Big Daddy Medicine Man
Scott Kelso was born in Lyndhurst, New Jersey, a tough blue-collar town in the shadow of Giants Stadium. He graduated from Allegheny College in 1982 and went on to start medical school in Grenada where he watched the US Marines wade ashore during the 1983 invasion of that country, Operation Urgent Fury in military speak. Between studying anatomy and dodging bullets in Grenada, Kelso found time to meet and court Ardis Danon, a bright, attractive pathology student who also just happened to be from New Jersey.The two were married in 1990 and now have four children, all in college.
Kelso left Grenada after the invasion and completed his medical training at New York Medical College. After his internship and residency at Columbia University’s prestigious Roosevelt Hospital in Manhattan, Kelso was Board certified in two disciplines—internal medicine and emergency medicine—and was named a Fellow of the American College of Emergency Physicians. Kelso started his career as Assistant Director of Emergency Medicine at Southern Maryland Hospital in Clinton, MD. By 2004, he had become Chief Medical Officer of the hospital; in 2009, he was promoted to Head of Emergency Medicine. In 2011, just after turning fifty, Kelso left Southern Maryland to practice emergency medicine at Andrews Air Force Base. After so many long ER shifts in big city hospitals, he assumed he had “pretty much seen it all,” or so he thought. Then one evening, he got a telephone call from someone at the Indian Health Service asking if he might be interested in a new challenge: practicing emergency medicine at a small new hospital in Fort Defiance, Arizona that served as one of the primary health care provider to the Navajo Nation. “Tell me more,” he said.
The Navajo call themselves the dine’—the People. They believe that long ago they passed through a series of different colored worlds—black, blue, yellow—until finally emerging into this one, the one they call the Glittering World. They are a pastoral people given to tending flocks of sheep and small-plot farms. Highly independent, the People have divided themselves into bands, clans, and families that give an individual both a specific identity and a web of connections—human reference points—to the larger Navajo community. They speak a complex tonal language: during World War II, Navaho “code-talkers” were renowned for their unbreakable transmissions that helped win the war in the Pacific. Their cosmology and phenomenology are equally complex: at creation, their world was marked by four mountains on the distant horizons with two more in the center; on one of these, their primary goddess YolkaiEstsan (White Shell Woman), daughter of the Earth and Sky, was born.
As whites began to make their destiny manifest in the West in the 19th Century, the People’s history collided with a new and unforgiving world. In 1851, in a remote corner of the Dine’ Bikeyah (Navaho Homeland), the federal government erected Fort Defiance on a few acres of valuable grazing land, denying access to the People. Conflict was inevitable and so, too, was the result: by 1861, Brigadier General James H. Carleton and the renowned Indian fighter Kit Carson had imposed a brutal order on the Navajo. Thousands were forced at gunpoint to make the Long Walk to the Bosque Redondo, a federal internment camp, some 400 miles away. Their spirit broken, many of the People starved along the way and most of their livestock was destroyed. At the Bosque, disease was rampant. There was little firewood or water; the people could neither plant crops nor keep sheep alive. Although the federal army spent as much as $1.5 million a year to feed the population, white management of the camp was so inefficient and corrupt that by 1868, the federal government’s first experiment in keeping Native Americans on a reservation was deemed a failure and the Bosque was abandoned. The decimated Navajo population walked back home, returning to the northeast corner of the Arizona Territory where the Treaty of Bosque Redondo established a new reservation complete with an Indian Agency, compulsory education for Navaho children, ten years’ worth of agricultural supplies, and even compensation to some tribal members. The People and their ancient way of life would never be the same again.
Today, Fort Defiance (Tsehootsooi in Navajo) sits at the center of the Navaho Nation, an autonomous area covering roughly 27,000 square miles (more than 17,000,000 acres, roughly the size of New England) in the Four Corners (Arizona, Utah, Colorado, and New Mexico) of the Southwest, the largest land area retained by any U.S. tribe. There are layers of federal, state, and tribal government on the Reservation including a self-administered judicial system, tribal law enforcement, primary and secondary schools, a Native American college, and since 2004, The Tsehootsooi Medical Center, a brand new 52-bed general medical and surgical hospital complete with four state-of-the-art mobile units originally administered by the Indian Health Service, but now privately operated by the Window Rock Chapter of the Navajo Nation.
It’s an early Sunday afternoon: the flight from BWI to Albuquerque takes about four hours, then it’s another three hours drive due west to Gallup, New Mexico where Dr. Kelso—now known as Big Daddy Medicine Man—stops at the Safeway for two weeks worth of groceries and at the liquor store for his supply of “adult beverages.” From Gallup, it’s only a few more miles northwest to Window Rock, Arizona and then another few minutes up to Fort Defiance. He arrives just in time on Sunday evening to grill some ribs and put on his blue scrubs. By 8 pm, he’s on duty: chief attending physician in the ER at the Tsehootsooi Medical Center in Fort Defiance, Arizona, a long, long way from his home in Chevy Chase.
