Another reminiscence from our buddy Nathan (now a prominent Psychoanalyst living and working in Israel) from his years working for the Indian Health Service -
A crushed chest, bolo tie and porcupine quill earrings marked my exit from Eagle Butte, Lakota Sioux Reservation. Only tie and earrings were planned; the crushed chest was almost preordained, however. Mrs. Alpren was the organizer, the mover of my goodbye bash. A sheet cake smeared heavily with white frosting, a Sioux warrior astride his horse dressed the top. The regular docs were covering the floor and E.R. so that I and La femme de ma vie - of the moment (LFDMV) were feted. The nurses filled the doctors’ lounge, as did former patients and their family members. I recognized some of the women who had snaked around my first clinic, waiting quietly, somberly, with some embarrassment for their first Birth Control Prescriptions, the plastic rings marking each day of the cycle. John Running Horse, still limping, but without a cast. Before many words were spoken, before I had to face that awkwardness of how to say goodbye, mean sincerely how moved I was by these people, yet leaving them, the call came.
Being flown in by Tim, the cropduster, was John Captured Alive (how these names endured, I never learned), who was found after being run over by a truck. He had fallen asleep beneath the truck after a heavy drunk. John was known for the heavy drunks, but this was his first doze beneath a truck. He arrived with his chest flailing, both sides: he had a crushed chest. This flailing is a desperate movement, like the mad fluttering of a damaged moth, while the person strains to get air into his chest: it won’t expand. For this, I recalled, one needs to “inflate” the chest, stabilize the fractured ribs, by negative pressure. Then, he could be evacuated to a bigger hospital, perhaps Mobridge. But, Mrs. Alpern said that there was no modern vacuum to reinflate. I knew he would not survive without this. I remembered my old professor of anesthesiology once taught us to care for the patient before worrying about the respirator. He also told us of the “old days” when they had to make do. When babies in Africa were dying of cholera and it was too difficult to place IV’s in their veins, he would sluice fluids subcutaneously under the skin of their backs; most revived within hours and many survived. And for crushed chests, old vacuum bottles. Big, gallon-sized, thick-walled vessels whose wavey glass revealed its faults and heftiness. Such bottles my mother had used to brew sweet wine in the kitchen, lined up along the wall, rags stuffed in their mouths, emitting a sweet, almost vinegary fragrance.
Mrs. Alpren remembered these; had used them years back; got two and hooked them together with heavy rubber tubes, one in, one out between the bottles. From the first bottle a tube went to the patient; from the second, to a vacuum in the O.R. wall. While she assembled, I quickly draped and prepped the chest with Betadine. As I swiveled left to repeat, the hospital priest, truly named Father Casper, had tip-toed behind and to my right: while giving last rights, sprinkled water on my sterile site. I said, a bit too sharply, “He’s not yours yet,” and re-prepped. A sharp incision between the ribs, a tube inserted, a few stitches to make a tight skin seal, the vacuum turned on, Captured Alive’s chest stopped flailing and rose, and filled. The O2 into his nose now could flow into his lungs.
We called Mobridge; an ambulance arrived with a diminutive electric-powered pump to take over our bottle-array. Dr. L. agreed to ride shot-gun with Captured Alive and I returned to my goodbye party. LFDMV was styling the porcupine quilled pierced earrings. Mrs. A. explained that the needles were flattened by the artist’s teeth. LFDMV slipped the noose of the beaded bolo tie over my head. The knot itself was beaded and she slid that snugly to my throat. I felt a bit hybrid: cowboyish and Indianer.
I try to say something felt: how warmly I was received by the Sioux, how they trusted me with their children’s well-being, how appreciative they were. But, when I say that it would be hard to leave, Mrs. Alpern – reliably honest Mrs. Alpern – asks, “So, why are you leaving?” To this, I am speechless.
This was the tribe Erik Erikson had studied in the 1930’s, this German-Jewish refuge to America, learning about childhoods. He described the quiet despair of the Sioux versus the robust resilience of the Yurok after the White man arrived. The despair I still saw. The people I left. The bolo? Gone with the earrings and the LFDMV.
But, not the memories. Not gone.
