Although I felt immersed in an unrelenting state of siege much of the time, helping women deliver their babies gave me a joy-filled reprieve and remained one of the highlights of my Cuba experience. Over the course of two years, I delivered approximately 200 babies. Even in my chronically sleep-deprived state, the time of birth filled me with a kind of primal ecstasy.
With some of the births, other emotions—fear and anxiety—preceded the joy. When I lifted the drapes covering the laboring mother, I dreaded that, instead of seeing the crown of the baby’s head, I would see a foot or a hand in the vaginal canal. Or I would discover that the baby’s heart rate had slowed to a dangerously low rate—usually because the umbilical cord had become wrapped tightly around the baby’s neck before the birth.
Many of the mothers did not come in for prenatal visits when potential complications, like a breach position, could have been detected and addressed well before the delivery. The Cuba Health Center was not equipped for major surgery such as c-sections. With most deliveries imminent at the time of the laboring mother’s arrival at the Health Center, evacuation to Albuquerque was out of the question. We had to fly by the seat of our pants. I said my often-repeated prayer, “God help me,” before every single delivery.
When a baby presented in a breach position at the time of delivery, it was customary for doctors to make phone contact with one of the seasoned obstetricians at the Indian Health Service Hospital many miles away in Gallup, New Mexico. An especially empathetic physician at the Indian Hospital, Dr. Waxman, agreed to be on stand-by for Cuba’s obstetrical emergencies involving Native Americans. On the speakerphone, Dr. Waxman’s calm voice walked me through many difficult deliveries until I gained the confidence to handle them on my own.
One memorable occasion of obstetrical terror is engraved permanently in the archives of my life. The baby’s head delivered but the body did not follow. The size of the baby’s shoulders blocked its passage. No amount of maneuvering could relieve the obstruction. The baby showed signs of distress with deceleration of the heart rate. The emergency transport helicopter team from the University of New Mexico had been notified and would soon be in the air. In spite of the urgency, the neonatal team did not arrive in time to help with the delivery.
By a stroke of luck, one of the nurses got through to Dr. Waxman. His comforting voice flowed out of the large black speakers on the wall in the delivery room. “Okay, Erica. First of all, I want you to remember to breathe. We’ll get through this together. Ready? Now slide your hands down both sides of the neck until your thumbs reach the collarbones. Do you feel them? Press on those bones until they snap. We’re going to break the clavicles so we can bring in the shoulders toward the midline and deliver the rest of the body.”
One of the Hispanic aides held the Navajo mother’s hand during the entire ordeal. The mother remained stoically silent throughout the difficult delivery. I wondered what she was thinking and feeling.
A wave of nausea came over me as I felt the little bones break under my thumbs. I did exactly what Dr. Waxman said and moved the shoulders midline. With some gentle pulling, the baby eventually slid out of the vaginal canal and required only brief resuscitative efforts.
By the time the emergency transport team arrived to fly the baby to the newborn intensive care unit in Albuquerque, the baby girl was already out of danger and breathing on her own. With the helicopter back in the air heading south, I wept tears of joy and relief as I held the new mom’s hands in mine.
Two months later the mother brought her new baby girl in for her first well-child checkup. The baby looked vigorous and active. A bony callous at the midpoint of each clavicle created a visible bulge—the only reminder of that perilous night. I learned at the well-baby check up that the parents had given the baby an uncommon name—Erica. (Several babies I delivered were given my name over the two years at the CHC.)
It was tough staying up night after night doing deliveries. There were stretches of time when I was the only doctor available because the temporary doctor was on vacation or out job hunting. When the temporary doctor eventually resigned, I became the medical director by default—in addition to all my other duties. That position involved working with the administrator from Santa Fe who was under intense pressure from governmental agencies to get the Health Center up to certain standards and in compliance with national hospital regulations. The Health Center was so marginal—understaffed, under equipped, disorganized—that it would require a miracle to pass the site inspection.
The added responsibilities I assumed as medical director followed me relentlessly, even through my own emergency hospitalization.
