Writing Contest
Physician Winner
Therese Zink, M.D., M.P.H.
Family Physician, Zumbrota, Minnesota
Family physician Therese Zink, M.D., M.P.H., has long known the power of writing. As a high school student in the 1970s, she started keeping a daily journal for an English class. That assignment turned into a life-long habit. “It was cathartic,” she says. “I never stopped.”
Journaling became a constant, even as her academic training traversed medicine and literature. Zink majored in English and theology at Marquette University in Milwaukee. But after graduation, while working as a clerk and aide in a pediatric emergency department, she finished up the science requirements she needed to enter medical school at Ohio State University. As she became immersed in her training, writing in her daily journal—often at the end of the day—became an indispensable tool to process what was happening, she says.
Zink began writing creatively when she was an aid worker in Chechnya to work through feelings she had after the director of the project was kidnapped. Then the writing started at 4:30 a.m., she says, before her busy day began. That led to writing classes in Cincinnati, Ohio, where she lived for a time, and then at The Loft in Minneapolis after she moved to Minnesota in 2004. Slowly, over the years, Zink began to take some of her jottings to the next level, crafting them into publishable essays, a number of which have appeared in national periodicals, including the Journal of the American Medical Association.
Zink says the challenge of moving from journaling to writing for publication has been a process of going “from catharsis to craft” and that writing classes have helped her learn to paint pictures so that the reader can share in the experience. And she says that for the most part, her writing springs from her experiences as a physician, which is true of her winning essay “On the Navajo Reservation.” Zink has worked on the reservation off and on for years, never staying permanently because it was so isolated. “Caring for this elderly healer was a moving experience for me that allowed me to reflect on the humanness of all healers,” she says.
On the Navajo Reservation
By Therese Zink, M.D., M.P.H.
In an outpatient clinic in eastern Arizona, Navajos of all ages wait in a room without a television, so different from the waiting rooms at home where the television blares. Nurses shepherd patients into the exam rooms and I, along with the other physician and a nurse practitioner, try to address their worries and concerns—a typical day. Outside the exam room window, the sagebrush desert unfurls to orange and purple mesas that step up to oak- and aspen-covered mountains rising to greet the big sky. About a mile behind the clinic, Canyon del Muerto cuts into the earth, stretching several miles until it connects with Canyon de Chelly, a sacred place for the Navajo and a national park. I am here for several months, between jobs. In the east, it rains, vertical gray streaks skirt a ballooning black cloud. But here, the sun shines. We are at 8,000 feet; I get winded when I run.
I pick up a chart from the plastic holder on the door; the complaint reads “weakness.” Marge, one of the Navajo nurses, comes up behind me and says, “Mr. Anderson is one of the few authentic medicine men. The weakness is in his chest.”
I knock and enter with Marge. Mr. Anderson is accompanied by his grandson and his grandson’s girlfriend. Their shiny black hair in identical ponytails, tied at the nape of their necks, reaches to their waists. They are casually dressed in jeans and sweatshirts. In contrast, Mr. Anderson has dressed up to come to the clinic, as most elders do. He wears a crisp blue denim shirt buttoned at the neck with a bolo-tie clasped with a turquoise stone framed in silver filigree. He sits in the chair next to the desk, the skin of his face and neck the texture of weathered wood.
I introduce myself and extend my hand. Palm touches palm, the Navajo handshake. I mention the rain in the east and, perching on the stool in front of him, inquire about his weakness. Marge positions herself to my right, where I can watch her face, and translates my question into Dinè, the Navajo language; her voice is a low alto. She is middle-aged, her body thickened by five children. Now a grandmother, she remembers her boarding school days when, as a teenager, she was forced to kneel on the floor in her slip, the Caucasian priest pacing between the rows of young Native girls, admonishing them for speaking Dinè with each other.
Mr. Anderson responds in a soft bass. Navajo words seem to come from the middle of the tongue. I lean forward to hear the rhythm and imagine him chanting the healing hymns at ceremonies, a steady drone.
I ask his age.
“Somewhere past 90, I think,” Marge says.
No fevers, sweats, or chills. His clothes fit the same. No chest pain, no shortness of breath. He eats all right. He’s bothered by passing gas at ceremonies. His urine stream is strong. Many nights he performs ceremonies. He spends his days in prayer. When he sleeps, he sleeps soundly. He does not drink alcohol. He lives with his wife. They have six grown children.
Direct eye contact is uncommon among the Navajo, and as we talk, Mr. Anderson looks at his lap. Traditional healers and medicine men intuit what is wrong and dispense with this oral history. I wonder if he is frustrated with me.
I suggest that it is time to examine him and ask his grandson and the girlfriend to wait outside. Mr. Anderson stands and shuffles along the linoleum floor to the exam table, one hand holds open his eyelid, the other grasps a carved wooden cane. He has the redundant eyelids of old age and, in order to see, he must lift his eyelid with his fingers. A little taller than I am, about 5 feet 5 inches with a C curve in the upper part of his spine, he hyperextends his neck to look straight ahead. In his younger days, he was probably as tall as his grandson, with the same long black hair. Now his hair is trimmed short and peppered with gray.
I examine him, palpating the scalp and neck, looking in his eyes, ears, and mouth, listening to his heart and lungs, checking his abdomen and groin. When I examine his genitals, I apologize. No edema in his ankles. No clues.
I ask more questions. As he speaks, he sometimes gestures with his right hand.
“Do you have any worries?” I wonder how that translates in Navajo.
Mr. Anderson shakes his head.
