Reentry to Doctoring: On the Lakota Sioux Reservation
Nathan Szajnberg, MD
A limp and a death among the Lakota Sioux marked my first day at Eagle Butte, devoid of eagles and buttes. I had a free summer after Covid and chose to return to General Medical practice.
Two days’ drive from Chicago, I am greeted from afar by John Running Horse, he dipping and rising like a Venetian gondolier, waving aloft what from afar seemed to be the plaster sculpture of a leg. Up close, it is!
Before I could stop completely, John Running Horse lay one hand on the open window of my red Fiat 128, inserted first cast, then head, and barked, “You the new doc?” I was. “Put this thing on again”; hands me the cast, then points to his gondoliering leg. I park. I do.
The Indian Health Service and reassured me yesterday that there were two docs here; arrive Sunday, they said.
But by Sunday, Dr. K. had been flown out with her own atrial flutter to be cardioverted eighty miles up the road to Mobridge; Dr. L. was riding shotgun in an ambulance with a mother in active labor also to Mobridge. His arm was pushing the baby back so it would not breech before they could do an emergency C-Section.
No docs left in Eagle Butte.
I wrapped a dripping, wet new cast on John Running Horse’s right leg and asked as I did so — dipping plaster rolls in warm water, smoothing them first around, then smoothing downward along the fracture to make it seamless.
“How’d your old cast get cut off?” I asked, I thought nonchalantly.
“Itched,” he said, “Hacked it off m’self.” He unsheathed and lofted his James Black/Musso pattern S-guard bowie knife. White plaster still dusted its curved Stainless steel back tip and brass quillion; hadn’t even wiped it clean.
I told John Running Horse that his skin would itch again after a few days; dried skin flakes. I found a metal coat hanger, bent it straight and showed him how he could insert it within the cast to scratch itches. He found this marvelous; made a special leather sheath for it to hang from his belt. Days later, he returned; brought a water color gift; painted himself on his horse; he wearing Sioux gear. In his right hand, raised like some victorious banner is not a leg cast, but his Winchester Model 1894 lever-repeating rifle — the gun what won the West, the weapon of choice for the Rifleman of TV. The painting had a static quality: horse, rider were stiff, quite upright. Signed below in flowing script is “John Running Horse.” Painted like by some talented twelve-year old. Still have it.
Today, replastered, equipt with a cane, John gondoliered away, dipping and rising into the horizon.
Mrs. Alpern, the head nurse, a full-blooded Sioux, asks me to round with her on the forty-bed hospital before settling into my apartment across the parking lot. With call every third night, trips to the ER would be short. Mrs. Alpern is of solid build; broad of beam, legs akimber, she sweeps ahead, clearing the corridor like some Arctic ice-breaker, leaving a wide wake behind. The swish of her white, opaque beige Supp-hose as she walked lent to the sense of being wave-washed at sea. Months later, Mrs. Alpern had warmed to me — the Sioux, finding the Christian missionary doctors overbearing, welcomed a Jew; I passed out birth control pills and no missionary religion. Months later, before I am to leave, she confides that we might be distantly related: her husband’s name she suspects came from a dry goods itinerant salesman, a Halpern, some generations back; left behind both “wet” and dry goods; perhaps she was part-Jewish by marriage; perhaps if not related, we were at least of common spirit.
But today, rapid-fire rounds. After years of pediatrics and child shrink, I would work as a general practitioner here; everyone on-call did snake bites, deliveries, cut men out from overturned tractors, sewed-up knife wounds. Yet, this Sunday, the most acute cases were the Bad Warrior twins and the newborn lying alone, almost agonal in a crib. The Bad Warriors’ skin was impetigo-stamped; their hide looked angry and they, both corralled in the same crib, acted angry. Scowls greeted all; food, spoons, toys, pillows, anything loose became missiles. My girl friend, D., La femme de ma vie (LFDMV), of the moment, is put on twin-feeding duty; she gets aproned and gloved before battle with the Warriors. She gets a plastic face mask, allegedly for Covid, but now more to deflect the twins’ flying oatmeal, eggs and milk bottles. I turn to the baby.
He looks septic and dehydrated: tented skin, labored breath, eyes shut. Neither docs nor nurses could get an IV inserted. I shave the scalp, prep. The delicate skin reveals veins like earthworms beneath a membrane of detritused leaves. Mrs. Alpern finds a #25 Butterfly needle (smallest made) and I slid this into a vein. I anchor the lifeline firmly, using the coilings and tapings that I had learned at the University. Antibiotics for both gram negative and positives and some fluids appeared to brighten the baby within a few hours. Time to wait.
Enough time to move suitcases into the grey cinder-blocked Bureau of Indian Affairs apartment building across the way, have dinner at the only restaurant in Eagle Butte, return for evening rounds. This baby would not make it here. I ask Mrs. Alpern about the nearest Infant Intensive Care Unit; Fargo, some hundreds of miles away. No problem, she assures; we would be flown out.
There were two pilots in Eagle Butte: Tim, a white crop-dusting rancher; and Mr. R., the grey-skinned undertaker. Tonight, Tim would fly us out in his ancient four-seater V-tail Beech Bonanza, made in Wichita; it was later monikered — shortly before production was discontinued in 1982 — the “fork-tailed doctor killer.” Much duct tape on the interior; a can of WD-40 between the seats for anything that stuck. The back two seats are removed for the baby’s incubator crib, oxygen, resuscitation equipment and myself. The baby’s crib is strapped-in tightly, like cargo. Tim asks me to take a front seat for take-off; weather’s brewing, could be bumpy. I refuse, crouch and huddle over the crib. Soon, my head dribbles off the ceiling throughout the flight; a helmet would have served well. The ambu-bag and cardioverter I use thrice in the hour flight. The baby dies on landing. I hand over the Xrays and labs to the doc who greeted us in Fargo; on the tarmac against the setting sun, shoulder to shoulder, we duly review the Xrays.
Tim and I head back, emptied. Storms had brewed; retribution for life lost. By the time we approach Pierre, the capital — pronounced “peer” — rain, hail and wind shears were bad enough we were told to land, not try for Eagle Butte. Winds were blowing ninety-degrees to the single runway. I, now belted-in, am annointed co-pilot. Tim tries to demonstrate an acrobatic landing: we fly into the wind, perpendicular to the runway. “Watch.” I must admire his maneuver as he harnesses the head-wind to yaw ninety-degrees for the landing. My nodding face is tucked into a barf bag.
On ground, sheets of horizontal rain sweep us into the waiting ambulance to take us eighty miles to Eagle Butte.
D. (LFDMV), I learn, had been joined by Sister Marguerite, the Roman Catholic nun and nurse. Sister had followed the weather reports. Rosary in hand, she adhered to D., praying for my safe return; not sounding reassuring. I, too preoccupied with a dying baby, innured to weather’s bluster, had been oblivious to danger. Even until today, a bit oblivious.
Then, we felt timeless; we thought we would be forever.
