Intended for healthcare professionals

Fillers My elective

The silent sentinels

BMJ 1999; 318 doi: (Published 08 May 1999) Cite this as: BMJ 1999;318:1245
  1. David Cummins, clinical tutor
  1. Harefield Hospital, Middlesex.

    The air outside was warm and sultry, with no wind. Dark clouds covered the mountains, and mist lay over the forest and nearby hills. The scattered wooden houses seemed empty and derelict; the dusty roads were deserted. “Take a look around,” he had said, “but be back by five.”

    The doctor visited the reservation once a fortnight. His patients were Gitksin Indians. Traditionally the Gitksin were hunters and skilled wood carvers, but those we had seen in the clinic were sad and smelt of whisky. The doctor said that when it all gets too much the Gitksin walk out on to the highway to join the Great Spirit.

    I strolled to the settlement's northern edge, where the road to Alaska enters the forest and where a Gothic church displayed warnings about hell and the demon drink; past the railroad stop, where the diesel penetrates into the interior three times a week and where a naked light glared aimlessly in the early evening gloom; and on to the trading post, where Red Indian dolls from China cost 50 cents each. Then I saw the totem poles.

    I had seen several pictures of those extraordinary creations, and had read about the guardian spirits that protect the Indian from harm. None of this produced the sense of wonder that the reality inspired. Carved out of giant cedar and over 60 feet tall, the totem poles stood erect against the darkening sky. Engraved on their northern aspects were haunting, mask like faces whose implacable expressions seemed vividly alive. Diverse in character, yet distinctive in form, the faces belonged to another world, far removed from mine. But most memorable were their staring eyes, which gazed across the valley to the horizon.

    The man outside the medical hut seemed to be in pain. He was holding his lower abdomen and his face was drenched in sweat. His high cheekbones and swarthy complexion betrayed his Gitksin forebears, but he did not look a full blood.

    “Is the clinic over, sir?” he asked.

    “Finished an hour ago,” the doctor replied. “If my friend hadn't been so engrossed in his sightseeing we'd be halfway home by now. What's the problem?”

    The man told us that he had been in pain for three days. His family lived on the reservation but he worked at a logging camp 30 miles to the north and had set out on foot the previous day to reach the clinic.

    We helped him inside, where the doctor told him that he needed surgery and that he should come with us to the hospital. The man quickly agreed and that night, 70 miles away, the surgeon removed a gangrenous appendix. When I saw him the next day he looked much better and, with a wry smile, thanked me for returning late from my sightseeing. I suggested it was not me he should thank, but his guardian spirit.

    It is 20 years since my student elective. The totem poles are decaying fast. Continually at the mercy of mist and rain, their substance fragments and ultimately perishes. Soon they will be gone forever.


    We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

    Log in

    Log in through your institution


    * For online subscription