How long have I known you?

By Arne Vainio, M.D.
News From Indian Country

Since I started at the clinic over seventeen years ago. From the first day you were a resource and you took on tasks for me that weren’t really even your responsibility. Insurance companies expect a doctor to stay on hold while they preauthorize a medicine and this long process tethered to a phone is a very poor use of a doctor’s time. You did that first one for me and we slid into a pattern of me always hoping you would make that call and fill out the form and of you always doing just that.

Did I ever really thank you for that?

Your voice was always cheerful and you always asked and truly cared about how my day was going.

When did we become friends?

That evolved over time. We work in a small enough setting that we get to know each other.  Trust is a strong basis for friendship and there was never any reason to question that trust from either direction. With trust comes respect and with respect comes understanding and with understanding comes friendship.

Some lives seem easier than others. The reasons are not always clear and often have to do with simply where you were lucky enough to be born or with superficial and shallow things society makes us believe are all-important.
Some lives are hard.

How do we choose the path we will follow when we come to this earth? Is it chosen before we are even born?  If so, how do we make the best of that choice? Maybe it’s by taking each day one at a time and hoping this day will be better than the day before.

And the day before that.

You told me that being an only child was a blessing when you were young. That blessing turned into a curse when your mother was diagnosed with cancer and you had to carry that burden alone. In addition to your own health concerns you had to go to her chemotherapy treatments and wait for her to get out of surgery and to go to her doctor visits to make sure she understood what was happening. I could hear that in your voice and see it in your eyes and yet, you continued to fill out my forms without complaining.

Did I ever hear you complain?

We’re all human. You knew I would listen and I was glad to take that on.  Mostly, I listened. You already knew what you needed to do. Taking care of others made your own concerns take a back seat. We talked about this many times and those others always rose above looking out for yourself.

When did things get so complicated? Diabetes has a way of involving everything and your kidneys couldn’t handle the high blood pressures and when your kidneys failed, your blood pressure became unmanageable. Recurrent infections almost made you lose your foot and our relationship changed when I was following you in the hospital. Your potassium levels fluctuated wildly and either too high or too low could throw your heart out of rhythm at any time with fatal consequences.
Money was short and you ran out of heating fuel in the middle of winter. I expect those were some bad days. You didn’t tell me about that until after it was passed. A desperate someone looking for something to sell kicked your door in when you weren’t home and made your crumbling house lose some of that precious heat. Visiting your mother in the nursing home must have been warm. Your old television couldn’t have brought much money.

Your car got repossessed.

Your death came as a total shock to me. In retrospect, it shouldn’t have been a surprise, but you were a survivor and any given day of yours would have been too much for one of those given an easy life to bear.

The church was big and empty and it was easy to find a parking spot in the snowy lot. There was no waiting in line to get in. The stained glass windows made your casket look small. I found out during your funeral that you bought that casket in advance and had the burial preparations arranged in advance. You even had your headstone taken care of in advance. Kevin was touched and honored to learn you wanted him to sing at your funeral. He shook his head and smiled when he learned you already had the songs picked out.

He stood at the front and he sang them beautifully and the hurt and the love in his voice echoed in the high arched ceilings of the church. There were less than ten of us who worked closely enough with you to be given time off work and it was all too evident that we were your family. Mary Jo was sitting next to me and as Kevin sang Amazing Grace, she slid her arm into mine and we leaned against each other. The last time I sat in this church, Mary Jo was at the front and we were burying her husband.

That was the same week my brother Kelly died.

The priest asked us to kneel several times. Some people didn’t and I didn’t know for sure if I was supposed to or not.

I knelt. For you, I could be catholic. The priest chanted and sang and swung a lantern back and forth and went around you and the smoke from the lantern bathed your casket and he made sure it didn’t miss any part of it. It was a beautiful ceremony and he quoted scripture I had never heard before and he talked about resurrection and the promise of everlasting life. Your mother was bent and broken as her wheelchair was pushed down the aisle behind your casket. Kevin sang your final song and his voice filled the church as we walked behind your mother.

The reception line was short. There was no meal provided by the community and no milling around of long lost friends. Your mother’s wheelchair was parked just shy of the exit door and the few people there paid their respects to her. I knelt in front of her and held her hand. Her eyes were tired and old and her hair was just barely growing back from her chemotherapy. Her nurse respectfully stood back and your mother was truly alone.

I’m not sure she recognized me in her grief. “It’s Dr. Vainio,” I said softly. She started to cry silently and her shoulders shook as she squeezed my hand. She didn’t say anything and I didn’t say anything either. I felt we both understood holding hands was enough and anything I could possibly say would only compound her tragedy.

The cold winter sun couldn’t quite warm me on the drive back to the clinic.

My pager went off and the afternoon clinic was started. My first patient was a little boy in foster care. He was off to kind of a rough start. I opened the door and he looked up and smiled at me.

Maybe we can do something different this time. If you taught me anything, it’s to take this one day at a time. I closed the door and I smiled back at him. I knew this was going to be a lot of work and that we were in it for the long haul. I also knew I had my entire work family at the clinic beside me. You made me remember just what we mean to each other.

Did I ever really thank you for that?

Arne Vainio, M.D. is an enrolled member of the Mille Lacs Band of Ojibwe and is a family practice physician on the Fond du Lac reservation in Cloquet, Minnesota. He can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it..





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