Pages From a Rez Journal, continued

Following additions to our clinic staff, I was able to free up time to explore the Northern Cheyenne Reservation while making housecalls. Community health representatives (CHRs) selected patients to visit and drove me to their homes.

Back in the hills, barely accessible to even a four-wheel drive, we approached remote little cabins, relics from the early days of the reservation. Our patients were mostly old folks. Some refused to come in to the clinic, not trusting government doctors and the modern system. (When the Rez was young, health care was provided by Army docs, who wore the notorious blue coats which evoked racial memories of events like the massacres at Sand Creek and the Washita.) Others were too disabled to make the slow, bumpy trip into town.

Although I could draw blood, attend dressings and administer such medicines as I had thought to pack in my little black bag and a big plastic tacklebox, most of the usual amenities were not accessible out there. No X-rays, on-site lab, full pharmacy or ancillary services like optometry and dental. No matter. Improvising can be fun.

We stopped in to see a young lady with crippling MS who could barely get out of bed. I returned with some items from my work shed and built a "trapeze bar" over her bed. Reaching up to grab it, she could pull herself upright and swivel to the edge of the bed, from which she could be transferred to a wheel chair. Cobbled together, far from elegant, but she loved it.

On another occasion, we entered a small log cabin to visit an old man with a painful knee. Tipi poles had been suspended horizontally just below the ceiling.

Sheets of expertly-cut raw venison were draped over the poles, hanging down to dry just like those on outdoor racks. "Dry meat" is a traditional dietary staple and can be made into stew or pemmican.

Slices of deer lungs also dangled, and I ducked under a pair to enter the man's bedroom. I let the CHR introduce me, then shook hands, complimented them on the beautiful dry meat in the kitchen, and asked permission to look at his knee.

Exam showed it to be garden-variety degenerative arthritis, but incurable; he wasn't any candidate for operative knee replacement. I turned away to withdraw some sweet cedar from my bag. Avoiding any self-serving flourishes, I held a flame under it to produce some fragrant smoke. "Smudging" is associated with healing, and cedar helps dispel any bad influences in the vicinity. Also, the odor conjures ancient memories, the security and comfort that a medicine person might've provided this old man when he was a child.

I went back outside to gather some "man sage." His wife heated some water on their wood stove, and brought me a towel. When the water was comfortably hot, I folded the towel lengthwise a few times, with the sage layered inside. I dipped the towel in the hot water, wrung it out a little, and then wrapped it around his knee. The aromatic sage vapors filled the air, complementing the lingering cedar. Moist heat has some real benefits, but sometimes -- because it's so simple -- people need to be motivated to bother with it.

He was gratified, and so was his wife. They were to repeat the process several times a day. I left him a little ibuprofen to use at bedtime, but only if the pain was bad.

The CHR told me later that he almost never used the pills; not that he didn't trust them, but just knowing that there was more he could do if he really had to, he was able to tolerate the pain, confident that he always had something in reserve.

We visited an old lady, Susie Tallbull, who was bedridden with burnt-out rheumatoid arthritis. After the usual introductions, I knelt beside her bed to examine her.

Suddenly, wham! Something hit my head hard, knocking my glasses askew. I turned to see her son, Myles, standing expressionless, weaving slightly, fist clenched. Pretty drunk. I didn't want to respond in kind, or be driven away; the old lady was already embarrassed, and needed treatment.

"Knock it off, Myles!" I said. Poor choice of words. I returned to my exam. Clop! He hit me again.

"C'mon, Myles, I'm just checking your mom," I growled, but this time I sat up on the edge of her bed before continuing. When I focus on the exam, I tune out everything else -- which wasn't too bright, under the circumstances.

After the third blow knocked my glasses plumb off, my CHR had had enough. An imposing woman, Emma Littlebear. She stood and drew herself fully erect to tower over Myles, who was solid, but short and wide, like a toad.

"This doctor is a good man," she said, fixing him with a menacing glare. "He isn't going to fight you." But I will, she implied unambiguously. That was enough for Myles.

Maybe he forgot this episode, but later Myles came to see me in clinic -- he'd developed agoraphobia and couldn't enter a crowded place like Kmart without panicking. I applied hypnotic desensitization, which required a great deal of his trust.

It worked fine, he was cured, and we were friends until he died -- of cirrhosis.

Jon Hauxwell, MD, is a retired family physician who grew up in Stockton and now lives outside Hays.

hauxwell@ruraltel.net