H A S T I N G S C E N T E R R E P O R T 7May- June 2006

Because I was born, raised, and ed-ucated in Toronto, my exposureto First Nations people and cul-

tures was limited to what little attentionwas paid them by the mainstreammedia and the educational system.When I became an intern and residentin a downtown hospital, the familiarstereotypes were reinforced by encoun-ters with homeless adult Natives, manywith substance abuse problems. I con-fess to not giving aboriginal issues inmedicine and in Canada much thought.

All that changed when I moved toWinnipeg to practice as a pediatric neu-rosurgeon at Winnipeg Children’s Hos-pital. Winnipeg has a larger aboriginalpopulation than any other major city inCanada, and First Nations people makea significant contribution to its culturaland artistic vibrancy. For the first timein my career, I encountered First Na-tions children on a daily basis.

One of my new patients was a seven-year-old boy named Timmy. He livedon a remote reserve several hours fromWinnipeg, accessible only by air.Timmy had suffered headaches for afew weeks and was starting to developweakness in his left arm and leg. CTand MRI scans revealed a large cystictumor in his upper brainstem extendinginto his right thalamus. Despite hisheadaches, Timmy was a happy, activechild. He spoke Oji-Cree and very littleEnglish and seemed to want nothing todo with me until I showed him I couldwiggle my nose just like he could.

I met with Timmy’s mother to ex-plain the nature of Timmy’s brain

tumor, propose surgery, and discuss thepotential risks and expected recoverytime. Parents usually react to a talk likethis with a mixture of fear, anger, andgrief. They often question why this hap-pened to their child. But for the mostpart, Timmy’s mom seemed uncon-cerned with these issues. Her questionsthrew me off guard. They didn’t havehot water in their small house on the re-serve—could I help them get it? Whatabout an indoor toilet? As a matter offact, maybe I could write to the author-ities and stress that they needed a newhouse altogether.

My first reaction was disbelief—thiswoman seemed more concerned aboutmaterial things than the health of herson. But over the next days and weeks, Ibegan to understand that these were le-gitimate questions from a woman anx-ious not just about the welfare of hersick child (though she clearly was deeplyworried about this), but also about thewelfare of her entire family. Her ques-tions implied a fear of being unable toadequately care for a child who could bequite sick for a long time in conditionswhere it was hard enough to raisehealthy children.

When it came time to officially “getconsent” for the proposed surgery, ameeting with the family was arranged. Ilike to meet with parents and one ortwo other close relatives or friends (andthe child, if he is old enough). I typical-ly refuse requests to meet with largegroups of people—I find that too manydifferent people asking questions tendsto confuse things. In this case, though, I

quickly realized that the process of ob-taining consent would not be typical.

When I entered, aunts, uncles,brothers, sisters, and parents crowdedthe room. An older woman sat in the farcorner, saying nothing, but listening in-tently throughout the encounter. Intro-ductions were made, and I began withmy usual description of the clinical pic-ture, proposed intervention, alterna-tives, risks, and probable outcomes. Iwas then peppered with questions:Would Timmy be okay? Would he beable to go back to school? Play outside?Fish? Had I ever done this type ofsurgery before?

I answered as best I could, and thensomething remarkable happened.Timmy’s aunts, uncles, and mother allturned to the older woman in the cor-ner of the room—Timmy’s grandmoth-er, who had not yet spoken—and asked,“What should we do?” She paused, thensaid: “We should go ahead with thesurgery.” That was it. No more ques-tions—the decision had been made.

Later that day, I told his mother thatTimmy should know what was going tohappen. In a matter-of-fact way, she in-formed me they had already told him,“You have a bug in your head”—pro-nounced “munjuice” in Oji-Cree—“and the doctor is going to take it out.”When I saw Timmy, he quickly pointedto his head, saying “munjuice” andsmiling while wiggling his nose.

I’ve been in Winnipeg four yearsnow, and the consent process I experi-enced with Timmy and his family hasbeen repeated countless times withother First Nations families. It alwaysincludes extended family supporting thechild and parents, with the wisdom ofolder members actively sought and re-spected. I am struck by the strength ofthe family unit—something not oftenmentioned in the mainstream media.

Timmy’s tumor came out unevent-fully. Fortunately, it was a benign braintumor of childhood. The day after hissurgery, Timmy pointed to his head andasked, “Munjuice?” He smiled when hismother looked at me and said, “Nomore munjuice.”

There’s a Bug in Your Head

by Patrick McDonald

in practice