Kelso is a florid, larger-than life kind of guy. His Scottish genes are clearly dominant. He’s gruff and loud but often reduces things “to make a long story short.” After his wife and four children (all in college), he loves his dogs (two gun-broke German short-hair pointers), his truck (a loaded Dodge Ram with a full lift kit and a lot of steel built-ins in the bed), his 360 acre hunting ranch in Texas, and his sailboat, a 48 foot Hinckley yawl with a blood-red spinnaker that he keeps in Herrington Harbor on the western shore of the Chesapeake Bay. He walks with a pronounced limp, the result of a bum hip that will need to be replaced soon. Funny and frank, he cultivates the put-to-bed-wet look of someone who likes to hunt and fish and doesn’t care about clean underwear. Underneath, he knows he’s really a softie: he openly adores his wife and he’s not above admitting he cries when he thinks about his kids or when one of his Navaho patients stops by to give him a wall hanging she made in gratitude for services rendered. He’s touched by small kindnesses. One of the things he loves most about life on the Rez is that kids draw pictures he tapes to the walls of the ER and that his patients actually thank him for his services. He’s the doc that brings a rack of ribs to the ER staff after a long shift, the guy that leans over the fence to chat with a neighbor about his tomato crop.
When he’s out on the Rez, Kelso leads an upside-down life: his ER schedule at Fort Defiance is two weeks on, two weeks off. Two weeks in the middle of nowhere, two weeks back inside the Beltway. When he’s on duty, he works the night shift by choice: 8 pm-8 am. After work, he comes back to his house near the hospital, has an “adult beverage” or two, has a bite to eat and goes to bed. At 6 pm, he wakes, makes dinner, and heads back to the hospital. At the end of each two-week stint, he returns to DC and resets the circadian rhythmof his internal clock for diurnal living. It’s been this way for almost two years and if this lifestyle takes a toll, Kelso pays it willingly. “I was just curious when I started, but now it works. I love this place. It’s freakin’ nuts, isn’t it?”
It’s a typical night in the ER: multiple gunshot wounds; a dual stabbing (quarreling brothers); massive head trauma from a cast-iron skillet wielded by an angry wife; hypothermia (fell asleep in a ditch for five hours in sub-freezing temperature); a severely altered state from eating a toxic lily (thought it was an onion); insulin shock (lots of diabetes on the Rez); multiple patients with blood-level alcohols enough to kill a horse. Oh: and one automobile accident victim who actually did hit a horse that was standing in the middle of the road. (“Road kill is a real problem here. Cows are the worst.”) Kelso treats many patients in the ER, but the most severe cases must be airlifted to Albuquerque, the closest hospital with a trauma center, about 200 miles away.
Back in Washington, Kelso and his family live in their comfortable home off Western Avenue in Chevy Chase but out on the reservation, his rental house is a standard government-issue two story, two-bedroom duplex with a red tin roof a quarter mile from the front door of the hospital. There are two hundred others exactly like it in a meandering neighborhood that houses other hospital staff. He drives back and forth to work in a rented Ford pick-up.
Unlike 35% of all Navaho dwellings on the reservation, Kelso’s house has electricity, running water, and indoor plumbing. Inside the house, furnishings are, well, bachelor spare. In the living room, a cowhide rug covers a small patch of linoleum. There are two plastic palm trees with white, pink, and green Christmas lights. Magazines are sprawled on the floor: Western Horseman, Cruising World, Gray’s Sporting Journal. There is a basic kitchen, although most of Kelso’s meals are prepared on the Weber in the backyard. There is no coffee maker because Kelso’s schedule doesn’t really accommodate coffee. The freezer has ten cartons of Bob Evans mashed potatoes, several dishes Kelso has prepared and frozen, and an enormous frozen kielbasa; the pantry is stocked with pasta, rice, and beans. The dining room table is a section of 4x4, propped up on cinder blocks balanced on two chairs. The television is wired only for Netflix. There is no washing machine: when on duty, Kelso alternates two pair of blue scrubs. He wears one and washes the other in the kitchen sink. In summer, it dries within minutes. There are no hangers in any of the closets. In the empty two-car garage, there is a supply of bottled water and a box of plastic hot pink flamingos that would surely go in the front yard, if there were one. There is one self-indulgent luxury: a hot tub, good for a long soak after one of those busy twelve-hour night shifts. Kelso savors it naked, save for his cowboy hat.
When he worked at Southern Maryland Hospital, Kelso, like many other hospital physicians today, formed a corporation with himself at the helm and signed a personal services contract with hospital ownership. He then recruited and contracted other physicians to his team to staff the ER. It was more business plan than medical practice. Kelso soon found himself concerned more with patient length-of-stay, cost-effective registration procedures, patient transfer rates, left-without-being-seen rates (“that’s money walking out the door”), fee bundling, the hospital’s in-state rating, and overall customer satisfaction than about effective and personal procedure and treatment. Although patient care was critically important to Kelso and his team of ER physicians, Southern Maryland’s bottom line was profit. They didn’t necessarily want you to get well, but they sure did want you to come back.
