The Scalpel and the Silver Bear

The Scalpel and the Silver Bear is the autobiography of Dr. Lori Arviso Alvord, the first Navajo woman surgeon in the United States. Dr. Alvord speaks on the challenges she faced combining traditional Navajo healing with modern western medicine. The child of a Navajo father and a white mother, she experienced first-hand the clash of cultures during her childhood on the reservation.

We follow her through her undergraduate years at Dartmouth and on to medical school and surgical residency at Stanford. She returns to her hometown as a surgeon, hoping to bring western medicine to the Dine (Navajo people) but finds reluctance with her patients on her Bilagaana (Anglo; white person) healing techniques. She explores the ancient Navajo power of healing through song, and learning to respect the emotional and spiritual needs as well their physical ailments. Our health care system is in crisis. Dr. Alvord's philosophy is a clear example of Engel's Biopsychosocial model. Having a more balanced approach to patient care can lead to better patient outcomes.

I can relate to Dr. Alvord's sense of being torn between her Navajo heritage and her American side. While working as a surgeon, she had difficulty treating patients because the Navajo are private, dignified and social. In modern medicine doctors have forgotten certain aspects of someone's life can affect the healing process. Our relationships, how we live our lives, our feelings of belonging and wholeness. Doctors forget about the patient, their feelings with his or her treatment, thus leaving the patient with no input in their own treatment. Modern medicine needs to look at the medical education and culture being fostered on medical students first. Dr. Alvord shows us that there is a lot more to medicine than science. Bridging the gap between holistic medicine and modern medicine can improve the lives, wellbeing and finally become healers and not just doctors.

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I can look at my own children as an example, being half-Filipino and half-Peruvian. Is this the best of both worlds? Or a hinderance for them? I use this analogy, just as Dr. Alvord struggles with her own upbringing. She feels like she's two different people in two distinct roles, one being Navajo and the other being white. The realization that her life is split between two different cultures just as my two sons. I get the sense that she doesn't accept her American heritage. She is heavily influenced by her grandmother, she grew up hearing stories of her people. Even though her grandmother encouraged her to be both Navajo and American.

Navajo history is one of great sadness. The wars with the United States government, their forced relocations to reservations. Many Navajos live improvised, even lacking basic electricity and running water. I empathize with Dr. Alvord's grief for her people, especially the anger towards whites because of the past injustices suffered by the Navajos. Being a minority myself in this country, I have felt alienated and discriminated many times in my life especially in the military. Growing up in Miami, which the majority are Latinos. I never experienced racism. In boot camp was the first time I was called a racial slur.

I can agree modern medicine needs to adapt and include the patient's perspective into their treatment. Western medicine can learn from different cultures especially the Navajo. The Native American's philosophies on healing, is the concept of "Walking in Beauty." It is the Navajo way of living a balanced and harmonious life, in touch with all components of one's world. This a path to better health, healing and life. Dr. Alvord realized this phenomenon during Evelyn Bitsui's surgery. She had complications during surgery and suffered a stroke as a result. She concluded that her anger and frustration might have caused the stroke. Her Navajo side knew she was in disharmony and not in beauty.

Working in an OR, that itself can be stressful. Medical school and residency, every medical student is pushed to the limit, but every situation can be coped with. If Dr. Alvord knew her triggers to stress maybe she could have better handled all the issues during Evelyn's surgery. A positive outcome would have been the result. Coping strategies especially active and planning strategies would benefit her future patients. She went through many ups and downs trying to find a way to blend Navajo healing with modern medicine. In order for her to be a better doctor she needed to look at the Navajo tradition of healing for her answers.

She finally learned to clear her mind of all thoughts and letting balance and peace take their place. She essentially created her own small healing ceremony. Clutching her silver bear necklace, her pulse slowed and her mind became focused. Western medicine can learn from a Navajo's belief and spirituality can be a coping technique to deal with the stress of illness. She knew she cannot let her anger interfere with her patients.

The medicine men and women of the Navajo were the spiritual leaders of the tribe. They see a person not simply as a body, but as whole being. Body, mind and soul are connected to other people, to families, to communities, the planet and the universe. Every relationship lives in harmony and order to be healthy. Even the patient and healer need to be in sync in order to achieve healing. Medicine men use the power of the human voice to sing the patient to health. They perform healing ceremonies, in which the medicine men or women sing and chant to cure illness.

This belief sees illness as a consequence of things falling out of balance, like losing one's way from the path of beauty. Song can give the individual hope and have a positive effect on their condition. Dr. Alvord describes such ceremonies as magical and powerful things. The energy that surrounds these healing ceremonies calm everyone present. Their belief in their body's harmony is restored.

I was amazed how the hataalii (medicine men) could predict ailments individual have from diabetes, gallstones, and other diseases. They knew "white men's medicine" can cure "white men's diseases." They worked with a patient's mind and body and practiced a viable form of medicine that modern medicine has yet to understand. Their belief that everything is interconnected and that everything has a cause and effect. One's sickness can be from some other aspect of their life that out of balance or not in harmony.

Navajo healers didn't treat a part of the body but treated the body as a whole. Their medicine was for the whole human being-mind, body, and spirit. Modern medicine is now realizing that effect the mind has on an individual's health. New technologies and research have discovered how the mind can positively or negatively affect the immune system. Modern medicine doesn't need new research to figure this out, all they need to do is look at other cultures healing practices.

