For the past three years, Dr. Scott Kelso has lived a topsy-turvy life. For two weeks each month, he leaves his home in Washington, DC to practice medicine on the nightshift in the Emergency Room of a hospital in Fort Defiance, AZ. It’s not a lifestyle for everyone, but it works for Kelso. His patients certainly agree: they call him Big Daddy Medicine Man.
Fort Defiance is in the northeast quadrant of the Navaho Nation, an autonomous area covering 27,000 square miles (roughly the size of New England) in the Four Corners region of the Southwest. There are overlapping layers of federal, state, and tribal government including a self-administered judicial system, tribal law enforcement, primary and secondary schools, a Native American college, and since 2004, the Tsehootsooi Medical Center, a 52-bed general medical and surgical hospital originally administered by the Indian Health Service, but now privately operated by the Window Rock Chapter of the Navajo Nation.
Kelso sleeps during the day. At 8pm, he reports to the ER and is on duty for the next twelve hours. He’s likely to see almost anything: multiple gunshot wounds; a dual stabbing (quarreling brothers); massive head trauma from a cast-iron skillet wielded by an angry wife; hypothermia (patient fell asleep in a ditch for five hours in sub-freezing temperature); a severely altered state from eating a toxic lily (patient thought it was an onion); insulin shock (lots of diabetes on the Rez); multiple patients with blood-level alcohols that would kill a horse. Oh: and one automobile accident victim who actually did hit a horse standing in the middle of the road. Kelso treats most patients in his ER, but the most severe cases must be airlifted to Albuquerque, the closest hospital with a trauma center, some 200 miles away.
Kelso’s ER is a front-line operation. Because everybody knows or can quickly reference everybody else, not a lot of time is wasted on paperwork. Health care is a federal entitlement program for tribal members: patients walk in, get treated quickly, no questions asked, no insurance hassles. Also, because there is little depth of field in the hospital—no cadre of resident specialists to refer patients to—Kelso actually gets to practice clinical medicine, a dying art in his profession. He see things he wouldn’t encounter anywhere else: hanta virus (carried by mice), brucellosis (a bacterial infection carried by bovine or ovine cattle), even bubonic plague, a virus carried by prairie dogs transmitted to humans through flea bites.
The health care professionals who work alongside Kelso admire him, partly for his medical expertise, partly for his gurney-side manner, and partly for his utter lack of professional hubris. No one has ever heard him respond to a patient request with “Ask your nurse.” One colleague with years of patient care under his scrubs says, “Doc’s never above it all and nothing is beneath him. He’s right here in the middle with us and with the patients. Never seen anything like it; I love the guy.”
At Fort Defiance, Kelso has relearned the art of connecting directly to his patients, many of whom may have walked for hours just to get to the hospital. He has also learned that Anglo medicine has its limits. Now when Kelso bumps up against a patient’s belief in a more traditional cure—a sweat lodge, a hitaalii’s complex sand painting, or a sing—he backs off. He’s heard “Doc, you wouldn’t understand” more times than he can count. His first instinct is always to practice the medicine he was trained to practice, but with every shift, he is learning to appreciate another kind of medicine, a more spirit-driven healing art. “Who knows what really heals a patient,” he says with a shrug.
(For publication in American Cowboy magazine, June/July 2017)