A Gallup-ing Journey

The home had eight sides and a door facing East. The walls remained half-finished, and a wood stove burned warm and smoky inside. The nurse practitioner, Navajo translator, and I were 5 miles off the main road and 20 miles away from the nearest town. We had come to pay a medical visit to an elderly Navajo couple. There was no car in the dirt driveway leading up to their hogan. Instead, the 78 year-old medicine man walked, jogged, or hitchhiked the 25 miles to town. His wife, our patient, was an ex-weaver who suffered from the sequelae of diabetes. Her teeth missing, hearing diminished, sight nearly gone, this hearty Navajo grandmother sat before us in a wheel chair, her feet wrapped in bwages. Yes, this amazing Navajo Earth mother wore the deep, carved creases of life upon her face. She had CHF, retinopathy, and neuropathy. We took her history and did a physical exam. While answering our questions she would occasionally, mid-sentence, doze-off in a nap of hypoperfusion. Then we removed the bandages on her feet. Her lower legs from the shins down were necrotic and required amputation. Not until after we had dressed her wounds did she break down, crying, "Thank you, thank you, thank you on Kishmesh" (for Christmas was only a week away). This woman would have died had we not made that home-health visit. Some say that an old couple like that should not live so far from town. But to separate this couple from their land would be the severance of a crucial and sacred life-line. The "home health visit' serves a vital role for rural Navajo families.

It is fascinating how religions flourish in Gallup. Followers of many sects have descended upon the Southwest over the years. Some have come to convert the Indians or "save them" from their own "primitive" beliefs. Others have come with a sense of good will, wishing to help those "less fortunate" than themselves. Some sects come fleeing persecution elsewhere. Why come to Gallup? Perhaps it is the sense of omnipotence that courses from red rock at orange sunset or the pink jet streaks and morning clouds that paint the sky as Navajos awaken and travel Eastward during their morning prayer run. The power of the Earth is rich in Gallup.

As for teaching .... superb. Few medical experiences are as enlightening as spending an hour and a half in a car with Dr. Bruce Tempest. While driving to Tohatchi medical clinic, Dr. Tempest taught us about medical issues ranging from post-coma recovery to antibiotic choices for treatment of ceruhts; of course, he would always cite specific studies (some of which he had published) to support his choices. Dr. Tempest is an astounding compendium of medical insight and information; and, unlike many physicians, he is an excellent communicator as well. Dr. Tempest continues to teach during clinic. Dr. Tempest believes that in order to learn, medical students must be given the responsibility to make treatment choices. While in clinic, the medical student functions as practitioner. I would work-up the patient (History and Physical Exam), come up with a differential diagnosis, and decide upon medical interventions. Before the patient would leave, Dr. Tempest would see the patient, comment on my treatment choices, make suggestions, and always end with a teaching point related to the patient's case. I wish I could have recorded those short discussions ... Wonderful!

The entire Gallup experience was an enchanting one for me. It was a chance to learn about medicine, yes, but also an opportunity to experience the strength of a people shaped by the earth, struggling to maintain its Navajo identity.

Each morning in Philadelphia I awake early to run through the dark city streets. As many Navajos do, I run Eastward in order to greet the Creator and rejoice in the rising Sun. As I run I give thanks for life, for my connection with the Earth, and for the growth of all living things, "hajonja." I run to the South, to the West, and to the North,...knowing that someday I will return to Gallup.