by Robert Coles
Standing in the intensive care unit that morning and many other mornings in the years that followed, surrounded by patients whose illnesses could all be traced to the abuse of alcohol, I realized that in my profession as a surgeon, I would see the saddest side of this disease—the casualties. I would treat their sick livers and stomachs, and I would treat their bleeding bodies. But there would be little I could do about their souls, the captives of a cruel substance that would probably never let them go. Almost every Navajo family had a member with an alcohol problem.
In my own family that person was my father. Soon after I arrived in Gallup and began practicing surgery at GIMC, my medical work and my personal life came together in a tragic intersection.
My father’s story showed me in a personal way how alcohol is destroying our community. When I got back to Dinetah, I saw his alcoholism differently than I had before I left. Before, I had seen it as a problem in our family, but now I also saw it as a disease, in a clinical fashion. Because of him I was able to look at my patients as individuals, each with their own particular story and paths to this illness. Our historic grief had led to a collectively experienced plague; my father was the window through which I could see it.
Robert Cupp, my father, was by any culture’s standards an extraordinary man. He had a gift for speaking to animals. Almost everywhere we went, on the reservation or off, he knew the dogs, and they recognized him and came running. Rez dogs. Chocolate and black-splotched or the color of coyote and mesa and riverbed mud. One blue eye, one brown, or two piercing green. They are everywhere on the reservation, used to watch the sheep or guard the hogan, and when you arrive they appear magically, just like those annoying friends who materialize at mealtime. My father knew them. Crows also seemed to gather in groups or come and stand on a fencepost whenever my father was around. Sometimes I’d turn a corner and find my father standing deep in a philosophical discussion with a crow.
In the Navajo world, where everything is connected, talking to animals or acknowledging their presence is not as unusual as it is in other places. In addition to fluent crow and rez dog, my dad sometimes seemed to know the dialects of deer, elk, and even trout—he could easily decipher their language of leaps and cautious lingering in the pools made by rocky eddies. He taught his daughters how to hunt, how to look at a certain set of tracks and determine instantly what type of animal it was from its size, and how long ago it had passed. My two sisters became accomplished hunters. I would usually go along but sit on a rock and read. He also taught us camping and boating and showed us how to hand tie fishing flies.
But perhaps the most important thing about my father was that he taught us the simplest things—Navajo things—like how to just sit and be quiet, to blend in and watch, or to move so silently we’d become a part of the forest. My father taught us how to live the concepts of our culture, especially the importance of communicating with the natural world.
For most Native people the animals and environment have a spirit and life of their own that is respected and protected. Part of the Beauty Way ceremony teaches us that humans should live in harmony with the animal world and the natural world—the earth, plants, water, air, everything that surrounds us. Navajo chantways are beautiful in their descriptions of the world we live in. For example, the Mountain Chantway has passages that capture the power and glory of nature:The voice that beautifies the land!
The voice above
The voice of the thunder
Within the dark cloud,
Again and again it sounds,
The voice that beautifies the land!
The voice of the grasshopper
Among the plants,
Again and again it sounds,
The voice that beautifies the land!7
My father taught us that before a hunt traditionally raised Navajos sang sacred songs. He also taught us that part of the meat must be given away, and that nothing should be wasted.
Our family honored that tradition by providing meat for my father’s grandparents and other elder relatives, and by wasting nothing. We could not even leave any meat on the ribs we ate.
In their childhoods both my father and my grandmother had been punished for speaking Navajo in school. Navajos were told by white educators that, in order to be successful, they would have to forget their language and culture and adopt American ways. They were warned that if they taught their children to speak Navajo, the children would have a harder time learning in school, and would therefore be at a disadvantage.
A racist attitude existed. Navajo children were told that their culture and lifeways were inferior, and they were made to feel they could never be as good as white people. This pressure to assimilate, along with the physical, social, psychological, and economic destruction of the tribes following the Indian wars of the 1800s, the poverty due to poor grazing lands and forced stock reduction, and the lack of available jobs all combined to bring the Navajo people to their knees. The physical genocide of the 1800s, followed by the cultural genocide of the 1900s, left behind a tribe whose roots and foundation were shattered.
My father suffered terribly from these events and conditions. He had been a straight-A student and was sent away to one of the best prep schools in the state. He wanted to be like the rich white children who surrounded him there, but the differences were too apparent. My father resented the limitations that being Navajo presented in the 1940s and 1950s. He went to the University of New Mexico, majoring in premed and Latin. It was there that he met my mother.
“She looked so angelic,” he often said about their first encounter. To the Navajo boy who was taught to feel shame about the color of his skin, she must have. My mother has blond hair and blue eyes, and she probably represented everything that he felt he was not. When they married, my dad left college and went to White Horse Lake to run the trading post, leaving behind his academic dreams. Not long afterward he began to hate himself for being unable to fit into the white world and for not fulfilling his dreams. He escaped his grief with alcohol and would disappear for days, sometimes weeks. I remember the empty seat at the dinner table when he was gone. At those times his absence was a presence. We’d walk around the house, acutely aware of all the places he wasn’t—his workshop, the yard, his favorite chair in the living room.
