During the winter of 1980, I was assigned, as part of my residency training in ENT/Head and Neck Surgery, to the Gallup Indian Health Service in Gallup, New Mexico for 4 months. This was an integral part of my surgical education, and I functioned as a full-time surgeon, caring for the needs of thousands of Navajo and Hopi who lived in the region.
We were required to live in a shabby bungalow only a block from Gallup Indian Medical Center, a 100 bed hospital with expertise in all surgical and medical specialties. This was a somewhat traumatic transition for me, pulling me away from my friends, family and comforts of home, and thrust into a situation where I would function as an on-call surgeon for the needs of my new patient population.
During my stay, I gained experience in surgeries I would see only rarely in Denver, or any other metropolitan area for that matter. Native Americans were afflicted with a genetic tendency toward serious disease of the middle ear and mastoid, and for this reason, I spent entire days in surgery performing reconstruction of eardrums (tympanic membranes), and the bones that conduct hearing (ossicles), in addition to removing more serious disease of the mastoid sinus behind the ear. Despite our efforts, the Navajo seemed to only present to our center when all else (yes, including the Medicine Man) had failed. As a result, infections of the ear that could have been easily treated were allowed to extend into the bones of the skull, and even the brain. To this day, the experience gained with advanced disease of the ear in invaluable to me. There is very little that can go wrong with the human ear that I have not seen and dealt with before.
At the time, many of the Navajo men struggled with alcohol abuse, and as a result, we were called upon to deal with severe trauma of the face and neck resulting from assaults and fights. Patients would present to Gallup ER with pieces of their face, ear or nose missing, in part or completely, as the combatants often made certain to leave a lasting reminder of the fight with their foe. As tragic as this was, it was necessary for us to devise creative ways to rebuild facial features, using grafts, flaps of adjacent tissue, and “plastic” closures of wounds. I am grateful I do not face this kind of disfiguring trauma much in my current practice; however, the same techniques are used to rebuild defects of the facial area destroyed by the removal of malignancy.
After a few months, I was accepted guardedly by the Navajo nurses that staffed my clinic, enough so that they invited me to some of the sacred rituals and dances that took place on the reservation. I made several life-long friends during my service in Gallup, and still look back fondly to an unparalleled experience.