Things are different on the reservation. At Fort Defiance, Kelso’s ER is a front-line operation. There is a refreshingly notable lack of red tape. Because everybody knows or can quickly reference everybody else, the ER at Fort Defiance is a highly personalized place; there’s not a lot of time or human energy wasted on bureaucratic procedures. On the reservation, health care is a federal entitlement program for tribal members: you walk in, you get treated quickly, no questions asked, no insurance hassles. Also, because there is little depth of field in the hospital –no cadre of resident specialists to refer patients to—Fort Defiance’s ER doctors actually get to practice clinical medicine, a dying art in the profession. They see things they would see nowhere else: hanta virus (carried by mice), brucellosis (a bacterial infection carried by bovine or ovine cattle), even bubonic plague, a virus carried this time by prairie dogs that is transmitted to humans through flea bites.
At Fort Defiance, Kelso has relearned the art of connecting directly to his patients, many of whom may have walked for hours just to get to the hospital. He’s good at it; a little boy in for a sore throat that is probably strep gets not only antibiotics, but also a popsicle in his favorite color. Maybe most importantly, Kelso has learned that medicine—at least what passes for state-of-the-art Anglo medicine—has its limits. Now when Kelso bumps up against a patient’s belief in a more traditional cure—a sweat lodge, a hitaalii’s complex sand painting, or a sing—he backs off. “Who knows what really heals a patient,” he says with a shrug.
The Long Walk to the Bosque Redondo taught at least one very painful lesson: it is impossible to separate the People from their land. Navajo roots stretch deep into the thin, sandy soil; their spirits soar with the towering mesas that dot the landscape. The ancient Blessing Way has its rightful place here and the physical, mental, and spiritual health of the People depends as much on that as it does on cat scans, antibiotics and other so-called miracles of modern medicine. Maybe more.
Kelso does not get a chance to see much of the Navajo Nation in daylight. He sleeps through much of it. His world boils down to the artificial light and perpetual chill of night in the hospital’s Emergency Room. When he leaves work in the morning, it may still be chilly, but by the time he’s ready for bed, the sun is climbing into another cloudless sky and the temperature with it. When he wakes in the evening, the sun is slipping behind the red, wind-scoured rock formations and the earth is beginning to cool off. Whether Kelso knows it or not, he is the coyote, a trickster, lazy by day, roaming and restless by night…or so the People say.
The Navajo are both an unfailingly polite and an intensely private people. To interrupt someone who is speaking is grossly impolite; so, too, is referring to an absent third party by name. No one ever speaks of the dead; to do so would risk calling a ghost. The concept of revenge is unknown. In Kelso’s ER, the world of modern white medicine often collides with these and other Navajo cultural norms. He’s heard “Doc, you wouldn’t understand” more times than he can count. Kelso has learned to role with these punches. His first instinct is always to practice the medicine he was trained to practice, but with every shift, he is learning to tolerate another kind of medicine, a more spirit-driven healing art.
That is not to say that life on the reservation is always peaceful. As every doctor, physician’s assistant, nurse, and medical technician in the Ft. Defiance Emergency Room knows all too well, violence is never far away on the Rez. Almost always, it is sparked by alcohol. Weapons come all-too-easily to hand: the ceramic top of the toilet tank or a cast iron skillet can cause massive head trauma. (The hardware store in Window Rock stopped selling baseball bats recently because they were rarely being used for their intended purpose.) Knife wounds are common, too. Kelso’s remedial weapon of choice is to stop the bleeding quickly with a staple gun; he’s developed an ambidextrous technique that can close multiple wounds to the head or face quickly without the pressure of stitches that leads to scarring.
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Dear Dr. Kelso,
Jamie Whitehorse mentioned how wonderful you were and what great care you provided her daughter. Thank you for making a difference in the life of one of our employees and in the lives of our community.
Sincerely,
Margaret
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Even in Fort Defiance, the specter of corporate medicine looms large. In 2010, the Window Rock Chapter of the Navajo Nation opted to exercise its rights under Public Law 93, Section 638. Essentially, 638 shifted control of the hospital from the Indian Health Service to a private Navaho entity with a locally appointed Board of Directors. In theory, this allowed for more localized decision-making in hospital staffing and procedures, but at the same time, the new governing body would be directly responsible for revenue generation and cost-coding, the twin harbingers of corporate medicine. Within the last year, a high-priced consulting group was hired to make recommendations about more cost-effective procedures and marketing. Five years into the experiment, both patients and staff have adopted a wait-and-see attitude about the effectiveness of “going 638.”