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FORUMHealing and History on the Navajo Reservation
Sienna. Auburn. Burnt Orange. These used to represent nothing more to me than the exotic colors in a 64-box of Crayola crayons or the color choices I mulled over in the J. Crew catalogue. But since moving to northern Arizona, these colors have taken on new power. The redrock hills behind my house, bleached dusty brown by the searing noon sky, give off an enveloping rose glow when I walk at dusk. The imposing mesas stand golden in the distance as they catch the sun, gradually fading to deep violet-gray. Even the meager waters of the San Juan burn at sunset as the river winds through the chapped red cliffs. Fresh out of residency at Children's Hospital in Boston, I am starting my fourth month as a pediatrician on the Navajo Reservation. The high desert of the Navajo Nation covers an area the size of West Virginia and sprawls across Arizona, Utah, Colorado, and New Mexico. Life on the reservation is spare. Nearly 50 percent of the population lives without running water or electricity and nearly 70 percent has no phone. Most cell phones, including my own, have no reception out here. The instant access I was so accustomed to in the big city does not exist. I recently called a member of our staff and got her answering machine: "I will be out of my office for the next two weeks. If you need to speak to someone, just call back at this number until someone answers." First, Doing HarmThe gulf between the Western medicine I have to offer and the traditional lifestyle that many of my patients lead can be overwhelming. To make the issues more complicated, we have inherited a deeply troubled history. Our government forcibly moved the Native Americans off their lands. We offered "education" by forcing Indian children into overcrowded, unsanitary schools, where many were killed by epidemics of measles. We cut off the boys' braids and washed their mouths out with soap when they spoke their native language. The introduction of Western medicine to the reservation was similar. Well-intentioned physicians, convinced their therapies were superior, tried to beat the medicine men out of existence.The Navajo traditionally consider words to be very powerful because they believe that each person is part deity. If you warn of the potential for a negative outcome, you have the ability to will the event to happen. This makes discussing treatment options very complicated. Several weeks ago, a 59-year-old Navajo man came to our emergency department complaining of chest pain. An EKG confirmed a major heart attack. He needed to transfer from our tiny emergency department to a larger hospital for intensive care. But the man refused all treatment. Carlos, my husband and fellow doctor and HMS alum, tried to convince him to stay: "Some people with heart attacks can have serious problems. To keep your heart healthy, I strongly recommend that you allow us to transfer you to the hospital," he urged the man. Unconvinced, the man pushed past him and headed for the door. Finally, the nurse intervened. "I know that this is taboo in your tradition, but I have to tell you that you could die if you don't accept treatment. I don't wish it on you, but you have to know that," he said. The man burst out the door. At 4 a.m. the next morning, less than six hours after the man left, we were awakened for a code blue in the emergency department. It was the same man. He had become unconscious at home. It took the ambulance 30 minutes driving at top speed over dirt roads to reach him and another 40 to bring him back to the clinic. By the time he arrived, we could not save him. The Hard WordsAfterwards, Carlos agonized that he had not been explicit enough to allow the man to make an informed choice about refusing treatment. "We can use the excuse that we need to respect their traditions to avoid the hard conversations," he said. "Maybe I should have said more than I did."The painful history of white intervention on the reservation hangs heavy in the air. If we did not share this past, I would feel comfortable voicing my opinions more forcefully. I would worry less that I was compelling my patients to choose the "white way." Now I fear that I will alienate my patients, that they will believe I have contributed to their illness in what was a misguided attempt to heal. Titus, a social worker at the clinic, is the Westernized son of a medicine man. He spoke to our medical staff after the man died. "I don't know what the answer is," he said. "Many traditionals die in ignorance because they couldn't see the whole story, the way you see it. We are very grateful that you have chosen to be with us here on the reservation, to bring your talents to care for us." He offered a Navajo blessing for us. I found his words comforting. If Titus didn't know the answer, then that gave me permission to struggle, too. --Ellen Rothman, HMS '98 |