I look at Marge, puzzled. “What am I missing? There has to be something. Could he be depressed? Would you ask him about finances, the health of his wife…”
Still no clues. I explain that we need to draw blood, to check his blood count and thyroid, and that we will take an X-ray of his chest.
Marge guides him out of the exam room, and I bring his grandson and the girlfriend back in to question them more. It is the girlfriend who tells me about the alcoholic son, an uncle to the grandson. This son chased Mr. Anderson and his wife out of their heated home with indoor plumbing into their hogan this past winter. The hogan is the traditional home of the Navajo, a six-sided log building, the door opening to the east to greet the sun. They are generally reserved for ceremonies, although people still live in them in the cooler canyon during the sweltering summers. I imagine this elderly couple trying to stay warm during the bitter winter, wind creeping through the cracks between the logs and mud. No electricity. No water or toilet facilities. I am suddenly aware that I am shivering.
When Mr. Anderson returns from the lab and X-ray, I ask him about these problems with his son. Marge remains stoic as she translates. “He steals stuff: money, baskets, blankets, jewelry, gifts, and payments to Mr. Anderson for performing ceremonies. He sells them for alcohol. The son curses Mr. Anderson and his wife, yelling that his father’s ceremonies are trash, that the mother is a whore. They are afraid of this son.” I watch Mr. Anderson’s face, looking for a tear, some indication of his fear and frustration. There is nothing. He sits in the chair, periodically opening his eyelid to look at Marge as she speaks. The girlfriend leans against the whitewashed wall, wipes her eyes with a tissue; the grandson stretches his arm across her back, massaging her shoulder with his long fingers. Marge continues; her voice is low. “They’re afraid he’ll come home drunk and kill them. He has threatened.”
Beneath the complaint of weakness, this.
I readjust my position on the stool. Outside, it is now raining; raindrops pelt the exam room window. What are the right words? What is the correct response? I can only think to say, “I’m sorry that this has happened to you and your wife.”
“There is no word for sorry in Navajo,” Marge says.
No word for sorry; I’m not sure how to proceed. Apologizing is how I was taught to empathize with a patient’s pain. I blurt out, “Say what is culturally appropriate.”
Marge utters something in Dinè.
As she speaks, I collect myself and find my professional demeanor. Girded again, I explain that abuse of the elderly is a mandatory report for me as a physician on the Navajo Reservation as it is in most parts of the United States. I must call protective services; I describe what this entails.
The grandson tells me that he and his girlfriend have moved back to the reservation and plan to stay with his grandparents who are now back in their house.
Relieved, I suggest starting Mr. Anderson on an antidepressant. “It will change his brain chemicals and help his weakness.” I delineate how to take it, discuss the possible side effects, and ask them to return in two weeks. “We’ll see how things are.” I offer my hand to each of them, and we touch extended fingers and palms.
After they leave, I walk to the nurses’ desk and prepare to call Adult Protection. “Don’t expect much,” Marge says. Other nurses echo her concern. “You can call and report, but nothing ever happens.” They explain that reservation officials are notorious for ignoring abuse, even of children. I make the phone call, and the social worker who calls me back is familiar with the case. She tells me that their office has tried to file an order of protection, which means that the son could be arrested if he goes on the property. “But Mrs. Anderson has refused to sign it.” There is nothing more they can do until the Andersons sign it.
I urge her to check out the situation again, pressing that Mr. Anderson is in frail health. “Maybe now due to her husband’s health, Mrs. Anderson will sign.”
“We can try,” the worker says, her voice flat and noncommittal.
I assume that the other sons have tried to intervene and failed. Now the grandson has returned to the reservation and is willing to confront his uncle.
In the evening, I wait for the moonrise. Last night, the moon was full. Beyond the clinic and its compound of ranch-style homes is a basketball court where the children of the clinic staff skateboard when there are no teens playing basketball. Walking past the court, I am outside the range of the floodlights that light the clinic and compound drive. At the horizon line, a luminescence sharpens the outline of the tabletop mesas on the right. Silently, I stand and watch, listening to my breath. Inch by inch the sharp, curved top of the moon appears. As it climbs, the shadows of the telephone and electric poles lengthen.
I pray for Mr. Anderson, holy man and healer, caller of the spirits. Afraid of his son, forced back into the cold hogan, the gifts from his ceremonies pilfered for alcohol and drugs, the toll his earthly troubles take on him.
I think of other wounded healers. My colleague in residency, who sniffed whiteout in the hospital bathrooms, deluded all of us until fatigue caused by anemia interfered with her ability to care for patients. She had reached her breaking point and could no longer deny her addiction. Administrators forced her into substance-abuse treatment.
My sister, a physician, married to an alcoholic for 15 years denied his alcoholism, increased her drinking to pace his, until she learned of his two-year affair. Only then did she initiate divorce proceedings.
I came to the reservation between jobs to heal myself. Exhausted, I needed a routine and the space to walk in the canyon, to watch the sky, to smell the sage. Then I would start my university job.
Mr. Anderson, have I helped you today? With my black bag of remedies and healing, I prescribed medication, called protective services, and invited you back for a follow-up visit. I linked your fatigue to the course of events, listened to your pain. I cared. You and your wife are still faced with turning your son over to the police. Is there a breaking point at which you will take action?
There is my own blindness and denial, a lifetime of wounds still sore despite my efforts to seek full 360-degree self-knowledge.
A light breeze blows, and the sagebrush suddenly perfumes the air. A slightly lopsided moon balances in the sky. As healers we may try to escape our humanity, think we have a special status, but we are not above being human, we cannot escape vulnerability. MM
Postscript: I never saw Mr. Anderson again during my time on the reservation.