The Outsiders

Posted by • December 23rd, 2015

A few weeks ago we had our first Thanksgiving in our new home, complete with turkey costumes for the dogs and my wife’s best green bean casserole to date. We really feel like roots are starting to take. What was I most thankful for this holiday season? A home, a family, and the opportunity to bring happiness into our small part of the world. Or as my kookum would have said, “Someone to love, something to do, and something to wish for.”

Flagstaff is the tenth new city I’ve adopted, having moved frequently across the Midwest growing up, followed by New Haven for college and Boston for medical training. My parents separated when I was about three years old. I don’t remember much from that that time, except for the crying, the noise, and the movement. As I talk with my parents now, they tell a story which should be familiar to divorcees. They met young, loved fast, grew apart, and happiness together was unsustainable. As a result, I moved a lot, and events were, again, predictable and familiar to kids of divorcees. I showed up at a new school, often mid-year, got bullied, beat up, tried to fit in. When that failed, I retreated into school work, television, and sport. I found myself never feeling settled, always looking for acceptance, and never really at home. I grew up an outsider.

I write this not to be depressing or garner sympathy. My folks made the right call for our family. And despite the emotional toll, I always felt loved. They did the best they could and I love my parents. I took away a lot of really important lessons from that time. I add those hardships to the list of experiences I am thankful for, as they have allowed me to know why I am happy today. For example, I moved to three different reservations during those tumultuous years. I thought things would be easier than moving to a majority white school. After all, I am Native and from the same tribe. I expected there to be a kinship and shared understanding that would cut through most of the awkward getting-to-know-each-other phase. But that’s never how it played out. It did not matter where I came from. I was distrusted, tested, pushed away. Initially, I was consumed with contempt and resentment for perceived slights. And I was generally resigned to being unhappy. But then I learned some lessons that allowed me to cope with being an outsider. For example, respect is something earned not given based on background, race, sex, household income, or tribal affiliation. And virtues such as tolerance, generosity, self-regulation, patience, and resilience are absolute necessities to function in society. And finally, empathy and forgiveness are the keys to some semblance of inner peace and happiness.

And now I carry these lessons forward to my current position in the emergency department on the Navajo Nation. Again, I expect no special treatment due to my ethnicity, the letters after my name, or the beaded stethoscope around my neck. I never expect my words and recommendations to be taken at face value because of where I went to school and my training. I knew coming in as the outsider — the new guy — was going to be hard. I expected to be challenged and looked upon cautiously as I encountered each new face. And I believe that patients have a right to be just a little bit mistrusting of outsiders, Native or not, physician or not. Not to be flippant, but let’s face it, the historical record of Native people and outside influences is dismal. Not even the Indian Health Service — the organization bound by trust to care for the health and well-being of Native people — has a clean historical track record.

To illustrate, I want to tell a story about my aunty She-sheep. Her name is a phonetic form of our Anishinaabemowin nickname for her, zhiishiib, meaning duck (noun). I remember her vividly — her top dentures rattling around sometimes while she talked or smiled, her stout and doughy form, which calmed me when she held me close. Sometimes I would grab at the skin on the back of her arms and elbows, which I’m not sure she appreciated, but she protested little. And of course her gait, which, as you can guess, resembled that of a duck. Overall, I have such good memories of her. But as the rose-colored glasses with which we view memories become smudged with time, I learned something about her that shocked me.

My aunty She-sheep carried a great sadness despite her happy countenance. Her biggest regret was that she never had the big happy family she had always wanted. The reason was that right was taken from her, forcibly and with sinister motives. As she was going into labor, with her son of whom I know nothing about, the delivering physician and local priest took her husband, my great-uncle Dominick, aside and told him to sign a paper to consent for a cesarean. My great-uncle, illiterate and not sure of what he was signing, did not realize that he had just consented to a hysterectomy. This fact was hidden from my aunt who did not learn until years later after many failed attempts at pregnancy. I am not sure if this happened to any other women in my family but I know that my great-aunt was not the only Native woman to be sterilized without her informed consent.

In 1976 the Government Accountability Office (GAO) released a report confirming long-held suspicions that physicians were to blame for the declining birthrate amongst some tribes, and independent studies that followed estimated that as many as 1 in 4 women were sterilized without consent or under significant unethical and coercive practices.[1]  These practices were carried out by physicians, some employed by the Indian Health Service, who took the same oath as all physicians do to protect and hold sacred the values, beliefs and well-being of our patients. And, like in the case of my aunty She-sheep, many did so with the assistance of local clergy.

Now I can understand, appreciate and empathize with Native people and the distrust of outsiders. As I think on my chosen career and the tragedy of aunty She-sheep, I wonder if she would have been disappointed in me. After all, I have become part of the very establishment and profession that stole her dream. Would she welcome me into her arms as lovingly as she always did or keep me at arm’s length while looking upon me with suspicion and distrust?  Of course, I know her reaction would be the former. She learned it is our capacity for love, compassion, and forgiveness which allows us to find joy in this world. She would be proud of me, because I have the opportunity to make a positive influence in the lives of patients and Native communities.  She would encourage me to be the caring and compassionate physician that she never had. She would be sure that I would never engage, bear witness, or tolerate any mistreatment of Native people or any patient for that matter. Finally, I know she would want me to redouble my efforts to further a dialogue to understand and help heal those past injustices. By the way, I just thought of another thing I am thankful for — this forum, which gives me an opportunity to reflect on those efforts.

Because of my Aunty She-sheep’s story and my childhood as an outsider, I can understand why we — as a nation, or just as people who have suffered irreplaceable loss at the hands of others with different beliefs and backgrounds — have a distrust of outsiders. We hurt and resent until we find comfort in closing ourselves off, shutting down our borders.  But She-sheep knew better. There were bad doctors who ignored their oath and mistreated their patients. But far outnumbering those individuals are incredible doctors who have dedicated their lives to improving the quality of life of their patients. In fact, in the ultimate display of forgiveness and love, she nurtured one, my mother, who then went on to nurture me. And with our time’s recent events and today’s fears of terrorism and refugee flights, I see parallels and sadly repeated mistakes of the past. Yes, there are some horribly destructive, selfish, and misguided people who have committed atrocious crimes against others, but they are the exception. We cannot allow our compassion, generosity, and kindness to be blighted or smothered because of the actions of the terrible few.

The majority of people seeking safety and asylum, are, like you and me, looking for home — a place where they can become part of a community, raise their families without fear and invest in a future for their loved ones. They are outsiders, as all of us have felt at some time or another, adjusting to circumstances beyond their control. All they want is to be accepted, be productive, be happy. I have just one more thing to be thankful for.  I am thankful for people like my Aunty She-sheep, whose story I now share, whose example I now follow and whose expectations I now try to live up to.  I ask that others follow, let go of that resentment and fear. During this holiday season open your hearts and minds, and create some space for dialogue and forgiveness rather than vitriol and bitterness. Then, maybe we all can find a little more peace and happiness.

[1] J. Lawrence, “The Indian Health Service and the Sterilization of Native American Women,”American Indian Quarterly 24 (2000): 400-419.




2 Responses to “The Outsiders”

  1. Jane Byron says:

    How wonderful, Ken! I love learning more about you and your people through your poignant words. I look forward to your next post!

  2. Pankaj says:

    This is a though provoking writing that inspires us !