A limp and a death among the Lakota Sioux marked my first day at Eagle Butte, devoid of eagles and buttes.  Two days’ drive from Chicago, I am greeted from afar by John Running Horse, he dips and rises like a Venetian gondolier, waving aloft what from afar seemed to be the plaster cast of a leg.  Up close, it was.

Running Horse lay one hand on the open window of my red Fiat 128, bowed in head and cast, and asked, “You new doc?”  


“Put this on.”

 Hands me the cast, points to his gondoliering leg. 

I park; I do.

Yesterday, the Indian Health Service had said not to rush: two docs there.

But, Dr. K. had been flown out with her atrial flutter to be cardioverted eighty miles to Mobridge; Dr. L. was riding shotgun with a mother in active labor also to Mobridge.

No docs in Eagle Butte.

I wrapped a new cast on Running Horse’s leg -- dipping plaster rolls in warm water, smoothing them around, then downward to make it seamless. 

“How the old cast get cut off?” 

“Itched! Cut it off.” Running Horse unsheathed his James Black Musso pattern S-guard bowie knife, white plaster still dusted its curved stainless steel back tip and brass quillion.

“It’ll itch again after a few days; dried skin flakes,” I said.  I got a metal coat hanger, bent it straight and showed him how to insert it to scratch itches.  He found this marvelous; made a special leather sheath for it. Later, Running Horse returned; brought a water color gift; painted himself on his horse; he in Sioux gear. In his right hand, born aloft like some victorious banner was his Winchester Model 1894 lever-repeating rifle -- the gun what won the West, the Rifleman’s weapon of TV.  Signed below in flowing script, “John Running Horse.”  Still have it.

Today, replastered, equipt with cane, John gondoliered away, dipping and rising into the horizon.

Mrs. Alpern, the head nurse, a full-blooded Sioux, asks me to round with her before settling into the apartment across the tumble-weed blown lot. On-call every three nights, trips would be short.  Mrs. Alpern is of solid build; broad of beam, arms akimbo, she sweeps ahead, clearing the corridor like some Arctic ice-breaker, leaving a wide wake behind. The swish-swish of her white, opaque supp-hose sounds like the wave-washed sea.  Months later, Mrs. Alpern had warmed to me – the Sioux found the Christian missionary doctors overbearing. Welcomed a Jew; I gave birth control pills without religion.  Before I leave, she confides that we might be distantly related: her husband’s name came from a Jewish dry-goods itinerant salesman, a Halpern, generations back; left behind both “wet” and dry goods. Even if not related, she concludes, we are of common spirit.

But today, rapid-fire rounds.  After a year of pediatrics, I am a general practitioner here; everyone on-call did snake bites, deliveries, cut men out from overturned tractors, sewed knife wounds.  This Sunday, the most acute cases were the Bad Warrior twins and the newborn lying alone, all but agonal. The Bad Warriors’ skin was impetigo-stamped; their hides looked angry and they, both corralled in the same crib, acted angry. Scowls greeted all; food, spoons, toys, pillows became missiles.  Sister Marguerite, our lone nun, is placed on twin-feeding duty; she gets aproned and gloved, goggled and masked for battle. 

I turn to the baby.

He looks septic and dehydrated: tented skin, labored breath, eyes shut.  No one could get an IV inserted. I shave the scalp, prep. The delicate skin reveals veins like earthworms beneath a membrane of detritused leaves. Mrs. Alpern finds a #25 butterfly needle; I slide this into a vein, anchor the lifeline firmly, with coilings and tapings.  Antibiotics for both gram negative and positive and some fluids brighten the baby briefly.  Now to wait.

Enough time to move suitcases into the cinder-blocked Bureau of Indian Affairs apartment building across the way, have dinner at the only restaurant in Eagle Butte, return for evening rounds.  This baby will not make it here.  The nearest infant Intensive Care Unit; Fargo, hundreds of miles away.

“No problem, we’ll fly you out,” Mrs. Alpern offers.

There were two pilots in Eagle Butte: Tim, a white crop-dusting rancher; and Mr. R., the grey-skinned undertaker.  Tonight, Tim would fly us out in his four-seater V-tail Beech Bonanza, later monikered–before production was discontinued in 1982–the "fork-tailed doctor-killer."  The back two seats are removed for the baby’s incubator crib, oxygen, resuscitation equipment and me.  The baby’s crib is strapped-in tightly, like cargo.  Tim suggests a front seat for take-off; weather’s brewing, could be bumpy.  I refuse, crouch and huddle over the crib.  The bumpy take-off dribbles my head off the ceiling; a helmet would have served well.  The Ambu-bag and cardioverter I use thrice in the hour flight.  The baby dies on landing. On the tarmac, the greeting Fargo doc and I review Xrays against the setting sun.

We head back, emptied.  Storms had brewed; retribution for life lost.  As we approach the capital, Pierre (pronounced “peer”) rain, hail and wind shears force a landing.  Winds blew ninety degrees to the single runway. I, now belted-in, am anointed co-pilot. Tim demonstrates an acrobatic landing: perpendicular to the runway. “Watch!”  I admire his maneuver, my nodding head tucked into a barf bag.

Sheets of horizontal rain hustle us into the waiting ambulance to take us eighty miles to Eagle Butte.

At the reservation, Sister Marguerite had followed the weather reports.  Rosary in hand, she had been fervently praying for my safe return; while full-faithed, she had not been reassured. I, preoccupied with a dying baby, had been oblivious to danger.  Even today, a bit oblivious.

Then, we felt invulnerable, timeless; illness and death our only nemeses.

Dr. Szajnberg is the Wallerstein Research Fellow in Psychoanalysis, formerly Freud Professor of Psychoanalysis at the Hebrew University and in private practice in Bay Area. He treats children, adolescents and adults since 1977. His books include: Educating the Emotions: Bruno Bettelheim and Psychoanalytic Development (Editor); Lives Across Time (with Henry Massie); Reluctant Warriors: Israelis Suspended between Rome and Jerusalem; and Sheba and Solomon’s Return: Ethiopian Children in Israel. He is a training analyst of the Israel and International Psychoanalytic Society and has been teaching psychoanalysis and development in China.