first day meeting open space

Have finished my primary care rotation in Chinle Arizona on the Navajo Indian reservation, and am slowly backtracking in writing about the experiences. It will probably take awhile, but here are some thoughts of the first day.

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[October 19]

I approached Chinle Hospital in the dark, turning left onto the first paved road after a long stretch of lightless highway. The past hour and half encompassed nothing behind or ahead, focusing on the few feet of sight afforded by my headlights and hoping hard that my car wouldn’t break down or run into livestock. I’m relieved to see a sign, and a building in the distance; my fingernails released slightly their hold on my steering wheel. The directions written by one of the physicians noted that we would pass over three cattle grates on the road to the hospital. I didn’t know what these were, but I soon learn that when the sounds of the ground and feel of my seat beneath the car’s wheels changed, that meant I’m going over said cattle grates. This is how I came to know Chinle, in pieces of sensations. In the dark, the expanse is immeasurable; the next morning, the immeasurement is visible.

When parking my car facing the hospital, the sky stretches behind. Every morning the clouds are a different kind of spectacular, still and nonchalant. When I ask employees who had grown up there where they were from, they point to specks in the landscape: that peak next to the dipping crests, this bend in the road. On runs and drives along the two roads that take me from my housing to the hospital and back, looking at what’s straight ahead is like looking down from above; this and the sharp cold reminds me of the 5000 feet elevation. On one day, a cluster of green trees on the side of the road are burning in transitional sunlight, between the day’s rawness and the modesty of dusk. The space above the grove is encased in thick creamy gray cloud, such that you have to face the other side of the road to find the source of the yellow cloaking the trees.

Against the open space, I slip into the interior of the hospital a little off balance. There I am surprised to find that at first the inside here is not so different from the inside back elsewhere. There are aisles of patient rooms equipped with computers, otoscopes and ophthalmolscopes, and hand sanitizer. I recognize these sights, but I’m newly aware of the air surrounding them. The first day of clinic is muffled, faintly familiar with a lot I couldn’t quite understand. The medical problems are not dissimilar from what I have seen: diabetes, hypertension, hypothyroidism, back pain, joint aches; nor were the services rendered: routine physicals, medication changes, laboratory tests. Despite the intimacy of our relation to our blood and hormones, it is normal to disengage them from ourselves to form concepts of illness. Reading the medical chart before entering the patient room, I feel no hitch in turning the wheels of listing these problems and considering treatment of them. But once inside, I’m struck in that compact space, as I was in the emptiness of Arizona desert, by a depth made foreign not only by its thickness but also by the texture of it layers.

Meeting a homogeneous patient population connected by their residence on the 26,000 square mile Navajo reservation, where the distances between homes are far in miles and close in experience, I’m worried that it is at first too easy to perceive things in broad strokes. I’m surprised to find that the backdrop doesn’t blur individual outlines; instead it places details in relief, some of which do converge into a large perception.

The town of Chinle holds a little under 5000 people; this had seemed small when I read it on paper, but encountering a dozen patients in a day feels the same here as it does in a city of 500,000. The patients I see on the first day of clinic make me wonder at how many people exist, how much experience lies in what’s considered a gap in life when driving across country.

On the first day there are several people who individually move me, and as a group make me question our separation of illness and person. Not separation in the sense that we forget there is a person experiencing the illness; we know this happens often and the danger of this kind of thinking is familiar to us. Separation in the sense that illness happens to a person by outside forces, and thus can then be taken away by outside forces. The people I meet today attribute so much of what they feel physically and emotionally to themselves, and this philosophy and practice of internalization is new to me, as someone who learned about disease first as subjects in school, then as objects people have the way they might own a winter coat, something not readily shed but is in principle detachable.

There is a 13 year old girl with very long, straight hair obscuring her pretty features, with glasses and crooked teeth still too large for a mouth still adjusting to the shape of her face. The oldest of six children, she is unsure of how she should stand. She’s tall, but skinny too such that she easily folds herself over at the waist and looks small. She’s here for her annual physical exam, and tells us that she often contemplates suicide. She admits to cutting her wrists, a process I hear a relative lot about over the rest of my time here. It’s hard for her to express why, her feelings spanning a spectrum broader than her vocabulary. On the teenage questionnaire that asks if you could change one thing about your life and yourself, she responds that she would choose to “be brave and emotionless.”

There is a middle-aged man who is here for management of his chronic lower back pain. He wears glasses too, but they don’t overwhelm his face the way the teenager’s did. He yells at himself when the pain is too much to take, because he knows he’s to blame for the source of it. Years ago, he fell off a ladder while intoxicated, and the impact to his back has continually flared since then. He yells at himself outside, away from his children, and defers from repeating his words here in the office. He doesn’t want counseling; he has had it in the past and does not think he is in a place where counseling is necessary. He is reluctant to pursue surgery for his back, because he won’t be able to take care of his children, and his wife who left him a year ago will then take them from him.

There is another middle-aged man with a cowboy hat, checkered blue shirt, and heavy brown boots, compliant with his medications and without any complaint other than fatigue after a bout of cryptogenic organizing pneumonia on top of severe heart failure. He says that a native medicine healer told him that this was due to his practice of killing and burning snakes during his childhood. The defiled spirit of the snakes has encroached upon his own, causing him physical illness. When asked why he killed and burned snakes, he replies that he was scared of them. He says that the healer believes this is also the reason why his face has been more swollen recently. It’s hard to be Navajo, he says to me. He says it not for his sake but for mine.

Each person responds differently to their respective self-blame: the girl tells herself cutting is stupid, the first man resorts to alcohol to soothe the injury first induced by alcohol, the second man participates in a ceremony to remove from himself the spirits of snakes killed. Successfully or not, they carry and shift and distribute the weight of whatever is disturbing them, in a way that I haven’t recognized before. I’m not sure how this new awareness, still a vague theory without real understanding, will help in handling the weight. But learning to be open to its presence and to the process of building a sense of its character made for a fitting first day.