Jack’s Story

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Applicable Courses

  • Health Promotion and Active Living
  • Social Determinants of Health
  • Human Anatomy and Physiology
  • Human Pathophysiology/Altered Physiology
  • Perspectives in Aging
  • Mental Health and Disabilities

Jack’s Story

In 1946, Ojibwe parents in Northwestern Ontario brought a son into the world.  At age 6, he was forcibly removed from his home on the reserve, sent to a Residential school run by a religious organization, and given the name ‘Jack’.

A black and white photograph of students at residential school.
CC BY 4.0 https://upload.wikimedia.org/wikipedia/commons/thumb/6/6e/Students_at_Blue_Quills_Residential_School_%2815873685907%29.jpg/640px-Students_at_Blue_Quills_Residential_School_%2815873685907%29.jpg

The school focused on instruction in trades and agriculture.  He was often subjected to harsh discipline, malnutrition, poor healthcare, physical, emotional, and sexual abuse, and the deliberate suppression of his culture and language.

Jack recalls that first day; he was loaded onto a bus and drove him to the school.  He thought he was just going for a drive for a few hours and would be returning home.  That first day after he arrived, he didn’t know what was going on.  They gave him clothes and a shower, it was difficult for him to stay there. When allowed outside to play, the boys were segregated from the girls in the yard.

A typical day at the residential school consisted of waking up at about 6:00 am, having breakfast, taking a shower, and then going to church.  He remembers praying more than going to school.  In the early days when Jack spoke his own language, the teachers would pull his ear and hit him with a ruler.  They would make him kneel down in the church as additional punishment for speaking his own language.

If he had stayed with his parents, he would have been able to speak and understand the language and their culture.  However, the few times he returned to see his parents and community, he felt like an outsider, as he was unable to understand the language and communicate effectively with his family.

Jack would describe his years at the Residential school as bad.  It made him scared of regulations and rules.  After Jack left the school, he was always getting in trouble with the police due to alcohol consumption.  He would get picked up for being drunk and disorderly, and spend a few days in jail.

The thing Jack hated the most about his time at Residential school was the daily showers.  They would dry the kids off, and rub powder all over them.  Jack did not realize at the time that this was sexual abuse, he and his friends would laugh at teachers rubbing them.

He did not feel like he received a good education from the Residential school.  When he first left, he lived on the streets.  He found it difficult to gain employment, as his education lacked, and no one wanted to employ an “Indian”.  Jack persevered, eventually finding odd jobs over the years.  He worked as a farm-hand, in the local lumber yard, and finally got a permanent position working in the mine.

Based on the recorded story of Tim Antoine https://legacyofhope.ca/wherearethechildren/stories/

A group of boys standing on the grounds of a residential school.
CC By No known copyright restrictions https://upload.wikimedia.org/wikipedia/commons/thumb/1/1c/A_group_of_students_in_front_of_the_school_buildings_of_Washakada_Indian_Residential_School%2C_Elkhorn%2C_Manitoba%2C_circa_1900_%2815063094020%29.jpg/640px-A_group_of_students_in_front_of_the_school_buildings_of_Washakada_Indian_Residential_School%2C_Elkhorn%2C_Manitoba%2C_circa_1900_%2815063094020%29.jpg

He met Mary in 1962 at the general store where she worked.  He was away working in the mines for a few years, upon his return they married in 1969.  Jack found a mining job close to home and worked there until he retired.  Jack and Mary had two children.  Mary attended church regularly with the children, however Jack refused to go with her as it brought back too many painful memories.

Jack often felt he had nothing to offer his children, he had lost his heritage years ago.  Of Jack’s two children, he was closest to his daughter Nancy.  He encouraged her to play sports, took her fishing and hunting, these were things he felt comfortable doing.  Jack’s son, Phillip had no interest in any of these activities.

Jack worked hard to maintain the home that he has shared with his wife for almost 50 years.  Over the last 5 years, Jack has been struggling with pain and numbness in his feet which has affected his ability to maintain his home. Jack started doing less and less as time went on due to the pain and numbness.

Jack was diagnosed with Type II diabetes mellitus just before he turned 50.  Jack takes short-acting insulin with meals.  Jack required insulin injections, because his meal planning, weight loss, exercise and prescribed medications did not achieve targeted blood glucose (sugar) levels.

CC BY 2.0 https://upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Yurt%2C_Iran_coal_mine_explosion_136.jpg/640px-Yurt%2C_Iran_coal_mine_explosion_136.jpg

A Turn of Events…

While his spouse, Mary, was in hospital for 7 days, Jack struggled with meal prep, testing his blood glucose levels, and giving himself his insulin injections.  As Mary’s discharge from hospital approaches, it is decided that Jack and Mary will move in with Nancy and Paul.

A few days prior to Mary’s discharge, Nancy travels up to the family home to help pack up what her mother and father will need while they stay at her house.

Nancy is shocked at the disrepair of her childhood home and the unkempt look of her father.  Nancy quickly assesses that Jack is unwashed, appears to be slightly short of breath (SOB), limping slightly, and there is a strange odor coming from her father.

