I walked out of the clinic into the sunlit morning after what seemed like an interminable night shift taking care of a steady stream of emergencies. The rain had finally stopped. The air smelled clean and invigorating. I headed straight to the convenience store across the street and drugged myself with something sugary, washing it down with caffeine so I could keep going after working all night. When I returned, patients were already filling the waiting room for their appointments.

Bill, the temporary doctor, arrived at eight o’clock, looking fresh and chipper. He’d obviously had a good night’s sleep.

“You wouldn’t believe the night I had on call last night,” I said.

“Oh, yes I would,” Bill answered with certainty. Apparently my experience was not that unusual.

Staying alert during the many appointments that day proved to be challenging. I was scheduled to see patients about every ten minutes, just enough time to hear a three-minute history from the patient, give a two-minute exam, and take five minutes for writing out the prescriptions for pills and for giving an explanation of how to take them. Fortunately, the highly competent Navajo and Hispanic nurses and aides helped fill in the many gaps in my rapid-fire “consultations,” giving the patients more complete information and answering their questions after their appointments with me.

It’s no surprise that the Navajo word for a western doctor is azee’iił’ini, which means “the one who gives out pills.” With sad resignation, I became the stereotypical pill dispenser. I could see no alternative, given the circumstances I had to work with.

Approximately forty patients came to me for help that first day in the clinic. With the dozen or so patients I had seen the night before, that meant I had treated nearly sixty patients in a twenty-four hour period—not an unusual experience for the Cuba Health Center, I would come to discover.

At the end of the day, around five-thirty, I walked to my car in a daze, wondering how I could maintain this pace for two years.

I drove home up into the foothills in the drying mud with my little Honda sedan sliding in the ruts, oblivious to the breathtaking beauty surrounding me. After unpacking a few boxes in my tiny adobe house, I succumbed to exhaustion. I was too tired to think about what I had gotten myself into in this remote part of New Mexico—and too tired to care about the sounds of mice scampering around the room.

When I reported to work the following morning at eight o’clock, I discovered I was scheduled to be on call again that night. The thought of being on duty all night again, after seeing an endless stream of patients all day, was daunting. There hadn’t even been time to recover from the first night on call.

Bill saw me staring in disbelief at the call schedule. He said, “We will alternate night duty and weekends until some indefinite time in the future when the administration in Santa Fe can persuade a few more temporary doctors like myself to do locums tenens in this underserved area.” (Locum tenens is a Latin term that refers to physicians who temporarily offer their services when there is a shortage of doctors.)

After looking at my call schedule more closely, I did some quick calculations. The average number of hours I would spend on duty each week ranged between 90 to over 100 hours.

These figures promised to take my understanding of sleep deprivation to a new level, even beyond the extreme deprivation already experienced during my internship.

The second night on call was fortunately less brutal than the first night, but marked by more misadventures. An adolescent Navajo girl came to the emergency room doubled over with periodic waves of pain, saying she had appendicitis. She came alone. A family member had dropped her off and driven away. Marie was a heavy-set fourteen-year-old wearing a very large white tee shirt. On routine questioning, she denied being pregnant or ever having had sex. I helped Marie get onto the exam table and then I put on the latex gloves for the abdominal and pelvic exam. The abdomen felt rock hard. I lifted the drapes and saw a baby’s head crowning in the vaginal canal.

“You are going to have a baby,” I announced, trying not to sound shocked. Marie lay impassively on the bed as the tears rolled down her cheeks. During the difficult delivery, not a single sound came out of Marie’s mouth—no screams, no moaning. After the delivery the young girl remained mute and did not answer my questions.

As soon as I spoke to her in Navajo, she revealed to me, with her hands covering her face, that her uncle had raped her. I notified social services to come by in the morning. In the meantime, I gave her all the emotional comfort I could, given the limitations of the situation.

My tired heart ached for this young girl. I heard later from one of the Navajo staff members that Marie never bonded with her baby. She gave the baby to her auntie who welcomed the new member of the family with great joy. Marie went back to school and got counseling through the school system. The uncle received no punishment for the rape.

During a lull in the action, I drove home to try to get a little rest before the next drama unfolded. After about an hour of fitful sleep, the phone rang. The EMT on duty informed me there was a woman in labor at the clinic and could I come back to the clinic to check her.

I jumped into my Honda and swerved down the heavily rutted road. Halfway to the clinic my car got stuck in the thick, red mud that covered the wheels and caked the sides. There were no cell phones in those days and I didn’t have the hospital’s two-way radio with me. I got out of the car and ran the remaining two miles in the dark.