On one of my weekends off duty, I went white water canoeing in the wilderness with my trusty canoe. I invited a friend to join me, the son of the head nurse at CHC. He claimed he had ample experience canoeing in Class II water. Halfway down the river, he requested to switch positions so he could be the one navigating the canoe in the stern. In spite of my doubts, I agreed to make the switch. We beached the canoe, switched positions, and then pushed the canoe back into the water. A few minutes later, the canoe capsized in a particularly turbulent stretch of water. Pinned under the canoe, the current dragged me along for a few yards before I could extricate myself. My left index finger was fractured and partially severed at the joint, hanging on by a bloody strip of skin and torn tendons. My friend helped me tightly bandage the ends together with my torn-up tee shirt and then set up camp. I spent a sleepless night beside the river.
The next morning we managed to paddle to a place downriver where I could seek help. By the time we were able to get to the take-out place on the river, I felt feverish with shaking chills. My hand throbbed. I watched helplessly as the redness and swelling progressed over the course of the day. After spending the night at the Cuba Health Center, I was transferred by ambulance to Albuquerque where I could be seen by a hand surgeon who was eventually able to reattach and save the mangled finger.
During the five days in the hospital, while feverish and on intravenous antibiotics for sepsis, wondering if I would lose my pointer finger, I received phone calls several times a day from the PMS administrator assigned to the Cuba Health Center. Despite my condition, he insisted on discussing business and asked repeatedly when I would be back to work, saying that PMS needed me back at the Health Center as soon as possible.
In those days I hadn’t yet learned to set clear boundaries for self-preservation. Early in my medical training, I had prayed that I might be of service to others. I failed to pray that I might be of service to myself as well. But by the time I completed my National Health Service obligation in Cuba, I was well on my way to being cured of this oversight.
Life in Cuba
After a week in the hospital as a patient, I went back to work with a cast on my hand and forearm, braced for re-entry into my role as physician/ER doctor/medical director at the Cuba Health Center.
Life at the Health Center was unsustainable by anyone’s standard. The fatigue was crushing with no chance of real recuperation. Sometimes I was so tired that I would have a series of micro naps with my eyes open—periods in which my brain repeatedly disengaged for a fraction of a second. Needless to say, this half-awake condition posed a potential threat to me and to others.
Early one evening, after being on duty for thirty-six hours, I drove to the convenience store across the road to get gas for my pickup truck. After pumping the gas, I drove off and within seconds rammed my truck into a concrete post that stood directly in front of me. My eyes had been open, but my brain was disengaged. The crash gave me the resolve to do something about my situation. I could no longer continue in this sleep-deprived manner, no matter how committed and conscientious I was.
In a moment of desperation, I telephoned the National Health Service office in Washington, D.C. and spoke to one of their officials. I related my plight, including my concern that I might inadvertently harm someone by making a mistake from sheer exhaustion—like writing the wrong medication or the wrong dose on a prescription pad. I boldly asked for a transfer to a place with more help and humane conditions for the doctor. The official at the other end of the phone listened to me politely, but was unwavering in his position. “There’s a serious shortage of doctors willing to serve in underserved areas. The Cuba Health Center needs you. They’re in a somewhat desperate situation at the moment. You’ll have to stay there until they can find some more long term help.”
I told the official I could not keep going anymore. He responded, “You just have to hang in there, Doctor. If you quit, under current policy you would owe the government three times the amount of the original loan, plus interest.” When I asked if I had any other options, the official cited jail as a possibility. I insisted there must be another viable alternative. He chuckled and said, “Well, the only other options for leaving Cuba early are dying or being declared insane.”
After hanging up, I called my friend, Leonard Cain, one of the doctors I befriended during my initial site visit who had subsequently resigned and left the area. In my desperate state, I discussed the possibility of declaring insanity—half-jokingly. He advised against it but had no other suggestions.
I tried calling in sick one day to get some much needed rest, but when I thought about all the people who needed help, my conscience made me get out of bed and get dressed. Besides, if the patients didn’t see me in the clinic, there was always the possibility that they would come looking for me. It was not unusual for Navajo patients to drive out to my house on my days off, looking for help.
