SAMMY’S STILL SCREAMING | Ron Turker
In the summer of ’98, on a hot, dusty Monday, I met Sammy Tsosie for the very first time. Standing in my cramped exam room, I tried to make sense of what I saw. This sixteen-year-old kid, whose severe cerebral palsy had confined him to life in a wheelchair, looked okay, but it was clear that “okay” wouldn’t last much longer.
The two reddened and skin-threatening lumps below the back of Sammy’s shirt collar held me fast. This would need surgery, and soon.
Grandma, or so I assumed, stood beside Sammy, her tanned Navajo face expressionless but for the myriad of lines mapping out sixty-odd years of decisions and consequences. I paid little attention to the lines, or to Grandma for that matter. Sammy had a problem, and now so did I.
My five-year contract and my time working with the Navajo people were just about up. Having accepted a position in cloudy, wet Oregon, I’d be leaving the relentless desert sun behind in three short weeks. A potentially complicated case like this would have been best left to my partner, if I had one.
Damn!
***
The people of the “rez” had taught me plenty. I’d learned that the Diné, or Navajo, as most “bilagáana” (white folks) call them, don’t point with their fingers. That’s impolite. And they don’t look you in the eye. That’s rude. They aren’t a very chatty folk until you get to know them, and then their collective warmth washes over like the summer waves of desert air that bake every rock and cactus on their land. And in the early ’90s, get to know them I did, although that was never the plan.
Through the crystal lens of hindsight, it was no mystery how I ended up in the waterless backwater of Shiprock, New Mexico. The lingering question was, how could I have been so stupid?
The answer stands as a cautionary tale for every chief resident planning an East Coast career. If your New York orthopedic chairman asks for honest feedback about their program, the incorrect and stunningly naive answer was—is—the truth. The last words of our consequential conversation were, “The Indian Health Service is always hiring.”
One moment, I was clinking champagne flutes at a graduation dinner, and the next, I was sitting in a hogan, a traditional Diné home made of mud, bark, and wood. In hindsight, the image of a New York Jewish kid watching a pirated copy of Priscilla, Queen of the Desert with a handful of chuckling Navajo elders is funny. At that time, however, it felt anything but.
Outside the hogan’s east-facing blanket of a door, tumbleweeds tumbled by. Tumbleweeds, for God’s sake.
***
What had begun as a self-inflicted career wound, working with the enigmatic Navajo, had become one of the greatest honors of my life. Conflicted when I arrived, the people and their land won me over. And now, with a wife and baby boy in tow, I felt more conflicted about leaving.
As a pediatric surgeon, I took care of a lot of kids who’d had a tough go from the very beginning. Misaligned chromosomes, traumatic births, and even postnatal events sometimes upended the hopes and lives of unsuspecting families. My one-year-old son, whole and healthy, was a gift—a gift my wife and I acknowledged with gratitude. Especially, knowing all that we knew.
Things had, indeed, gone wrong for Sammy. His thin, fragile frame, along with his flexed elbows and wrists, gave him the appearance of a flightless bird. He smiled at me. More likely, some misfired electrical signals from his brain conspired with his facial muscles to mimic a cheery grin. Those uncooperative muscles made it difficult for him to eat and impossible to speak.
In fact, Sammy Tsosie had never spoken a word in his life. But this wordless kid with cerebral palsy was about to teach me a cardinal lesson: surgical success hangs not only on the hand that wields the knife, but also in the ear that hears the story.
I stared at the angry red lumps on his upper back. Of the three of us in that stifling room, Grandma, Sammy, and I, only I had the wherewithal to verbalize a clear and cogent description of our problem.
“Shit!”
Those jutting bumps could mean only one thing. The spinal rods that a previous here-and-gone surgeon had placed to straighten Sammy’s twisted back had broken free of their years-long grip on his upper spine. Now, only a few tenuous skin layers stood between the rods and Sammy’s inevitable infection.
Time wasn’t on our side, mine or Sammy’s. All doctors know about time. In med school, we’re taught, “Take time to do a thorough history.” “Take time to do a thorough exam.” In residency, we’re taught the primacy of lesson two, “Hurry the hell up.”
In my time on the rez, a place rife with neglected illness and trauma, my New York style butted up against the Diné’s unhurried demeanor. They were a deliberate people whose long history offered more perspective and fewer heart attacks than the “get-it-done-with” crowd of my youth.
Sammy’s Grandma listened respectfully as I told her what we needed to do, reshape and reaffix the rods as soon as possible. If she had a story to tell, my rapid-fire directives gave her little room to interrupt. At that moment, I had no time for stories. No time for listening and barely enough time to act.
For the last few months of my tenure, I had avoided taking on any complex surgeries before I became the latest here-and-gone Indian Health Service surgeon. I couldn’t risk the complications. The next surgeon wouldn’t be along for at least six months. But Sammy’s untethered rods upended my plan.
We got Sammy to the operating room the very next day. Thankfully, the surgery to revise and re-anchor his implants was uneventful. Until it wasn’t.
“He’s not making much urine,” the anesthesiologist said as he fiddled with Sammy’s catheter under the O.R. table.
“How much is ‘not much?’” I asked.
“Mmm. None really.”
“None?”
And that’s how it started. The “straightforward,” three-hour surgery turned into an intubated, renal-failured disaster in the ICU. By the end of the week, as Sammy’s kidneys slowly recovered, my jittery heart rate slowed back to normal, along with his. The moving truck was coming the next day. Two weeks after that, my wife, my son, and I would follow. The ICU doctor assured me Sammy was on the mend.
When I arrived the next day for rounds, Sammy’s breathing tube was out. Good news—except Sammy—was screaming. Not moaning, not whining, but screaming at the top of his lungs. Two things were obvious: Sammy was hurting, and his lungs were perfect.