By the time I reached the clinic, splattered with mud and out of breath, the nurse on duty had already delivered the baby. Fortunately, there were no complications. But the muddy jog had quickly converted me. The next free weekend off duty I drove the 85 miles to Albuquerque and bought a blue Toyota four-wheel drive pickup truck. From then on I looked like I belonged in this part of the world—at least while I was driving the truck.

During another memorable night on call I again tried to slip away to get a little sleep. It wasn’t long before the phone rang. It was the EMT saying I needed to come in right away to pronounce a car accident victim dead. I jumped out of bed and into my brand new blue pickup truck and sped to the clinic.

“Why do I need to pronounce the victim dead when it is clear he is already dead? Can’t this wait until morning?” I asked the bleary-eyed EMT. He answered, “Just routine protocol. It’s for the death certificate.”

The victim on the gurney had no head. A tractor-trailer truck accidentally drove over his small car, taking the top off the car and decapitating the driver a few miles outside of town. Looking at the headless man was a shocking and nauseating experience for me. By this time I had come to accept that my life in Cuba would be full of bizarre and shocking experiences.

Nevertheless, despite the stress and overwhelming fatigue, I realized that I was having an incredible, once-in-a-lifetime medical experience, an opportunity that few doctors would ever have—for better or for worse. It was truly a third world experience. I was doing procedures that were normally done by specialists, not because I wanted to, but because they needed to be done and no one was around to do them on an emergency basis.

It was not uncommon for me to have an orthopedic medical textbook open next to the patient lying on the exam table in the emergency room with a dislocation or a compound fracture, or in need of a Bier Block—a regional anesthetic technique administered by anesthesiologists. Most of the procedures we did are normally done by specialists. We had to manage on our own.

Referring to a textbook in front of the patient did not usually inspire confidence. Some of the patients thought they were serving as guinea pigs for the doctors’ training and expressed resentment, a sentiment that I could well understand. But most of the patients were grateful that they could get any help at all in this remote area—no matter how inexperienced the doctor might be. Some of the patients even brought me gifts when they came for their appointments. The gifts included various foods, paintings, Navajo jewelry and homemade weavings.

 

Teaching from my Experiences

The University of New Mexico medical program recognized the value of the kinds of third world, fly-by-the-seat-of-your-pants experiences that were routine at the Cuba Health Center. Medical students and residents aspiring to be rural doctors vied for the coveted opportunity to apprentice at the CHC.

Mentoring these eager students and residents provided me with some of the most rewarding experiences I had during my stay in Cuba. Toward the end of my two-year commitment, UNM offered me a position as assistant professor for their residency program in family medicine. It puzzled me that UNM would want to hire someone to teach who was only two years out of residency, but apparently the faculty viewed the Cuba experience as worth a decade of experience elsewhere.

One of the physicians in the family medicine program said that the school had been searching for female role models for their student doctors and residents. With excitement, I signed the contract and planned to move to Albuquerque when my two years in Cuba were up.

 

Surprise Appointment

At the clinic, one never knew what to expect. Doctoring was full of surprises—including pleasant ones. One day a handsome man named Tom Dwyer came into the clinic for an appointment. Tom worked with the forest service and had been assigned to the Cuba Ranger Station. He came in to be checked for a chronically painful ankle. Normally oblivious to romantic attraction while in my professional on-duty demeanor, this time I felt unmistakable sparks as I held Tom’s ankle in my lap during the examination. The nonstop, ear-to-ear smiling gave my feelings away. We started spending time with each other. We were both lonely.

In the town of Cuba, I had heard fellow Anglos say how difficult it was to befriend the local people. They told me that if you weren’t Hispanic or if your ancestors could not be traced back to the time of the Spanish conquistadors, you were forever an outsider. But the biggest obstacle I faced to developing friendships of depth was the profound weariness that pervaded my body and mind, along with lack of time. In spite of the obstacles, developing a relationship with Tom looked appealing to me. Who would have guessed the role he would play in my future life?

 

Satellite Clinics

The Health Center had the good fortune to have many outstanding physician assistants, commonly referred to as PAs, who were highly trained and experienced. They came from various parts of the country; one had even come from Holland. They were enormously helpful and able to handle about seventy-five percent of the medical problems that we saw at the clinic. In fact, many of them were significantly more knowledgeable than the young, newly arriving temporary doctors.