Once, in the middle of the night I was lying with my sisters in the backseat of the car in my pajamas. It was like so many other nights, that night, but somehow it has stayed intact in my memory, almost like a film.
Karen, Robyn, and I waited amid a heap of blankets and pillows while my mother searched for my dad in the bars on Gallup’s main strip. We’d already been by the police stations in both Gallup and Crownpoint. Our last stop was the Gallup morgue, where an unidentified Indian man lay dead. Mom had heard about it from a man in one of the bars and didn’t want to explain it to us. But we knew where we were, and we knew why we were there. Karen, Robyn, and I huddled together in our blankets while she went in to see if the face beneath the white sheet was his. It wasn’t, but when she came out, she looked stark white and shaken.
After I went away to college, my father cut way back on his binges. But always, whenever he was gone, there was uncertainty and fear. I would wonder if he was okay, if he’d been arrested, or if he lay hurt somewhere, the victim of an accident, or if someone else had been injured as well. In our house, whenever the phone rang and Dad was away, we would exchange heavy glances. Such calls often brought bad news.
My father really was two people. One was the man who took pride in everything we did. He never missed a single one of Karen’s basketball games. He played for hours with Robyn’s baby son, B. J., and read Parents magazine.
The other man had black fire streaming through his veins, his life dreams scattered like frightened crows. Alcohol had erased these dreams. It had also enslaved him, as it had so many patients I saw. When I came into work and saw so many cases involving the deterioration of the body through alcohol, I would remind myself that each one had a story,
each one a reason why.
Two or three generations of our tribe had been taught to feel shame about our culture, and parents had often not taught their children traditional Navajo beliefs—the very thing that would have shown them how to live, the very thing that could keep them strong.
Today the tire marks have faded, where they left the highway on Interstate 40 near mile marker 47. I saw them all winter in 1993, two years after I came home to practice medicine. A pair of bright black parallel lines veered off the pavement to the right. The site was located between my house in Gallup and my parents’ house near Grants, so I had no choice but to drive by it again and again as I came to visit my family. One day I noticed that I could no longer see the tracks, but it didn’t matter, I’d memorized them. It was the place where my father’s car had rolled four times before smashing into an iron rail.
Each time I saw that place I whispered, “Ayóó ninshné.” I love you, Dad.
My father is buried in a beautiful, manicured cemetery in Albuquerque. But that is not where he is. I have been in that cemetery many times; I do not feel his presence. In fact, I often forget that he is there at all. Not so at mile marker 47. To the east is Mount Taylor, our beautiful, sacred Tsoodzil. It seems ironic that nearby, also, was the Top of the World, his favorite bar, at the town of Continental Divide.
It is as though this place were chosen for him.
Mile marker 47. My father’s spirit pulled me each time I passed it. It was as though he cast out with his fly-fishing rod there, and it hooked my soul.
Kirsten Emmott
UNWED
Entering another human being’s world in a brief medical encounter is particularly difficult in the birthing suite. As this poem bluntly portrays, birth can trigger expletives and rage that go far beyond a response to the pain of giving birth. This raging reflects another life, one unknown to practitioners in the birthing suite. Admission to that other life is denied the practitioner in this poem, despite her gentle ministrations.
KIRSTEN EMMOTT is a general practitioner and poet living in British Columbia. This poem and another, titled “1852: J. Marion Sims Perfects a Repair for Vesicovaginal Fistula,” which also appears in this anthology, are taken from Emmott’s collection How Do You Feel?
Donna
comes from a different world
and will stay there.
She will not return
for her six-week checkup.
She will not breastfeed
nor recycle.
Donna
put on a lot of weight,
got up to two twenty-five,
her face swollen, sullen, still.
Her tattoos announce
she is not like the slim lawyers
who have been to birthing class.
She is not polite in labor;
she yells and curses and wants out.
Though I mothered her
with respectful hands
as she gave birth,
she would not smile for me.
Her small smiles were for the baby
she showed her real mother.
They turned away from me,
traced the absent boyfriend’s looks
together.
Though I mothered her
and delivered her very well,
her body knowing what to do,
noisy and efficient as a cow,
when I looked up
she was back in her world,
clutching her boy.
The silence back in place,
Donna said she was sorry
for yelling “Fuck!” so much.
That’s all right, I said.
Penny Armstrong and Sheryl Feldman
from A WISE BIRTH
Writing of her work as a nurse-midwife among the Amish and Mennonite communities in rural Lancaster County, Pennsylvania, Penny Armstrong recalls that, during her early days there, for all her professional training, she was “undone by the infrequency of the need . . . to display [her] masterly [medical] strokes. Birth appeared to be another animal out in the country.” Labors were generally shorter, pain less severe, cuts and tears fewer. Yet when Amish women went into the hospital to deliver their babies, they had more difficulties than those giving birth at home. Why? The question—and the answers to it Armstrong finds—underscore the need for health professionals to “actively support traditional public health practices in their communities,” bringing together the best of natural childbirth with modern medicine.