We checked him head to toe, using hands, scans, stethoscopes, and labs. We combed and re-combed every inch of Sammy, and to the best of our knowledge, Sammy was fine. The rods, screws, and hooks were all in a perfect position. But the shrieking never stopped. It lasted a full twenty-four hours. And then another. And another. Sammy kept screaming, and I, along with a rack of vexed consultants, couldn’t figure it out.
The nurses who ministered to him 24/7 looked exhausted and exasperated. Through it all, his tiny grandmother sat vigil in a hospital rocking chair by his bedside. She cooed and patted. She placed, removed, and replaced his red and brown Navajo blanket a hundred times. She blotted endless rivulets of sweat from his forehead and sang in his ear. Still, Sammy screamed.
The moving trucks had come and gone. Our car, mostly packed, stood ready in the driveway. One week left, and Sammy howled on. Test after expensive test told us nothing. As I drove to the hospital for another set of rounds, I prayed that Sammy had calmed down; that whatever drove his enigmatic pain had miraculously broken. If not, I prayed for the words to tell my wife she’d have to make the trip alone. I couldn’t leave until we figured this out.
As the elevator doors opened, Sammy’s wails bade me a good morning. There, of course, was Grandma rocking by the bedside as the night-shift nurse attended to the multitude of lines and catheters running in and out of Sammy’s—well, his everything. The poor nurse looked as if every molecule of energy had been sucked from her body, save for the tiny reserve she’d held back to kick my ass for whatever I had done to cause this.
Grandma tapped my arm, as she did each morning, and repeated the request we’d denied every day. “Can I hold him?”
I looked at the delicate tubes and wires and Sammy’s frame, which practically dwarfed Grandma’s. About to repeat my stock answer of “no,” I hesitated. The nurse caught my pause, and from under a tight brow, she shot me an “Are you out of your mind?” look.
Grandma’s hand rested patiently on my forearm. I looked at her sun-weathered skin. Freckles and spots dotted the back of her hand like tiny constellations of human experience. I looked at the back of mine, nothing but aimless veins and bland privilege.
Grandma. Always Grandma. I’d never met Sammy’s parents. The consent was signed. Why ask? Those threatening rods, the urgent surgery, the kidneys, they all took precedence. The cerebral palsy, his fragile life, took a back seat to what mattered. The rods. The skin. Infection.
Back then, I was a young surgeon who knew his role. I dealt with tissues, not issues. What did Sammy’s story matter?
Grandma’s eyes held my gaze. They were a vivid blue-gray. So rare on the rez. Funny, I hadn’t noticed before. I looked at the poor nurse, whose spattered scrubs and tussled hair spoke of the endless night. She shook her head and mouthed “Nooo” over Grandma’s shoulder.
“Okay,” I said. “Let’s get him to your lap.”
I barely heard the nurse’s grumbling over Sammy’s in-my-ear screams as we gathered up the tubes, and I lifted Sammy from the bed like an 80-pound toddler. Enveloped in the smell of his sweat and dry-mouthed howl, I lowered him onto Grandma’s lap.
And then, it happened. Two weeks of shrieking agony came to a halt. As Grandma rocked and cooed, Sammy’s tight, spastic muscles melted like candle wax as he curled against her tiny body. He’d been trying to tell us.
With a mix of relief and exhaustion, I pulled a chair next to Grandma and sat. Just sat. That’s when Sammy’s story unfolded in quiet, halting English. His parents died on Route 666 shortly after he was born. A drunk driver. Sammy survived, his brain and body forever altered.
It was Grandma who’d raised him, Grandma who’d protected him, Grandma who’d rocked him every night. He wasn’t hurting. He was scared. He wanted what we all want: to feel safe.
As a surgeon, a guy who mitigates harm through the tip of a knife, I didn’t need to know his story—until I did. Sammy was teaching me to listen. And when I did, Sammy stopped screaming.
***
Some thirty years later, I was, once again, driving Route 666, the Devil’s Highway, from Gallup to Shiprock. This time I came to pay my respects. The spring thaw had cleared any threat of black ice, and the road, dead straight and flat, left plenty of time for a long-overdue post-mortem.
On my left, miles of cattle fence collected tumbleweeds like a giant lint filter. But up ahead, at a break in the fence, the tumbleweeds danced past my windscreen with happy abandon. Thirty years had passed in a blink, and the tumbleweeds welcomed me home.
As a resident in training, I had once asked my instructor how long kids like Sammy lived. In his Alabama drawl, he replied, “Oh, they can live for quite some time. But only a year or so longer than their moms. No one takes care of them like their mama.”
Sammy Tsosie died twelve months to the day after his grandmother passed. I had come for his funeral. The Diné buried forty-six-year-old Sammy, next to his grandmother and his gone-too-soon parents; a man who, with his grandmother’s devotion, had outlived his mother and father.
As a wordless teen, Sammy had taught me to slow down and listen. I’d kept in contact with his grandmother and a couple of his long-standing therapists, and eventually, with Sammy himself. A few years after I left New Mexico, Sammy’s therapists convinced the IHS to buy him a computerized communication board. Over crackling phone lines, and in a halting robotic voice, Sammy shared his words.
Like the pent-up tumbleweeds who’d found a break in the fence, Sammy’s stories finally danced free. And for those of us who stopped to listen, we were the better for it.
Ron Turker started in the ’80s as a standup comic and medical student. Through a series of nonlinear events, he became a pediatric surgeon by day and a writer by night. Thirty years of caring for kids at home and worldwide have shaped, sharpened, and ground his sensibilities into a resolute yet witty voice for healthcare change and equity in the U.S. He is the author of the award-winning satirical novel, The Wandering Jew of St. Salacious, his love letter to medicine written with a very sharp pen.