Denison Begay: Road Man
One evening I lay stretched out on the futon couch and stared out the large picture window at the sinking sun in the western sky as my tired mind tried to digest the events of the past 36 hours. A fiery orange glow appeared in the sky above the Jemez Mountains as twilight slid slowly into darkness in the high desert of northern New Mexico. The scent of incense from the cedar and piñon logs in the wood burning stove meandered throughout the adobe house and up into my nose.
While lost in my somnolent reverie, I heard the rumble of a vehicle toiling up the long, rutted driveway and then the honk of a horn. I waited in suspense. No one came to the house.
Using all my force of will to rise up from the comfort of the couch, I opened the door and peered out into the fading light. Through swirls of settling dust, I saw a familiar maroon pickup truck parked a few yards away.
Dennison and his wife sat motionless in the truck. I had delivered two of their babies at the Cuba Health Center. Dennison was a highly respected “road man,” an elder who leads peyote ceremonies in the Native American Church.
The couple waited for me to come outside and invite them into my home—a Navajo custom that originated from traditional Navajo life in remote and isolated homes, called hogans, where a sudden knock on the door could startle and frighten the people inside, especially if it was dark outside.
I beckoned the couple to come inside. I offered each of them a chair next to the wood stove. We sat opposite each other in the dimly lit living room.
Jet-black hair framed Dennison’s chiseled face with high cheeks bones and ruddy-brown complexion. He had on a plaid shirt with a bolo tie, tight jeans held up by a finely tooled leather belt with a big silver buckle, and polished cowboy boots. Dennison sat on the edge of the chair with his back straight, giving him a look of quiet dignity.
His wife, Lena, wore her long, thick black hair pulled back into the traditional Navajo knot adorned with white yarn. She dressed in the customary style of Navajo women, with a dark blue velvet blouse and a light blue satin skirt held in place by a red and white woven sash around her slender waist and a stunning silver concho belt on top. Thin white socks and tennis shoes covered her feet.
Lena and Dennison were friendly but spoke very little. Their eyes looked downward except when speaking, a common trait found among traditional Navajos.
The wood crackled in the stove. Mournful wailing of a lone coyote in the distance punctuated the long stretches of silence. I had no idea why they had come to my house, but I knew with certainty that this was not merely a social visit.
I sensed that they had something important on their minds and that they needed to tell me in their own time—Navajo time. I waited and let myself enter into the timelessness of the Navajo, not an easy task with my irrepressible curiosity and anglo impatience.
After an interminable silence, I jumped up and made them some tea. We engaged in short bursts of small talk, followed by more silence and staring at the floor. After a half hour had passed, exhaustion overcame me. I thanked them for coming to my house and asked if there was anything that they needed from me before they left.
Dennison began to speak in his slow and measured way. “My wife and I came because my people want to give you a gift to show our appreciation for your service to the Navajo people. We want to have an all-night peyote ceremony for you. In the ceremony, my people will pray that you will stay at the Cuba Health Center and continue your good work here for many more years.”
Dennison knew that I had participated in the Native American Church ceremonies several times in my younger years as a schoolteacher on the Navajo reservation. He did not need to explain to me how his people used the mind-altering “plant medicine” strictly for healing and other spiritual purposes.
Feeling surprised and touched, I enthusiastically accepted their gift. I smiled and shook their hands in the Navajo way, which meant our hands touched lightly for only a second or two. As they walked out the door, Dennison turned to tell me that he would let me know the time and place of the ceremony. I collapsed onto my bed and fell into a comatose-like sleep.
The morning came accompanied by a feeling of anxiety and doom. My heart pounded and I felt short of breath. Did Dennison really say that he and his people were going to pray that I stay at the Cuba Health Center? I cannot let this happen. I need to do something.
Having witnessed the power of prayer in other peyote ceremonies in the past, I knew this prayer must be stopped. The thought of staying on at the Cuba Health Center one single day after fulfilling my contract was unbearable.
After work, I drove to Dennison’s house. How could I tell Dennison that I didn’t want to stay in Cuba without seeming ungrateful for his generosity?
