37 pages • 1 hour read
Lori Arviso Alvord, Elizabeth Cohen Van PeltThe Scalpel and the Silver Bear: The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing
Nonfiction | Autobiography / Memoir | Adult | Published in 1999A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 3-4Chapter Summaries & Analyses
Chapter 3 Summary: “Journey Down the Medicine Path”
This chapter focuses on Lori’s path to becoming a surgeon. Her first post-college job was working for a medical researcher at the University of New Mexico in Albuquerque. At Dartmouth, Lori struggled with science classes. As a result, she thought she could not pursue medicine. At this job, however, she was able to easily learn the concepts. The medical researcher encouraged her to think about medical school. As Lori notes, “in traditional Navajo belief, speaking a thought into the air gives it more power” (36). Lori started taking science courses at the university and saw parallels between the scientific way of looking at the world and Native American cosmology. She applied to and was accepted at Stanford University’s School of Medicine.
Lori faced many obstacles on her path to becoming a surgeon. First, she was female, and at that time there were few female surgeons. Lori was also Native American. Not only were there few Native American surgeons, but many aspects of western medicine and surgery went against traditional Navajo customs and beliefs. One poignant example is when Lori had to dissect a cadaver for the first time in a class. One of the strongest taboos in the Navajo culture is against touching dead bodies. Navajos rarely say the word “death” because they believe in the power of language, meaning that speaking something can cause it to come into existence. Superstitions about the dead weave throughout their stories, such as how dead people can sometimes become skinwalkers. Lori was able to complete the assignment by remembering the lives she could impact as a surgeon. Navajo people consider surgery to be an invasion of privacy. Surgeons must ask their patients personal questions, often perform surgery on strangers, and touch the inside of another person; all of which contradict Navajos respect for personal boundaries. One individual who helped Lori overcome these hurdles was Dr. Ron Lujan, an accomplished surgeon from the Taos and San Juan Pueblo tribes. Lori did her rotations with Lujan at the Acoma-Cañyoncito-Laguna Hospital (ACL).
Lori notes that one of the most important parts of her education was when she had staphylococcus pneumonia, which in the late 1980s had a death rate of 30% for young patients. She spent several weeks in Stanford’s hospital where she learned what it was like to be a sick patient and how obtrusive the medical system could seem for Navajo people.
Chapter 4 Summary: “Life Out of Balance”
Lori describes her early years as a surgeon, after she finished medical school, at the Gallup Indian Medical Center in Gallup, New Mexico, a town that is around 50 miles from her hometown of Crownpoint. The author was overjoyed at being able to go home and give back to her people, but soon realized that the cost of her knowledge had been high. In medical school, Lori “learned to be white” (58), and therefore many of her Navajo patients were surprised to find that she too was Navajo.
Her experience at Gallup Indian Medical Center was medically unique, partially because the medical center was the intersection of two worlds. Navajos believed illness was due to bad spirits, ghosts, skinwalkers, or because individuals did not follow the Beauty Way. Thus, these stories became part of Lori’s clinical experiences.
At Gallup Indian Medical Center, Lori increasingly saw the need for culturally competent care. A routine surgery to remove Navajo patient Evelyn Bitsui’s infected gallbladder that went wrong made the need for this type of care clear. Lori performed the surgery, but she was not Bitsui’s intended surgeon, who had come down with the flu. Bitsui was already fearful of the surgery, and this surgeon change increased her anxiety and fear. During the surgery, Lori grew increasingly frustrated and angry. Not only was the gallbladder difficult to remove, but the nurse she was working with kept handing her wrong instruments. The two raised their voices at one another on several occasions. While Lori was able to remove the gallbladder, Bitsui had a stroke after the surgery; something which should not have happened. Reflecting on the surgery, Lori realized that the combination of Bitsui’s fear, Lori’s own anger and frustration, and the nurse’s inattentiveness and defensive posturing was a perfect set-up for the complications that occurred during and after the surgery. In medical school, Lori trained to be an excellent surgeon, but she never learned how to communicate with patients. To be a better doctor, she looked for answers in Navajo healing practices.
