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The Left Atrium
CMAJ 2001;164(11):1602-5

• Healing uncontrived [PDF] • The quizmaster [PDF]
• Overexposure: the Chernobyl photographs of David McMillan [PDF] • Jacob's ladder [PDF]

Healing uncontrived
The bear's embrace: a true story of surviving a grizzly bear attack
Patricia Van Tighem
Greystone Books, Vancouver; 2000
256 pp. $29.95 (cloth) ISBN 1-550-548077

On a sunny fall day in 1983, Patricia Van Tighem and her husband Trevor set out on a weekend trip to Alberta's Waterton Lakes National Park ... . But the following morning something happened that would change their lives forever: they crossed paths with a grizzly bear." So says the cover of this remarkable book, in what is really quite an understatement. In "crossing paths" with a bear, Trevor and Patricia were severely mauled and suffered extensive injuries. Seventeen years and numerous surgeries later, Patricia has chronicled their experiences in The Bear's Embrace.

This is a must-read for any physician involved in the treatment of severely traumatized patients. It is truly hard to put down, not because it makes for particularly comfortable reading, but because of the riveting reality it discloses. This is no feel-good account of some particular therapy that helps make everything all right. On the contrary, The Bear's Embrace ventures into despair, starkly revealing the experience of disfiguring trauma from a patient's viewpoint. But this is a patient with a difference, one who has been on both sides of the medical fence. The struggles that Patricia, a nurse, goes through to find healing are truly monumental, and the support she finds in her physician husband speaks eloquently to the power of a committed relationship.

Patricia is well acquainted with the culture of hospitals, medicine and nursing. Yet her interactions with doctors and nurses, many of whom had been her colleagues, sometimes leaves much to be desired. The book shows all health care professionals what it might be like to find ourselves suddenly on the other side of the fence: a patient in a large impersonal institution. It is not altogether a pretty sight. In spite of everyone's presumably good intentions, it seems that many patients — Patricia included — experience invalidation from a profession disconnected from the people it purports to serve. Such invalidation is by no means universal, of course; as Patricia points out, many individual physicians and nurses are indeed caring and compassionate. But those exceptional individuals struggle within a system that doesn't appreciate the value of subjectivity in medicine. There is little doubt that our scientific stance, based as it is in a contrived objectivity, has distanced us so far from the opinions and feelings of our patients that the result is a medical system in the service of itself. She records her disappointment in her own profession, the nurses who

are efficient and jollying. I am brave they just tell me. Just look at all I have been through. Later, I push the call bell. I ask a nurse to sit with me. She returns with some Ativan.

The gulf between doctors and their patients comes across time and again. Take, for example, the doctor who on his first visit comes right to her bedside:

Sees me stiff on the bed, bloody gauze covering the new hole in my head, my mouth twisted and crying. I make the mistake of looking directly at him with my right eye, beseeching him for relief. Every day after that he comes only to the door, asking brightly from there how things are going.

But perhaps more disturbing is the fact that such aloofness occurred even in psychiatry, where one might be forgiven for thinking the staff would try to be a bit more personal. Instead, Patricia faced the dogma of behaviour modification, administered with little love or caring, in which the patient who behaves in an acceptable manner gets rewarded with a discharge, while those who honestly express their feelings are labelled as difficult and treated as psychotic:

My reputation as a difficult patient precedes me. Along with chronic pain and recurrent infection, I now have a psychiatric history. In many doctors' eyes, I have no credibility.

Throughout her ordeal of repeated facial surgeries, unrecognized retro-orbital abscesses and inappropriate psychiatric diagnoses, Patricia manages to maintain a centre from which she is able to reconstruct her shattered existence, eventually finding peace with the bear through an experience of integration that, remarkably, arose spontaneously in a dream. And although this experience is relegated to a single paragraph right at the end of the book, it is probably the key event that brings balance and wholeness to this incredible story: it is here, perhaps, that the true meaning of illness is revealed.

It is through a nonrational embracing of the illness experience that healing arises, not through rational therapeutic interventions or the clever manipulation of behaviour. And even when apparently straightforward surgery is contemplated, attention to this notion of embracing is not misplaced. Without an experiential sense of integration, the most sophisticated surgery in the world will not heal the wounds to mind and spirit that lie behind the physical manifestation of illness.

The Bear's Embrace demonstrates graphically the direction in which medicine needs to go if it wants to shed the reputation of being impersonal and inhumane. Despite the technical marvels that emerge daily, we must not forget to work with love and acceptance. At the end of the day, in spite of the loving support of her husband and growing family, Patricia has to find that love and acceptance for herself.

