Jogging into Practice

From afar, it might have sounded like: "thunk, thunk, thunk, thunk." From my perspective, it sounded more like: "k'thunk, k'thunk, k'thunk, k'thunk." I didn't know what my evening run sounded like to a rattlesnake relaxing in the dusk of the South Dakota scrubland. My second day's doctoring done on Eagle Butte, the heat dissipating quickly at sunset, I hit the asphalt's edges to jog.

In Chicago, I had snagged a pair of Nikes with waffle-soles, a new sneaker design discovered by Bill Bowerman when he poured urethane onto his wife's waffle iron. Then, Bowerman and Knight's company was still called Blue Ribbon Sports. Word was that their victory sneakers would protect knees and add speed.

I grew up in an era in Rochester, N.Y., when leather was treasured for shoes. Once yearly, before Pesach, my parents took us to the leather shoe store where we played with a tall contraption, like a scale, into which we could insert our feet and see their skeletons. This was a more innocent time, before parents knew to protect their children from X-ray exposure. Good money, hard-saved dough, was spent on a pair of Oxfords. High-tops of flimsy cloth and thin sole were for basketball and any other weekend activity. It was an era before I knew the difference between an Oxford and a Brogue, between open- and closed-lacing, nor would I have cared. It was a time when I most admired my pediatrician's penny loafers, adorned with shining coppers. Loafers I desired, but my parents believed that laces protected growing feet.

Now, with my new waffle-soled Nikes, I had laid out precious bucks on a rapidly evolved descendant of polyester to protect my feet and knees.

Minimally dressed - white T, running shorts (these were the days before wick-a-ways), and my Nikes - I ran with traffic, not yet knowing the treacherous combination of Sioux or cowboys in pickups. But it was the k'thunking in my head, the tattooing of my feet in the desert eve, that should have hinted to me why the Indians came out to look. Some pointing, some waving at me - not quite a greeting, not a hello - a different sort of wave. A mother stepped onto her veranda holding her child, pointing. Words were shouted; muddled in the evening breezes, I understood them not. I thought it was a welcome to the new doc.

When I returned, Nurse Alpern greeted me in the lot between the hospital and my apartment building. “Rattlers are out,” she said. Like me, she said, Crotalus Horridus leave their shelters in the eve, hungering. Rattlers also hear k'thunking or thunking, or some rattled version of it. It helps them find their meal. Ever practical Nurse Alpern advised me: Don't do this again; can't afford to lose docs. Those Indians who came out to see me in my shorts and T? They thought it dumb; wondered how far I would get.

A few weeks later, I saw my first snake bite. It's more strike than bite when it happens. The bitten boy was in jeans, work boots; he was hustled in on the back of an ancient half-ton Ford 100, the twin I- Beam front grill had a grim or determined look to it. Ranchers - Sioux and Washichu (white man) - knew about bites. The boss told the boy to lie still in the bouncing pickup. He put a tourniquet on and elevated the leg. Even after the half-hour trip cutting across grazing land, the boy looked alright: no vomiting, no drooling, no shock; just local swelling and hemorrhaging. With anti-venom treatment he would be fine. When I saw him, I knew that I did not want to be brought in on the back of a pickup like that.

Rattlers ruled thereabouts, and although I never saw one, I kept hearing about them.

When I went off to Cherry Creek, a corner of the 5,000-acre reservation, to visit one of our clinics and with the hope also of meeting the medicine man, I came up against rattlers again. It wasn't the unseen rattlers nor the absent medicine man I recall most, rather it’s the clinic and the mother and child I found there.

Despite my requests, my interest, Nurse Alpern and the nurses murmured excuses: The medicine man is not around much, they said, doesn't have much to say, no one really sees him. Finally, it came out that he was in the sauce much of the time. I had read Illness and Curing in Zinacantan, the Harvard study of various shamans or medicine men in this Mexican village; I had studied the Ibo and Hausa (who, a few decades later showed a stunning capacity to slaughter one, the other); I had read and re-read Erikson's Childhood and Society, about when he spent the '30s visiting the Sioux and also the Yurok.

I wanted to learn about these fellow healers. But, shaman unseen (like rattlers), I had to settle for what my patients said. The Sioux staff wasn’t romantic-eyed as I was; they wanted the real Western stuff - a doc who could cut and sew, a doc who could give meds.

Decades later in the Bay Area, I met many Washichus who believed in medicine men and burning sage - many more than I could find among the Sioux. One Marin County woman described how her Native American medicine man kept her bowel disease in check by giving her various weekly belly kneadings during which flames emitted from her elbows and knees. This relieved - her shaman said - her bowel of inflammation. When her ex-husband would phone, her medicine man gave her a shrub of sage; set ablaze, it would smoke-out his spirit from the house. She wasn't Sioux.

But, in Cherry Creek, the "clinic" was a trailer on cinder blocks. Cinder blocks also served as the three steps leading up to the entrance. Only after I stepped up and into the cool darkness of the clinic, only after my eyes adjusted to the lighting and I could see the mother and child waiting for me - only then did the nurse tell me how rattlers could coil-up beneath trailers or in the cells of cinder blocks.

What happened next was a quiet, brief drama. The mother watched me examine her daughter as the girl sat on her lap. I found something minor (for a pediatrician, not for a parent): a middle-ear infection. The mother, reassured that I could care for her child, then told me of her own chronic cough, and the blood, and the weight loss. She let the nurse take her daughter so that I could examine her. TB, I thought from the history, from the look of things. TB, I hoped. The next week I felt relieved to confirm that TB and a course of INH would take care of the woman.
After the exam, a descent into the blaze of day, tripping down the cinder-block steps beneath which, the nurse said, rattlers lay. A drive home in the red Fiat to change into shorts, T, and Nikes. And I was off, to k'thunk the sunset down. It was the beginning of a long road working as a doc in many cultures.

Dr. Nathan Szajnberg, a psychoanalyst and child psychiatrist in NYC, is author of three books: Reluctant Warriors: Israelis Suspended between Rome and Jerusalem; Lives Across Time (with Henry Massie); and Educating the Emotions. He is Visiting Professor at Columbia University and Managing Editor of IP.net.

This article originally appeared online, September 2011, on PhysiciansPractice.com.