The desert lives the longest life. Its rains flood the thirsting ground. Its shrubs grow haggard in all directions. Heat kills. Sage refreshes the air.
On a clear day, the view from our clinic extends uncountable miles. Shiprock, a mountain that beckons to those who can see it, stands in solitude in the middle of the view, rising from Earth’s floor like an idol or an omen. It haunts the landscape with majesty and shadows. I have never been to the American Southwest, or a reservation, before coming here. The views from my home in Maryland do not stretch so far.
I set to work in the pediatric clinic. As a visiting resident rotating with the Indian Health Service, I take diet histories, ask how often children brush their teeth, assess concerns about constipation. “It has been a brutal year with COVID,” I relay, “and many families have had trouble getting enough food. Has this been difficult for your family?” One mother says it has, but that her siblings and neighbors have helped each other scrape by. No child, no adult, has had to go hungry.
I drive toward Shiprock my third day at the hospital and take a wrong turn down a one-way highway with nowhere to turn around. Outside the town center human imprints fall silent. There are no streetlights and scarcely any road signs. I watch the sky change as I drive, watch the clouds swoop low and dark toward the land as lightning strikes. I look around at sand and open space, miles between my car and the nearest mesa on one side. There are no homes, no trees, no abandoned fixtures of human life. I drive and finally the shoulder widens enough for me to turn back.
It occurs to me as I watch the clouds that people die out here. I arrive at my dorm, still in view of Shiprock but embedded in the clinic compound, so alert from fear my eyes bulge. “Exactly,” my preceptor says the next day. “You do not have to worry about being hurt by people here. The land is what is dangerous.”
I return to work. One teen sat at his kitchen table last month with a butcher knife, thinking he might end it all. Today he has no thoughts of hurting himself. He says he thinks of his brother, who is younger but roasts him on the soccer field and helps make their grandfather’s bed. Thinking of his brother leaves him energized.
The sand outside the dorm looks different every morning. It clumps and ripples after storms, dries and scatters with the heat of the day. Smoke from fires thousands of miles away accompanies the wind. A western mountain range, usually framed on the horizon, stands inside the haze. My preceptor tells me that electric cars catch fire here when they overheat. A buzzard flies near me while I rest in the shade on a desert hike.
I return to work. A child knows he is transgender and yearns for his grandfather to accept him. In confidence, the elder tells me that his daughter, the child’s aunt, was murdered because she was gay. The man fears how others will receive his grandson but knows he will love him no matter what. He tells his grandson this. Crow’s-feet bend near the child’s eyes as he smiles behind his mask.
Listen, the Earth says. Respect this land. Hone your medicine. But it is the people who will keep each other alive.Melissa Hirsch, M.D./M.P.H., is a third-year resident in the health equity/urban health track in the Harriet Lane Pediatric Residency Program.