What surprised me the most was how she treated her patients with deep concern, worry and profound respect. Especially with the case of Melanie Begay, and her grandmother Bernice Begay who openly was not allowing Dr. Alvord to cut open her granddaughter. The Navajo culture is matriarchal, meaning the women were in charge especially the older women in the tribe or clan. The Navajo believe in the beauty of the body, the sacredness of the body, and to defile the body would disturb the harmony and balance of the individual. Dr. Alvord was in a very difficult situation.

A cultural clash between her western medical training and her Navajo upbringing. She had an inner conflict during this case, but deep down inside she knew the surgery was the best chance to heal Melanie. She was able to relate to Bernice's fear about western medicine and her reluctance to let the surgeons operate on her granddaughter. Her knowledge of the hospital social workers trying to get a court order to force Melanie to have the operation. She wanted to avoid any unnecessary anguish or pain on Melanie's family against the hospital staff. Her decision to speak with Melanie's father, and finally agree to let the surgery proceed before it was too late.

Dr. Alvord was offered the position of associate dean of student affairs at Dartmouth's medical school. She was honored to be offered the position but her one and only reservation was her grandmother and how she would handle the winter of New Hampshire. Somehow her grandmother was very intuitive and knew about the job offer. Through some powerful, ancient Navajo legend she chose to leave this world. Dr. Alvord grandmother's death had a profound effect on her. She was amazed even after she suffered a stroke, the doctors gave her one day to live. Her will kept her alive for another week. She finally let go and died peacefully, surrounded by her loved ones, the sacred mountains, and thus finally at home.

Dr. Alvord's philosophy was revolutionary to modern medicine. Her ideas she gained from her Navajo heritage, taught her to respect her patients and empower them. Not just her patients but the medical team too. It's important to acknowledge and respect each member. She learned the when it comes to treating someone's illness, everything is connected. Medical team's efforts, the patient's efforts, spiritual health, health of all their relationships, their comfort and trust in the operation they will undergo. She preached about the imbalance of people with their body, each other, the community, natural world, leads to sickness. The stress of disharmony can cause illness, depression, violence and even death.

Her ideal hospital would be a breakthrough in patient wellness and treatment. Her hospital would not smell or appear as any hospital. The hospital will be comforting, inviting, filled with warm light. The staff would be dedicated to the patient's comfort and actively participating in their healing process. Her hospital would be a place where illness wasn't thought of as organ or organ system specific but as the effect of imbalance. Illness would be seen as a lack of harmony in their mind, body, spirit, family, friends, community, environment. The Doctors would know and understand balance and harmony. The physicians would treat their patients by restoring balance and harmony in their lives. Even the operating room would consist of a team of professionals, who worked together smoothly and respected one another including their patients.

This book was a welcoming and rewarding experience for myself. I learned the history and the culture of the Navajos. The Navajo philosophy "The Beauty Way" is great example of the correct path to living a healthy and stress-free life. I believe also with Dr. Alvord of living in balance and harmony, especially with your mind, body and spirit. Everything is connected, your relationships with family and friends, to nature are all intertwined to someone's life. New clinical studies and research support her beliefs of illness as multifactorial.

Her success in breaking barriers is very influential for anyone looking to become a surgeon. I believe her life, is a great example for young Navajo girls to break from tradition and dream big! Her efforts in her new position shall greatly impact new medical students on how to respect and gain the trust of their patients. Not only just the Navajo but all cultures can benefit from the new philosophy. Western medicine needs a new infusion of specially trained doctors treating their patients as a whole not just as pieces in an assembly line. Is our healthcare system in crisis? Will these ideas help usher a new way to treating the wellness of people, years to come? Only time will tell, but I do believe this is a start in the right direction.

Bibliography

1. Biography The Scalpel and the Silver Bear. (2000, January 19). Retrieved from JAMA Network: https://jamanetwork-com.proxygw.wrlc.org/journals/jama/fullarticle/1843186
   Dr. Lori Arviso Alvord. (2015, June 15). Retrieved from Changing the Face of Medicine: https://cfmedicine.nlm.nih.gov/physicians/biography_7.html
2. Engel, G. L. (1977, April 8). The Need for a New Medical Model: A Challenge for Biomedicine. Science, 129-136. Retrieved from JSTOR: https://www-jstor-org.proxygw.wrlc.org/stable/1743658?seq=1#page_scan_tab_contents
3. Fenigsohn, H. (2008). The Scalpel and The Silver Bear (Book Review). Retrieved from University of Massachusetts Medical School eScholarship@UMMS: https://escholarship.umassmed.edu/cgi/viewcontent.cgi?referer=https://www.google.com/;httpsredir=1;article=1005;context=omha_book_reviews
4. Lori Arviso Alvord, M. a. (1999). The Scapel and the Silver Bear. Bantam Books.
5. Taylor, S. (1998, July). Coping Strategies. Retrieved from UCSF MacArthur Research Network on SES ; Health: https://www.macses.ucsf.edu/research/psychosocial/coping.php
   The Scalpel and the Silver Bear Study Guide. (n.d.). Seattle: BookRags, Inc.

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