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I have been to the end of the earth, I have been to the end of the waters, I have been to the end of the sky, I have been to the end of the mountains, I have found none that are not my friends. --Navajo Proverbs

To walk in beauty once again

--by Sriram Shamasunder, Jan 17, 2021

Fragility sticks to everything alive like the quiet wetness of morning dew
in this global pandemic
as a doctor
I see this fragility 
Threatening to swallow so much of what we love
like a large red blanket covering a small bed
and I can’t unsee it

In the spring
I spent five weeks in Navajo nation
An indigenous community in the southwest of the United States
Taking care of covid patients
Covid as common as desert cactus in Arizona
blooming like dandelions in an open field

That evening like every other evening
I stood outside a patient room
an emergency room converted into several pods of plastic
cocoons that separate one patient from the next and them from us
all in the hopes of keeping the virus at bay

Blue plastic reflects emergency room light
light like a parking lot at night or a mall
perpetual and yellow glow fluorescent

I methodically wear my PPE
Velcro gown clasp
secure the back
face shield
N 95 on
cloth mask over
double glove blue glove pulled over brown skin
no brown skin between gloves and gown
Double-check
Zip up tent step in/ zip closed
behind me

He lies left side down
a young Navajo man
Black hair braided down long past his lower back
right down the middle of his back
like an outer beautiful spine 
stark against
bleached white sheets

each thick hair knot
Dense and Strong as rope
like ancestors clasping hands one over the other
Each knot
a closed Knuckle
Gathering like a prayer at the base of his skull

He has an oxygen mask on.
I watch his eyes closely for signs of fear
And I watch his hands for signs of trembling or what they might reveal
About a life before and up to this moment

guilt hangs in the room
like fog
“where did I get Covid and why
and who in my family did I expose?”

He breathes fast
We make small and short talk
A few words between catching his breath
he says real soft between quick breaths
I don’t wanna die

I say we will get through this
and then again louder
the first time for him
the second time for me
we will get through this

I leave the hospital at midnight

The next morning
short coffee run in my rental car
my colleague calls to say that overnight my patient emptied his lungs like a gas tank and puttered into the early morning in fumes
exhaustion
He was just intubated
He will be flown to Albuquerque or Phoenix
Off indigenous land

My wife calls at that moment FaceTime with my five-year-old daughter behind her shoulder

I submit to the fact I likely will never see him again
I submit to the fact that he may not survive
I submit to tears that slip down my cheek
And I watch my own hands as they wipe them away

Everything submits to something I tell myself.

The bears rummage through rotted wood and suck up and slurp up ants.  The ants submit to the bear
The bear submits to winters
trees submit to fire
the rocks submit to water as it etches grooves across grey
the river water submits to the seasons thinning out come late summer
and our bodies to time.
And so many black and brown bodies this time.

This is the year of submission
Or surrender
Or survival
I can’t decide which

When a patient is about to be discharged from the covid unit a call goes overhead
From all over the hospital

like a bird migration we descend on the covid unit from anywhere we might find ourselves in the hospital
All the health providers gather in a line on either side of the hallway
like a sports team
waiting to high five their star player to come out of the tunnel onto the field

It is this moment a covid survivor gets wheeled out the big doors into the sunlight
Like exiting a dark tunnel
Into
Their families arms
in those sweet moments, i think
This is the year of resilience
the year of I won’t let you go


my Navajo friend tells me with confidence
The navajo people will walk in beauty once again
And she repeats it again
We will walk in beauty once again
The first time for me
The second time I think she says it to convince herself


***

For more context on the work Dr. Shamasunder and the HEAL Initiative are involved with on the ground in Navajo Nation check out these links:

Three minute segment on NBC evening news live

On Democracy Now 

UCSF Press Release 

ABC nightly News on story in Navajo Nation   




Sriram Shamasunder, MD, DTM&H is an Assistant Clinical Professor of Medicine at UCSF, and co-founder of Heal Initiative. He completed his Internal Medicine residency at Harbor UCLA. He has worked extensively in Rwanda, Liberia, Haiti, Burundi, and India. Recently, he was awarded a Fulbright Scholarship where he studied implementation in resource-poor tribal areas in rural India. In 2010, he was named an Asia 21 fellow as well as the Northern California Young Physician of the Year. He continues to work with Partners in Health (PIH) several months a year.


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