The right words will come when they’re needed

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

Every year I get the distinct honor of presenting to the University of Minnesota, Duluth School of Medicine first year medical school class. I get two hours with them and in the first hour I show “Walking Into the Unknown” and then we have a discussion about the film and what it means to be a physician for the next hour.  Tomorrow is the day I speak to the medical students.

The UMD School of Medicine has a stated mission to increase the number of rural family practice physicians and to also increase the number of Native American physicians. These are lofty goals and I went to UMD for my undergraduate work and I also went into the UMD School of Medicine in 1990.

What can I possibly tell them that they don’t already know? Any class of medical students is the brightest of the bright, the highest scoring on tests, valedictorians and salutatorians. They’ve worked hard to get to this point. The only problem is, medicine is so broad that it’s completely overwhelming. The amount of medical knowledge increases every year and the technology for imaging and testing advances steadily.  The human genome has been decoded and has huge implications for the future of medicine. New treatments and new medicines are constantly replacing older versions and new diseases are becoming epidemics.

They will be treated as less than they are by nurses and by doctors already in practice when they rotate through the hospitals and clinics on their specialty rotations. They will be asked questions rapid fire on teaching rounds until they cannot answer and be left feeling they fell short somehow. The field of medicine has always treated medical students this way and it happened to me on multiple occasions.

Medicine is so vast that a first year medical student can easily get the impression they don’t know anything. Embryology, statistics, neuroanatomy, cardiology, pharmacology, anatomy and physiology are just a few of the subjects that need to be mastered to become a physician. A full college credit load is 12 credits and the credit load in medical school is over 30 credits. This has been likened to trying to take a drink from a fire hose.

Medicine has become political. We live in a country that is increasingly becoming either very rich or very poor. Most of the wealth of this country is being accumulated by just a relatively few people and corporations. The strong middle class that formed after World War II with high paying jobs and pensions is disappearing. Unions that were once strong enough to fight for fair wages and equitable treatment have been broken by the political machine and by big corporations. Healthcare and health crises are among the leading causes of bankruptcy in this country.

Climate change affects medicine. The last decade has seen some of the hottest temperatures ever recorded and melting polar ice is changing ocean currents and this changes our weather patterns.  Changing weather patterns change migratory bird patterns and have allowed invasive species to spread out over a larger and larger area. “Hundred year storms” have wreaked billions of dollars of damage in the last decade and this is projected to get worse. Los Angeles is currently in the longest drought in history. Crops don’t grow where they used to. Epidemics due to weather changes are inevitable and will have to be dealt with.

Universal health care is a recent innovation and has been under constant attack and there have been and still are constant attempts to repeal it. Medicine is more and more an industry and the number of patients a doctor is expected to see is staggering at the same time insurance is willing to pay less and less. Those who are denied insurance won’t be able to be seen at all. We live in a litigious society and lawsuits are not uncommon. Billboards and phonebook covers cry out for people to join class action lawsuits and medical lawsuits that don’t always give what is promised.

We burn vast deposits of oil and the resultant pollution contributes to climate change, cancers and to respiratory illnesses. There are places where people can turn on a water faucet and light on fire the gas that comes out because of fracking for oil. Sacred places are being bulldozed for profit.

Medicine is affected by all of these things and these doctors are coming into the field of medicine right in the middle of it.

Bleak?

Maybe.

Some things in medicine have not changed. Compassion is still the same. Dignity and respect are still the same. A broken ankle is still a broken ankle and needs to be managed with skill, a good cast, and time. Babies are still going to be born the same way they always have and end of life care is going to be just as difficult and just as rewarding as it has forever been.

These doctors will have families and will become integral parts of their communities. They will have kids in kindergarten and in sports and in high school band. They will want to see their communities safe for their children. 
They will want to pass a better world on to those children.

These young doctors spent their entire lives aiming for the stars and have worked tirelessly to fill those seats in the classroom. They have self-selected to be those who want to practice in small communities and on reservations. They have inside them the will and the strength to work within these constraints and overcome the barriers placed in front of them. They are the ones who will care about our homeless, those less fortunate, our unemployed and our veterans.

These will be our doctors.

I don’t always know what I’m going to say when I speak to the medical students and I once told this to George Earth. George is 79 and he introduced my parents to each other back in 1956 or so. George was a lumberjack at the time and lived in a tarpaper shack in a logging camp with his mother and father.  He tells me his dad loved me as if I were his own son. George’s mother was hit by a car and killed when she was walking along the highway and it was never investigated because she was an Indian. My father committed suicide when I was four years old and George went out of our lives.

We were at a pow wow about seven or eight years ago and Ivy spotted him standing by a folding chair with his name in big letters on the back. He’s been in our lives ever since and he stays with us when he’s in the area. We stay up late and he teaches me the things he thinks I need to know.

“The Creator wants you to speak from your heart. You don’t have to have everything all planned out, the right words will come when they’re needed.”

I think that’s what I’m going to tell these brand new doctors tomorrow. The right words will come when they’re needed. The Creator wants you to speak from your heart.

I think they’ll get the anatomy right.

Every vote counts. Don’t forget to vote.

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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