ITF email@example.com_county.toronto.toronto_star 2005-07-04 published
Dr. Ian NAKAMURA, 44: A kind, gentle man
By Catherine DUNPHY, Obituary Writer
He was a doctor with heart -- a huge heart -- and in the end it killed him.
Dr. Ian NAKAMURA made house calls, lots of them. Every lunch hour he would slip away from the busy Richmond Hill practice he shared with his sister, Liane, to see his patients who were shut-ins, or frail, or unable or even unwilling to leave their homes.
Sometimes his workdays started at 7 a.m. -- because that's when patients could see him -- and often they ended long past 6 p.m.
"He'd call and say he was going to be a little late. That he was just stopping to see a patient on the way home," said his wife Silvia, with a rueful smile.
She knew that meant he would be having a very late meal when he finally got home. "He took care of everybody."
He lent money to a patient whose husband ran off with the car, baby seat and all, and the cash from their bank account. Because the parents of a child undergoing chemotherapy were worried about him coming into contact with people with colds and viruses in the waiting room, he went to their home. An elderly patient who had broken her foot was surprised to find the doctor at her door one day, bearing her pain medication.
He sat long into the night at the home of one man who was dying of colon cancer. There was little he could do medically by then, but he wanted to comfort the man's family. He stayed until after 2: 30 a.m., driving home in time to pick up his own family and head to the airport for their vacation and an early flight to Florida.
But first he phoned his sister, on a mini-vacation in Niagara-on-the-Lake with her own family, and extracted a promise from her that she would take over in his absence and go to the man's home to pronounce him dead when the time came. The man had wanted to die at home and Ian NAKAMURA was determined he would have his wish, which he believed meant not being taken to a hospital to be pronounced dead.
"He did that with every patient," said Liane NAKAMURA, also a doctor. "If someone's kid had an earache he'd call the next day. He didn't know where to draw the line. He gave out a lot of himself and in the end it took all his energy."
Ian NAKAMURA died May 12. He was 44 and he had forgotten how or was unable to heal himself instead of others.
"Within our family we thought he could never say no, even when it was bad for his health. His good-heartedness meant he had a higher level of stress," said his oldest brother, Glenn. "But he would tell us that it brought so much comfort to all those families."
Ian NAKAMURA suffered a stroke in January 2004, when he awoke one morning so dizzy he couldn't stand up. Doctors discovered he'd been born with a hole in his heart and put him on blood thinners to prevent further clots and strokes. He was off work for a record five weeks, but when he returned to the office he went back to his old ways. His wife, who worked with him in the clinic as a laser hair-removal technician, tried to block off some downtime for him in the appointment book.
"He would pace in the office, worrying why he didn't have any patients to see," she said.
Always a worrier, he had been under a great deal of stress since the previous summer when he was notified he was going to be audited by the Medical Review Committee. According to his sister, the red flag had been the number of house calls he made.
"He was outside the norm of house calls. He was doing one or two a day when most doctors don't do one a month," she said.
He was so devastated when he got the audit package in May 2003 that he couldn't come into work for three or four days. These audits are a contentious issue with the country's doctors, and both the Ontario and Canadian medical associations are on record as being strongly opposed to them.
"They do make you feel you are doing something wrong," Liane said.
In her brother's case, the auditors had spent a day in the office, poring through files and grilling him about various billing procedures. Expecting the worst, he had remortgaged his house in Maple while he awaited their decision.
"It was like a black cloud over his head," said Liane.
A week before NAKAMURA died, George SMITHERMAN, Ontario's health minister, got a standing ovation at the Ontario Medical Association's annual general meeting when he announced that the government had stayed proceedings for all audits in progress, as a result of an independent study submitted to it April 22 by former justice Peter CORY that concluded the physician audit system was detrimental to the province's health services.
The patients never knew that their gifted doctor was worrying about his own troubles.
"They all thought of Dr. Ian as their friend," said Silvia.
"And as family," said Liane.
Although Ian was 6 years older, she graduated from medical school just one year after him. Ian had dropped out of university in 1981 to return home to care for his mother who was bedridden with terminal cancer. "He lost a lot of time," said Glenn. "He had to start from scratch and reapply for med school."
He graduated from the University of Alberta's medical school in 1990, the same year he married Silvia.
He worked at a walk-in clinic and in the North York Branson hospital's emergency ward before he went into his own practice; he used to tell his sister he'd still be working emergency at Branson if she hadn't set up the clinic.
"I always thought it would be the two of us working together, just family," she said.
After five years they were each carrying a full patient load (about 2,000 each). Every day, Ian and Silvia's children, Kristen, 13, and Alex, 10, would come to the clinic after school, along with their cousins, Liane's children, Madison, 10, and Mackenzie, 3, all of them heading to the back where there was a television to watch their favourite soap opera, Passions, before doing their homework.
"They're like one family, with two fathers and two mothers," said Glenn.
But last December, Ian NAKAMURA underwent non-open heart surgery to try to close the hole. "Part of his goal in having the surgery was to get off the blood thinners so he could play football again," said Liane.
A season ticket holder for the Argos back when few other people were, he had been playing with the Fierce Rooters of the Metro Touch Football League for 20 years with guys he'd grown up with on Parent Ave. in Downsview.
But the procedure didn't work and in April he was admitted to hospital. "There was a risk of bleeding and that's what happened," said Liane. "It bled into his brain."
More than 1,000 people came to pay their respects to the family 600 attended the Monday morning service. Glenn told them Ian had donated his organs to five people in Ontario, one of whom was a 10-year-old. "A final act of love from a man whose capacity for caring was boundless," he said.
He was the one who bought their father a new van for his 65th birthday, bought Glenn a big-screen television for his 50th and then decided to give the same gift to the family of their brother, Nolan, who had died in 1999 at 45, on the day he, too, would have been 50. But he refused to let Silvia do anything big for his 40th birthday. He thrived on giving; receiving made him uncomfortable.
The family has set up an education trust fund for his children. Liane's husband, Anthony BELO, is administering it, c/o ITF Kristen and Alex, at the clinic at 10815 Bathurst Street, Unit 25, Richmond Hill, L4C 9Y2. Hundreds of his patients have contributed to it one wrote a cheque for $5,000 -- perhaps because this was to be the only way they could ever thank Dr. Ian NAKAMURA for all those house calls and extra attention.
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