Health | Opinion

Arne Vainio: A mother's gift carried me through many life journeys

Thursday, May 26, 2016

Photo courtesy Arne Vainio

My stethoscope is broken
By Arne Vainio, M.D.

My stethoscope is broken. The upper part where the ear pieces go into the tubing separated and I can’t find any way to fix it.

Why don’t I just get a new one? Because my mother bought it for me when I graduated from medical school in 1994. The photo seen above is at my medical school graduation party. The party was also for mine and Ivy’s engagement party. I proposed to her a few hours after I graduated from medical school.

I wore that stethoscope around my neck every single day I was in the clinic or in the hospital in Seattle. I listened to newborn babies with it. I listened to lungs by the thousands and I learned to identify the wheezing of airways tightening up in a young boy who couldn’t stop coughing when he played outside. His grandmother thought he was trying to stay home from school and she didn’t believe him all those times he was in trouble. He was on the verge of having to repeat the third grade when his grandmother brought him into the Seattle Indian Health Board and he was on my schedule at the end of the day. His lungs sounded fine when I first listened to him and his grandmother glared at him when I told them that. I could see the resignation in his eyes as he pegged me for just another adult who didn’t believe him.

I had him and his grandmother come outside with me and I had him run in the parking lot until he started coughing. I listened to his lungs on the pavement between the yellow stripes of the parking lot and I heard wheezes everywhere in his lungs. I ordered an inhaler for him and the pharmacist showed him how to use it. I took him back outside and ran him again in the parking lot and he ran and he ran and he was laughing and jumping and he was an eight year-old boy again. He hugged his grandmother with the forgiving innocence of the very young and she started to cry because she hadn’t believed him.

I used that stethoscope to pick up a bruit in a grandfather’s neck. This is the sound made by blood being forced through a vessel that has been narrowed by years of cholesterol and cigarettes. His granddaughter brought him in because he had an episode of weakness in his right arm and some difficulty talking a few weeks earlier and refused to go to the hospital. His weakness and speech were better the next day. I had him turn his head to give me better access to his carotid arteries and I had him hold his breath.

I distinctly heard the “ssshhhooooo-ssshhhoooo-ssshhhoooo-ssshhhoooo” of every heartbeat being forced through his narrow left carotid artery. I sent him for an ultrasound of his carotid arteries and this showed an almost complete blockage. I referred him to a vascular surgeon and he had a procedure to open the artery the next day. The surgeon told him he could have had a stroke at any time and that his deficits could have been permanent.

He and his granddaughter came to see me again, this time so I could refer them for smoking cessation classes together.

I used that stethoscope in the ICU when we withdrew care on a 29 year-old mother of three with metastatic breast cancer. She foresaw this moment and had it in her written wishes to withdraw support if it came to the point where there was no turning back. Her cancer was widely metastatic when it was first diagnosed. She fell in the park when she was playing with her son and her chest pain didn’t get better after a few weeks. She was seen in the Emergency Room and a chest x-ray showed cancer in two of her ribs and multiple masses in her lungs and subsequent studies found it in her liver. She didn’t tolerate the treatments for it and they didn’t do much to slow her cancer down.

I was the resident on call the night she died and her husband and I were alone with her in the room when her labored breathing finally slowed, then slowed, then stopped. I listened for a heartbeat for a long time and I didn’t want to look up at her husband. He was holding her hand and was on the other side of the bed from me. I finally looked up at him with the earpieces of the stethoscope still in my ears and I could see the moment he realized she was gone.

I learned the sound of a belly full of fluid due to liver failure with that stethoscope. Normally the amount of fluid in a person’s abdomen is about a half a can of soda, just enough to lubricate the intestines and other organs so they can slide and move against each other. When the liver fails, the proteins that hold fluid in the blood vessels are no longer made and the fluid leaks into tissues, but really leaks into the abdomen. He had so much fluid in his belly I could push on one side and listen to the fluid splash against the other side.

His liver never regained function.

I wore that stethoscope through the scariest times being a resident and the scariest times being a physician in practice, but also some of the most perfect moments. I listened to a ninety year-old heart finally slow down with an IV drip in the ICU. His heart was beating too fast and he’d been having chest pain for an entire day and he was certain he was going to die. I was with him and his wife of 63 years when his heart started to slow down, then came into a normal rate and rhythm. He wouldn’t let go of my hands and all he could say was, “Thank you, Dr. Vainio, thank you.” He held my hands in both of his and he repeated that phrase again and again and I could hear his wife weeping in relief behind me.

Arne Vainio. Photo from Walking Into The Unknown / Vision Maker Media

By the time I was finished with residency, my stethoscope had been left in my hot in the summer and cold in the winter car over a thousand times and had been around my neck so long that the tubing was stiff and I was afraid it was going to break. My sister beaded it for me after I graduated from medical school and her beading had to be cut off to rebuild it with new tubing. I had it beaded again by someone else and she used regular thread and it didn’t hold up to the constant abuse and the beading started to come apart.

Mike O’Neil from the Red Lake Reservation asked if he could bead it as a gift and he used strong thread and he used buckskin under the beading to make it stronger. It was beautifully done and I’ve been using it for over fifteen years like that.

Now it’s broken. The earpieces and the bell of the stethoscope are from the original stethoscope my mother bought for me when I graduated from medical school. The images of that stethoscope are on the cover for Walking into the Unknown and are on the Native Report Health Matters segment and are in many other places. Every community talk, every medical school lecture, every health care event, every high school presentation has been with that stethoscope around my neck. There is a big part of me that doesn’t want to cut that stethoscope and the beading Mike so painstakingly put on. I want to put it away in a display case so I can see it forever.

How many of us carry or wear things from a loved one who has passed on? I didn’t realize my mother was with me every day when I wore and used that stethoscope. She struggled to raise seven kids by herself after my father’s suicide and she struggled to buy me that stethoscope. The only way I can keep that is if I have the stethoscope cut to reuse the bell and as much as possible of the earpieces and this will sacrifice my old and trusted companion.

I need advice. What should I do and why?

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 a-vainio@hotmail.com