PENNY ARMSTRONG is a nurse-midwife in private practice. She is co-author, with Sheryl Feldman, of A Midwife’s Story and former director of the University of New England College of Osteopathic Medicine’s Behavioral Science and Community Health Project.
SHERYL FELDMAN co-authored A Wise Birth and A Midwife’s Story with Penny Armstrong. She lives in Seattle.
I had just gotten my accreditation as a certified nurse-midwife when I responded to a call from a general practitioner out in agricultural Lancaster County, Pennsylvania. He was interested in expanding his practice among the Amish people and wanted a midwife as part of his service team. I had been raised in the country and it appealed to me to return.
When I went out for the interview, I was disturbed to find that I would be expected to do home births. All my experience with birth had been in the hospital and I was keen on having emergency equipment nearby and doctors available. I wondered if the doctor wasn’t being a bit cavalier about his Amish clients. They had only eighth-grade educations, they did not sue, and so could easily be taken advantage of.
But he took me around to chat with some of the women in their homes and they told me in their own words that they preferred to have their babies at home because it was economical and it suited their farm- and familycentered, low-tech lives. Until recently, Dr. Grace Kaiser had assisted them at home, but she had retired, and they were forced to choose between the hospital or one other home birth practitioner—a person whose methods, when I heard about them, I couldn’t condone. What the couples said convinced me that one didn’t force mainstream standards—that is, everyone goes to the hospital—on the Amish. I accepted the job and its requirement of attending home births.
I was a well-prepared midwife, exacting of myself and, in one way, ambitious. I was determined that the women I cared for would have the safest, best births possible. I immediately assessed the realities of home birth—being alone in the middle of the night at an Amish farm with my work area lit by gaslight and the closest phone a five- or ten-minute walk away—and compensated. I bought a two-way radio. I equipped my suitcase with all the drugs that midwives are licensed to carry. I put in Pitocin for the resistant placenta, Methergine for postpartum bleeding, Valium to counteract a suddenly elevating blood pressure, Epinephrine to compensate for the sometimes ill effects of numbing drugs used for episiotomy, pills for severe afterpains, antibiotics for the person at risk of infection. I put in Amni-hooks (plastic instruments for breaking the bag of waters), syringes, intravenous (IV) fluids, a ring forceps for examining the cervix, a variety of clamps and scissors, a suture kit, needles, a DeLee’s suction catheter for clearing the baby’s air passageway, a heavy oxygen tank, a laryngoscope for viewing the baby’s throat, an endotracheal (ET) tube to slip down its airway to get oxygen to the lungs, and a bag for forcing oxygen into the baby’s lungs.
The doctor and I eliminated (we call it risking out) those women whom we thought unsuitable for home birth. No mothers whose babies were in an odd position, no mothers having their tenth child (or more), no twins, no women with high blood pressure, no women with severe medical problems, no small-bodied women who seemed to be carrying big babies. Any known chance of a complication sent a woman to the hospital.
Meanwhile, I began attending births at home. I hadn’t made many forays before I realized that I was seeing births for which I had not been prepared. Accustomed as I was to the taut, often breathless birth atmosphere of hospital births, I was struck by the casual, comfortable movemen
ts of the women laboring in their kitchen and giving birth among quilts. Having based much of my assessment of myself as a practitioner on my ability to respond swiftly and accurately to emergency situations, I was undone by the infrequency of the need for me to display my masterly strokes. Birth appeared to be another animal out in the country. Labors were shorter than I was accustomed to. Pain appeared to be less severe. Cuts and tears fewer. Hemorrhage controllable. Babies did not need my suctioning devices or my tubes pressed down their throats; they gurgled when they were born and began to breathe. Their mothers took them to their breasts and nursed without much complication. If problems did arise anytime during a birth, most of them appeared to resolve themselves in short order.
I had an eerie sense of unreality. The births had not only power, but grace and simplicity. Coming home at four or five in the morning after births, each one seeming to unwind to a fruitful, healthy end, I groped for explanation. I wondered if I was witnessing a statistically aberrant population of women, ones who were, by genetic predisposition, good birthers. At other times, bewitched by the grace of the starry landscape and disarmed by the humility of the Amish, I indulged in the magical idea that God rewarded people who followed a religious way of life by giving them easier births. By daylight, the clinician in me credited the food the women ate, the number of hours they spent squatting in the garden, the herbs they took, and their experience with animals giving birth. Sometimes, when sleep-deprived, I considered the selfserving possibility that it was me making all the difference. Finally I countenanced the possibility that I had stumbled upon—as I vaguely put it—something extraordinary.