The physician assistants ran the satellite clinics in the surrounding area, functioning much like doctors. My duties at the Health Center included supervision of the PAs in those satellite clinics. According to state regulations, a physician was required to co-sign the PA’s charts and to be present at the satellite clinics at least once a week. But during the times when I was the only doctor at the Health Center, the PAs went unsupervised for several months at a time.

Well into my second year of service at the Cuba Health Center, another doctor came to Cuba to pay back his National Health Service loan. Having another full-time doctor at the clinic meant that my work load went from being totally unsustainable to barely tolerable, allowing me a bit of time to get some rest and have a personal life.

After the Health Center finally secured the second full-time doctor to help out, I was able to make the long drives to the remote, outlying clinics in Torreon and Counselors, as well as Jemez Springs. The drives were a sorely needed time of rest and reflection, a time to appreciate the magnificence of the land around me and the ocean of blue sky that stretched into infinity.

While the Torreon and Counselors clinics were located in fairly isolated areas and served exclusively Navajo communities, the Jemez Springs clinic was in a town nestled in the Jemez Mountains. This fascinating community included a conglomeration of such disparate organizations as the Catholic Center for Retired Nuns, the Bodhi Mandala Zen Center and Hot Springs, and the Servants of the Paraclete, a Catholic congregation of religious men who staffed a treatment center for priests and brothers with problems related to pedophilia and other predatory sexual behaviors.

One of those priests was my very first patient at the Jemez Springs clinic. He had come in for the history and physical exam required of all newly arriving priests in the rehabilitation program. In my ignorance, I asked why he had come to Jemez Springs. He said he was sent by his parish to get treatment for sexual misconduct. Intently taking notes, I kept my head looking downward at the chart, trying to hide my revulsion as the middle-aged man gave a detailed description of his acts of pedophilia with young boys. His lack of secrecy and the depth of his disclosures were unexpected and disquieting.

 

At the end of my work day, I paid a visit to the director of The Servants of the Paraclete. He told me about the rehabilitation center and explained that the priests in the treatment program are encouraged to tell their stories to appropriate people in their lives—like doctors and therapists—as part of the rehabilitation process.

Around this time, the national storm over pedophilia among Catholic priests brought attention to this rehabilitation center in Jemez Springs. I got a first-hand passing glimpse of a huge problem in the Catholic Church that our country was painfully beginning to face.

The Bodhi Mandala Zen Center in Jemez Springs was a place that I became particularly fond of. I occasionally participated in the Buddhist activities during my weekends off duty.

Joshu Sasaki Roshi—a well-known Japanese Zen master—presided over the Bodhi Mandala Zen Center. During my weekly visits to the Jemez Clinic, the Roshi’s personal assistant, a French woman who spoke both English and Japanese, frequently phoned the clinic, at the Roshi’s request, to ask if I could come to the Zen center after I finished my work and give the Roshi a complete physical examination. Although this remarkable octogenarian had no major medical problems, he seemed to enjoy having his body examined repeatedly. He insisted that the examination needed to be thorough and include every orifice. After multiple requests for genital and rectal exams, I referred him to a gastroenterologist and an urologist.

A few years ago, I read an article in the Los Angeles Times alleging that Joshu Sasaki Roshi has been exposed as a sexual abuser of female students over the past 30 years during his time as a teacher in the US.

In spite of the Roshi’s deviant behavior, the Bodhi Mandala Zen Center enchanted me and revived a longstanding interest in Buddhism that dated back to my time in college. When the Roshi invited me to participate in a sesshin—a weeklong meditation retreat—it sounded like the perfect way to spend my upcoming annual leave. I failed to ask for the details about the sesshin and only focused on the potential for a peaceful and quiet mind.

Instead of recuperating from sleep deprivation during my precious few days of annual vacation, I participated in the rugged sitting meditation that lasted for seven days. The “retreat” involved getting up at four-thirty every morning and sitting cross-legged for long stretches of time, until my legs went numb, and getting slapped on each shoulder with a long, flat stick when I started to fall asleep and slump over. The big treat of each day was the hour we spent in the natural hot springs next to the Jemez River, right on the Zen Center’s property.

At the end of the seven days, although I had regained a measure of inner peace and a quieter mind, I wondered what possessed me to voluntarily choose a week of strict Zen-style discipline and deprivation. I reminded myself to be sure and ask detailed questions in the future—before diving into the deep end.

A few weeks after I returned to my home in Cuba, a Navajo elder came for a visit that ultimately changed the course of my life. He gave me a gift for which I am forever grateful.

Stay tuned.