Traditional Navajo healers must lead by example. Because they teach their patients to Walk in Beauty, they too must follow this path. Balance and harmony are central from a Navajo standpoint. Lori realized that a harmonious healing environment could lead a patient to heal faster. She began to examine where the hospital staff could make changes to help make their patients more comfortable and at ease. Lori also adjusted her own methods with her Navajo patients, including speaking more Navajo with them, touching them only when necessary, and viewing them not just as patients but as part of her extended family. By mixing the best of both Navajo healing and modern medicine, Lori believed this would result in a “very strong kind of medicine” (78).
Chapters 3-4 Analysis
Chapter 3 opens with Lori’s monumental realization that she has what it takes to go to medical school. After completing her undergraduate studies at Dartmouth, she moved back to New Mexico where she found a job as a research assistant on brain physiology. Her mentor on this project was Dr. Gary Rosenberg. He was the first individual to encourage Lori to consider medical school. With this example, Lori more fully introduces her belief in the power of mentorship.
One other mentor introduced in Chapter 3 is Lujan. Similar to Lori, Lujan was also Native American. From him, she learned how to interact with, relate to, and care for Native American patients. Lujan also helped Lori overcome the Navajo cultural taboos about touching, making eye contact, and performing surgery. Lujan established an all-Native American surgical team, which was astounding to Lori and something that she hoped to someday replicate in her own operating room. Lujan understood how the historical traumas of federal policies, like forced removal and resettlement, and assimilation and acculturation, have negatively impacted the physical, social, economic, and psychological wellbeing of Native American people. To this end, he pushed Lori to learn how to give outstanding care, because he felt that “They [the Indian people] deserve the best” (47). From Lujan, Lori also learned another valuable lesson: Other physicians would constantly question her abilities and ideas because she was a minority female physician.
Adopting “white behavior” (52) in medical school was difficult for Lori. She felt like she was becoming less Navajo, something which she mourned. This feeling hit home when she returned to her Navajo community after medical school, as detailed in Chapter 4. As Lori notes, “with my short, pageboy-styled hair and white medical jacket and a stethoscope around my neck I did not look like a Diné women to my Diné patients” (58). It was her early experiences working with Navajo patients that made her realize she could learn much from traditional Navajo healing practices. After performing the gallbladder surgery on Evelyn that went wrong, Lori increasingly saw the need for culturally competent care. From a Navajo standpoint, imbalance or lack of harmony in any part of a patient’s life causes illness.
Things that patients encounter also impact them, including their ability to heal faster. To Lori, it made sense that a harmonious healing environment would help her patients heal faster and have fewer complications. She began to make changes to her surgical practices that would help her better accommodate her Navajo patients. She scheduled her patients’ surgeries so that they could have traditional ceremonies either before or after the procedure. She also made sure the hospital allowed healers to bring chants, prayers, and smudging to their patients. Because many Navajo individuals distrusted hospitals and western doctors, she felt it was of the utmost importance for the hospital to have their care for patients be as comfortable, harmonious, and welcoming as possible.
One theme that begins to emerge in these two chapters is how institutional and historic racism can have profound impacts on minority groups. Lori notes that the Navajo patients often had medically unique and baffling cases. One example was a man who came to the hospital with the worst case of echinococcus that any of the staff had seen. In general, echinococcus, which is a parasitic disease caused by humans coming into contact with animal hosts, is rare in the US, but it occasionally appears among Navajo people because they live in close proximity to their animals. While the patient received a drug to combat the parasites, he would likely have another chronic form again unless he disinfected his animals. Yet, gaining access to this treatment for the animals would have been a challenge and expensive. Native Americans living on reservations often live in poverty and do not have access to safe drinking water, basic sanitation, or electricity.