Michael T. Greenwood
Medical Director
Victoria Pain Clinic
Victoria, BC

• Healing uncontrived [PDF] • The quizmaster [PDF]
• Overexposure: the Chernobyl photographs of David McMillan [PDF] • Jacob's ladder [PDF]

Room for a view
The quizmaster

He always called me "Kahlin," with a long "a," as in "aardvark." The first time we met, I was 28 years old and had just arrived from Sheffield, England, to join his practice. My wife and I were driven over to his farm to be introduced. I'm sure that secretly he loved the "green" British doctors he met, because we were always awed by the sheer size and expanse of everything in rural British Columbia.

He asked me a question, not seriously, but in a whimsical kind of way with a long, almost Texan, drawl: "Kahlin, do you know how big our practice area is?"

"Um ... no."

"It's slightly larger than Wales!" he declared triumphantly.

It wasn't difficult for me to produce the obligatory gasp of disbelief. To anyone accustomed to British distances, it really was amazing.

Later we inspected his vegetable patch. There was asparagus over a foot long and as fat as my thumb. Corn with lush green leaves and huge cobs reached toward the cloudless sky. "This is an ancient flood plain, Kahlin. You can grow anything here. Just plant the seeds and add water and POW!" He gestured extravagantly.

He kept horses and four or five dogs. His 16-acre property, much of it alfalfa fields, stretched down to the Fraser River. The river wasn't pretty so much as awesome. The town of Lillooet stood on the far bank, and all around were mountains. Sun-baked desert ones to the south, forested snow-capped ones to the northeast.

We inspected his workshop. My experience of workshops was of tiny garden sheds the size of a small washroom. Mike's workshop could house three trucks side by side. There were large drawers filled with every tool imaginable, ranging from small hand drills to enormous two-handed drills and sanders that could make short work of an Egyptian pyramid.

In the middle of the shop stood a small aluminum rowboat. Mike had just bolted on a new oar lock, and the bolts were protruding an inch from the inside. Having done metal work in England, I knew exactly what to do. Eager to show I knew something, I suggested he saw the bolts off and then file them down.

"That takes a long time, Kahlin," he said. "Watch this." He then reached deep into his drill drawer and drew out an enormous disc grinder and a welder's helmet that wouldn't have been out of place in a Star Wars movie.

"Stand back, Kahlin." He turned on the grinder and went to work.

The noise was deafening. I scurried away, terrified by the shower of sparks that poured all over me. Then I cringed in a corner for the two minutes it took to grind down the bolts.

It was becoming clear that Mike did things a little differently from what I was used to in England. He loved to solve problems quickly, decisively and powerfully: hence his fascination with all those wonderful tools. He also loved larger-than-life numbers and facts, and during our partnership I was constantly quizzed.

"Kahlin, do you know how many simultaneous messages can be transmitted down a fibreoptic telecommunications cable?"

"Kahlin, do you know how many tons of dirt a day a D8 Cat can move?"

"Kahlin, do you know how many cells there are in the human body?"

Invariably, my reply would be "Um ... no." Invariably, the answer would be astronomical. Once, after his clothes dryer broke down, he figured out how many revolutions it had done in its lifetime. The number was, of course, in the millions, which seemed to reconcile him to the fact that it was time for the machine to quit.

Was he a good doctor?

Darned right. His problem-solving skills and larger-than-life sense of humour allowed him to handle anything thrown his way. He gave a safe anesthetic, did a safe cesarean, was bright, stayed up to date and knew lots of tricks of the trade for dealing with the vast array of problems, major and minor, encountered by isolated rural physicians. His faults were few. He admired "can do" people of any variety but had little time for the "can't dos." Sometimes his forthrightness with people could lead to tension, but being of a similar ilk myself I often didn't see this as a fault. One thing was certain: many people owed their life, limbs and health to him.

It's been a few years since I've visited Mike, but sometime soon I'll drop by his house. We'll share a pitcher of juice in the shade of his patio and look out at the Fraser River and the mountains beyond. We will catch up on all the news, and sooner or later he will show me his latest project. The last time I visited, it was welding.

"Kahlin," he asked. "Do you know what chicken shit is?"

For once, I thought I knew the answer, but of course I was wrong.

"Chicken shit is what you get when you're welding and the weld gets too hot. The metal sputters and it looks like chicken shit. It's darned hard to weld without chicken shit, Kahlin."

He then proceeded to show me a trailer that he had welded out of iron railings. There was plenty of chicken shit (this was the first time he had ever tried welding), but that trailer was light and functional and will probably survive World War Three.

I don't know what his current project is (I hear he has acquired a name for himself as a water diviner), but he'll tell me about it at some point. He'll turn to me with that almost Texan drawl and say, "Kahlin, do you know how many ..."

Colin Rankin
Dr. Rankin now practises as an anesthesiologist in Langley, BC. Even today he cannot look at power tools without remembering his old partner.

