I am a freedom fighter

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I am a freedom fighter. No, I haven’t been part of a flag-bearing convoy of protesting truckers.1 I am a doctor. I have been in general practice for nearly 20 years with experience in long-term care, heart health, sleep medicine, and, most recently, addiction medicine. If I have learned anything, it is that health is freedom. I have also practised long enough to know how precious and precarious it is to have good health.

Those who have physical, psychological, and socioeconomic health have greater access to the things we all cherish: the ability to use our bodies freely and to have clarity of mind, to be with friends, to help our communities and our loved ones, and to pursue dreams and new challenges. I have seen many people—patients and loved ones alike—struggle to keep these components of freedom. Appreciating health as freedom came into sharp focus for me when I journeyed beside my sister-in-law as she fought an aggressive cancer that metastasized to her throat. We were the same age when I became acutely aware of my ability to sprint into the drugstore to get her medicine while she sat in the car, immobilized by pain and gasping for air.

Nurturing health as freedom

Armoured with years of study, experience, and scientific evidence, I do my best to guide those in my care to make decisions that will not limit their freedom. When I discuss with my patients topics like smoking cessation, reduction of alcohol consumption, and exercise (I discuss this nearly every clinic day), nurturing health as freedom is my only motivation. I see patients whose capacity to even reach my office is restricted by their inability to move or breathe, and I hear their many frustrations. Some find it hard to bathe and dress themselves. Some wish they could clean their own homes again, go for a run like they used to, or walk their grandchild to school. Some do not live a moment without emotional, mental, or physical pain. Many regret taking for granted their previous health and the freedom that came with it. There are also those who, through good luck, have genetics that protect their health, while others do not. Regardless of the lucky or lousy hands they have been dealt, I celebrate every effort they make to fight for freedom.

My family life has also given me an intimate understanding of mental health issues and addiction, of struggling with cycles of anxiety and obsessions and compulsions, all while further being oppressed by shame and stigma. The loss of freedom tied to these struggles is high. At a young age, one of my loved ones said that his frightening thoughts made him feel like he was “trapped behind bars.” I myself have gone through the worry and tension that come from discovering an unwanted lesion: the tests, surgery, and clinic visits, and the limbo of waiting for results. All the uncertainty about the future affects the ability to enjoy the present or to focus on life’s other demands. While perhaps they are not quite the same as feeling “trapped behind bars” or battling metastatic cancer, we all have personal versions of such freedom-fighting stories.

In my practice, some patients don’t want their days to be spent in hospital or in clinics. They don’t want to be bound to medications and undesirable side effects, so they decide not to pursue recommended treatments. Always mindful of their decision-making capacity and of potential harms to themselves and others, I will fight for these freedoms, too. I offer them alternatives that minimize personal harm and better align with their lives. For the person who is ravaged by addiction and decides against treatment, I will make sure they have access to clean needles and a naloxone kit and have an awareness of safer drug use. For those suffering from an advanced, incurable condition, I will support medical assistance in dying. I will also always support a woman’s right to have control over her body and the healthy expression of gender identities and sexual orientations. I am a freedom fighter for all these things. Some patients will embrace every available treatment to preserve their slivers of freedom, and I will support this, too. I saw the decision that my sister-in-law and her surgeon made to repair the effects of the unrelenting cancer inside her body as a fight for a tiny bit more freedom, for more time with her young family.

Evidence, vigilance, and compassion

When I see a protest like the one that descended upon Ottawa at the end of January 20221 and messages about how vaccines cause harm and how mandates restrict freedom, I think about the science and my medical community. I think about how vaccinations and masks during the COVID-19 pandemic have been part of my arsenal to fight for health as freedom. These measures are steeped in expert consensus and incontrovertible evidence and have proven to be vital ways to protect us and our health care system.

While it can be difficult to wear a mask and it is sometimes inconvenient to get vaccinated, some depend on others to do these things. I had a patient with an advanced neurological disease that made her particularly vulnerable to COVID-19. She expressed gratitude for mask-wearing and vaccination mandates because they offered her added protection and safety. I have had far more inherently healthy patients express frustration about the constraints of mask wearing, and I have felt conflicted by their comments. I have wanted to step out of my professional role and explain my personal standards of equity and compassion in care for a moment to remind them how fortunate they are to have their health and resulting freedom.

My sense of conflict grew when a colleague told me of a patient who angrily cursed the physician preparing to intubate him to save his life from COVID-19. Based on his beliefs about the disease, the patient resented the diagnosis, but he also didn’t want to die. During the pandemic health care professionals have gone from being lauded and literally applauded to being harassed and attacked for our efforts. Even in the midst of such ongoing uncertainty, and while understanding that some harbour deep suspicion of the medical system, we will continue to fight to preserve the health and freedom of all patients.

We must, each of us, contend with the many elements of our mental, physical, emotional, and socioeconomic health in different ways. We have each been dealt a genetic hand—some better or worse than those of others. From my perspective, freedom is the appreciation and protection of the health we have and support for the health we do not have. Support can be found collectively, by following the advice of public health experts, or individually, through a personal choice such as to quit smoking or—like my sister-in-law—to choose surgery despite its potential futility. In my practice, freedom fighting involves mostly listening to and engaging in careful, delicate conversations. Instead of deploying misinformation, chaos, and loud horns, my fight uses the best scientific information available, vigilance, and quiet moments. Even as protesters and vaccination and mask mandates slowly recede into the background, the fight for health will go on. I will use the best knowledge I can to continue to fight for freedom.

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Competing interests

None declared

Copyright © 2022 the College of Family Physicians of Canada

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