One of his kids answered the door. When Dennison appeared in the doorway, I stumbled over my words until I finally blurted out the truth. “Dennison, I can’t accept your kind offer for the ceremony. I don’t want to stay in Cuba. I can’t. I signed a contract to teach as an assistant professor at a medical training program in Albuquerque. I must leave Cuba. I’m sorry to let you and your people down.”
Dennison did not reveal any emotion. He said, “We still want to give you the ceremony as our way of saying thank you for what you have done for our people. Just tell me what you want us to pray for.”
Without taking the time to ponder my answer to the question, I replied, “I would like you to pray for my peace and happiness.”
Peace and happiness are abstract concepts. Navajos generally are more concrete in their thinking. I had no idea how those two words would be translated into the Navajo way of thought.
The ceremony was planned for the following week, near a beautiful, isolated stretch of red rock land, far from habitation. The weather was warm and windy and the skies were clear except for occasional cumulus clouds that drifted near the top of the mesa. The ceremony took place in a teepee, a custom borrowed from the Plains Indians, and used by Navajos during the warm months of the year. About twenty-five Navajo men and women came to participate, some of whom I recognized from the clinic.
As is the custom in the Native American Church, the participants wore the traditional Navajo-style clothing. Fortunately, I still had the satin skirt and velvet blouse I made when I was a school teacher in the early 1970s and a participant in the NAC. I was given the woven sash and the silver conch belt as payment for my work as a sheepherder.
We sat in a big circle with the sacred fire in the middle as part of a ritual well-known to me. It was a night of praying and singing. The sacred tobacco, gathered from the mountains above Flagstaff, was passed around from one person to the next. Each person took a puff from the short pipe, said a heartfelt prayer, then passed the sacred tobacco to the next person. We chewed on the peyote buttons and drank the tea.
The sacred “medicine” is used in the Native American Church to enhance the intensity of the prayers and allow one to enter an altered state of consciousness where anything is possible.
The participants gave ardent speeches with expressions of their appreciation for my medical service and for being kind to their people. The ceremony was conducted in Navajo with a sprinkling of English words here and there, like “Jesus Christ Our Lord,” “praise God,” “doctor,” and “Cuba Health Center.”
While in a dream-like state, I heard Dennison, the road man, asking the participants to pray for me to have an awéé’, kéyah, hooghan, and hastiin—a baby, land, a home, and a husband—in that exact order. At that moment I realized how the road man had interpreted my vague request for “peace and happiness.”
I chewed on the four things that were mentioned. It sounded fascinating, but not at all possible, given my circumstances. I was unmarried, and although Tom Dwyer and I were friendly, we had no plans for marriage. I was two months short of turning forty and had already made the decision to accept my childless state if I wasn’t pregnant by the time I turned forty. And, at this point in my life, I did not have the means to buy land and a home. And besides, I had already signed a contract to teach in Albuquerque at the UNM Medical School family medicine program.
When it was my turn to pray, I thanked everyone for their prayers and their expressions of appreciation. And I shared with them how important the Navajo People had been in my life, especially in the early years after college.
Two months later, a few days before my fortieth birthday, I became pregnant with Barrett. It was a conception against all odds and happened at an unlikely time in my very predictable cycle when pregnancies don’t normally occur.
The pregnancy coincided with the completion of my tour of duty in Cuba. I followed Tom to his new assignment in the Pecos Ranger District several miles south of Santa Fe and gave up my teaching opportunity with UNM. I felt a lot of ambivalence about walking away from such a coveted position as assistant professor, yet I was certain that I did not want to commute to Albuquerque while pregnant and then afterwards with a newborn baby.
Six months after the peyote ceremony, Tom and I purchased a couple of acres of land outside of Santa Fe and began building our home.
Nine months after the ceremony, we went to the courthouse and got married. I was six months pregnant.
In less than a year after the peyote ceremony, I had a baby, land, a home, and a husband—in that order. It was the exact same order voiced in the prayer of the road man in the peyote ceremony.
I got the full Navajo version of “peace and happiness.” Thank you, Road Man, ahéhee, for your powerful prayers that profoundly changed the course of my life.