed a few nights in a downtown hotel not far from the hospital. She wondered how people managed to live in what seemed to be chaos. The bustling city and its nonstop activity were foreign to her. In her town, the only traffic light was at the exit from the highway.

As I waited back home for news, my belief in her and confidence in the surgical team’s skills could not stop my underlying anxiety from surfacing. What if this didn’t work?

I saw her 2 weeks after her return home. It worked! It worked! It WORKED! “It just felt abnormal not leaking again,” she said. I told her to worry about that later. I gave her a hug, this time a congratulatory one.

A wonderful gift

Later she called me, asking for a prescription for a smoking cessation drug—she always knows what she wants and what works for her. She was not wrong this time either; she didn’t touch a cigarette for more than 2 months! It was now time to catch up and concentrate on modifying risk factors and preventive care. She brought the leftover supplies she had used for incontinence to my office in case somebody else needed them. I was impressed by her kind practicality after yet another remarkable recovery, and thought of the story in the bible where the man miraculously healed from paralysis stands up and matter-of-factly carries his bed home.

She then informed me of a party planned to celebrate the successful plumbing repair; I was invited. And, soon, the next time I saw her, I would hear how things went for her neighbour.

Family medicine is so very rewarding. It is a 2-way business; we can make a difference in our patients’ lives, and also learn life lessons from their journeys. We can gather our strength from our patients’ perseverance and resilience.