• Healing uncontrived [PDF] • The quizmaster [PDF]
• Overexposure: the Chernobyl photographs of David McMillan [PDF] • Jacob's ladder [PDF]

Overexposure: the Chernobyl photographs of David McMillan

On April 26, 1986, an accident at the nuclear power plant at Chernobyl, in north-central Ukraine, released 200 times the radiation produced by the nuclear bombs dropped on Hiroshima and Nagasaki and forced the evacuation of 135 000 people from the surrounding area. To date, over 11 000 cases of thyroid cancer have been reported since the disaster. The contamination of the soil and food chain in the evacuation zone is anticipated to persist until the year 2135; former residents are permitted to return — to visit one another, and to tend graves — once a year.

David McMillan. Nursery School Classroom, Pripyat, October, 1997.
Canadian Museum of Contemporary Photography
Winnipeg photographer David McMillan has visited the Chernobyl evacuation zone six times since 1994, recording the solitary decay of this modern Pompeii in a series of images that now form part of the permanent collection of the Canadian Museum of Contemporary Photography in Ottawa.

In the 19th century, the art theorist John Ruskin described the aesthetic category of the "picturesque." Picturesque art typically dwelled on charming rustic scenes that had the attributes of age, ruggedness and decline. Ruskin considered the picturesque a suspect genre, for it indulged a "delight in ruin" that allowed the viewer to suspend any concern for the human implications of a scene. McMillan's photographs call to mind Ruskin's critique of the picturesque in that, despite the tragic ruin they record, their most noticeable attribute is beauty. Many are interiors: paint peels in enormous flakes from walls, and despite the terrifying meaning of this decay, the eye luxuriates in the softly saturated turquoises and greens with which these rooms were once so optimistically decorated. Some are infused with a pearly light pouring in sideways from windows; others, facing a window head-on, are flooded with a glare that obliterates everything beyond — an overexposure that is more metaphorical than technical.

David McMillan. Interior of Railroad Station, Village of Janov, November, 1996.
Canadian Museum of Contemporary Photography
Of course, this work shares more with documentary photography than with Victorian notions of beauty. Found objects provide ample scope for political critique: one image records an incomplete arrangement of flags on a wall, vestiges of a dismantled Soviet Union; in another, a shattered portrait of Lenin stands among the debris of a nursery school. The political hubris is clear. Not to mention the sheer environmental madness of it all: perhaps the most telling photograph shows the burying of heavy military equipment that became contaminated during the clean-up process.

But this is documentary that, indulging in some degree of manipulation, ventures into narrative symbolism. The door of a car on a road that goes nowhere is left ajar, which might accord with our notion of the panic of evacuation, until we learn that Pripyat, the former town of 45 000 where many of these photographs were taken, was not evacuated until 36 hours after the disaster. Other things we must believe even if we cannot comprehend them: grasses and ferns growing through the floor of a hotel room, or the branch of a tree penetrating a pane of glass. Plants thrusting up through asphalt, shrubs with tiny white blooms: these are also miraculous, given the fact that a 400-hectare pine forest near the reactor died within days of the accident, the trees, their needles bright red, were buried in a concrete-lined pit.

Pripyat was built to house the workers at the power plant. In these depopulated photographs, their lives are not represented so much as implied: rusting cots lined up against a nursery wall; shelves of little potties; school records abandoned, depriving children of part of their brief history. Suspended in time, every detail enters the realm of the symbolic as a token of loss. Even nature, with its mutated regenerations, has entered the symbolic realm at Chernobyl, for it is no longer, and never will be, as it once was. A tree that grows in a radioactive schoolyard is no longer a tree, but merely the idea of one.

Anne Marie Todkill

• Healing uncontrived [PDF] • The quizmaster [PDF]
• Overexposure: the Chernobyl photographs of David McMillan [PDF] • Jacob's ladder [PDF]

Jacob's ladder

He was coming in dead, the man who fell off the ladder. Pulseless
for ten minutes, travelling in from somewhere near Yarmouth. They told me
what an opportunity this was, as we waited
to put a tube in a dead man's throat (even if he were dead, or more so
  perhaps if he were,

because intubations are not easy,
and chances to practise are rare).
Here is the device to lift the jaw — you must not break
any teeth: even people whose lives have been saved
will sue over broken teeth,

although the ladder-man, when he came, was beyond saving.
I pulled at his jaw, shining the light
into his throat, looking
for the opening to the trachea. Don't intubate his esophagus, I thought.
But there was nothing to see except fluid
in his stiffening throat. There was no point in trying further, and I said so
to the ERP, who nodded.

I think there were other things we did, too,
minor procedures that I have forgotten, just as I have forgotten
how he looked, lying on the stretcher,
or his name,

or what was said when we decided to stop.
The point was, we were trying to save his life,
in a way.

I didn't feel too bad
that I didn't get the tube in. I was only an intern.
They say to breathe life into the dead takes practice.

Lara Hazelton
Halifax, NS



Copyright 2001 Canadian Medical Association or its licensors