Jack admits that he has been struggling since Mary went into hospital.  He has not been eating or managing his blood sugars and insulin well.  He is also embarrassed to admit he has not bathed since Mary has been away due to his inability to access the bathtub safely on his own.

Nancy prepares lunch for Jack and checks his blood glucose levels (12.4 mmol/L).  Nancy administers the required amount of insulin and eats their lunch.

After lunch, Nancy helps her father into the bathtub for a shower.  Jack’s SOB increases slightly with exertion, he states he feels like his heart is racing and he can’t catch his breath.  Nancy takes a radial pulse, and is pretty sure it is 130 BPM.  Although Jack is embarrassed that Nancy is helping him, he allows her to help him undress and get into the tub.

As Jack’s socks are removed, the odd odor increases.  Nancy now sees the source of that odor, an open, oozing wound on her father’s right foot. After Jack finished bathing, Nancy settled him with a snack and a cup of tea while she went to call his family doctor.

The family physician told Nancy to bring her father into the emergency department of the local hospital.  The physician notified the emergency department that Jack was coming.

Jack was seen by the emergency physician and diagnosed with a new onset of atrial fibrillation. 

Jack was admitted with a referral to the cardiologist for the newly developed atrial fibrillation and the endocrinologist to provide appropriate care for Jack’s Type II diabetes.  A referral was sent for the wound-care nurse.

Medications

  • Lovenox
  • Propranolol: beta blocker
  • Cardizem: calcium channel blocker

Nancy was now in a dilemma as both of her parents were in hospital.  Her mother was due to be discharged the next day.  The plan had been for Nancy to take both of her parents to stay with her while her mother recuperated.   She needed to get home to her son, husband and her studies.

Nancy spoke with the discharge planner and explained the situation.  Mary would be kept in hospital until Jack was ready for discharge.   Nancy then drove back to Toronto, awaiting her parents (both Jack and Mary) discharge.

Since Jack’s admission to the hospital, he has been transferred to a cardiology/telemetry floor and has been kept there to be closely monitored. When the nurses working the morning shifts come by to see Jack, she notices that there is increased swelling of the ankles, feet and legs and his lower extremities were cool to the touch.

When attempting to wake Jack, the nurse notices that he’s extremely tired and would not open his eyes. Jack responds to her questions in a very slow pace with a sluggish tone. He would further comment to the nurse that he does not know where he is and would like to see his wife.

The nurse immediately makes notes of her observations and reports her findings to Jack’s cardiologist to receive further orders on the interventions that must be taken. Upon Nancy’s return to the hospital, she is notified of Jack’s heart failure.

Four days after admission, Jack was ready for discharge. He had explicit discharge instructions for follow-up:

  • Wound care nurse to come daily to change foot dressing and assess healing
  • Blood sugar monitoring four times each day, values to be recorded
  • Insulin to be adjusted based on blood sugars, and given by Nancy
  • Medications to be taken as prescribed
  • Avoid the intake of fatty and salty foods
  • Exercise 3x/week
  • Follow-up appointments with cardiology and endocrinology in 4 weeks

Jack had now been in his daughter’s house for a week and had noticed the tension between Nancy and her husband.  He did not understand what was wrong with Sam, but could not help but think they should be able to return the sick child they had adopted, this is not what Nancy and Paul had signed up for.

He constantly felt like a burden with all the care he required and spent most of his time in the room that he and Mary shared.  He was concerned about his wife’s recovery and wished that they could just go home.

Eventually, due to Jack’s previous alcohol consumption, he began to experience abdominal pain as well as some swelling in the same area. At times, when he went to work, his co-workers would point out that his eyes and skin appeared yellow. Jack decides to book a doctor appointment in hopes of finding an answer to why he is experiencing some of these symptoms.

During his appointment, the doctor begins to collect information and later receives a phone call from his doctor. Unfortunately, he was told he was diagnosed with malignant liver cancer, his doctor informed him on the next steps for Jack’s care.

Since Mary has been ill, Jack has had time to contemplate his life.  He felt that if he had not gone to Residential school, he would have been a very different person, and led a very different life.  The school took away his birthright, his culture and history.  He stopped going back to the reserve to visit family shortly after he got married, as he felt like an outsider.  Jack felt that he had let his children down, as he was not able to provide them with the rich heritage of the Ojibway people.

Case Key Words

Key Words: Aboriginal , Atrial Fibrillation , Cardiovascular-Conduction , Endocrine System , Foot Ulcer , Heart , Indigenous, Occupational Illness and Disease, Pancreas, Peripheral Circulation, Peripheral Neuropathy, Post-Traumatic Stress Disorder (PTSD) , Residential Schools , Type II Diabetes, Type II Diabetes, Heart Failure, Liver Cancer, ISBAR, CPR, Cardiac Rehabilitation, Wound swab, Nursing Management in Radiation Therapy

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Multi-Course Case Studies in Health Sciences (Version 2) Copyright © 2021 by Laura Banks; Elita Partosoedarso; Manon Lemonde; Robert Balogh; Adam Cole; Mika Nonoyama; Otto Sanchez; Sarah West; Sarah Stokes; Syed Qadri; Robin Kay; Mary Chiu; and Lynn Zhu is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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