The Scalpel and the Silver Bear

First Navajo Woman Surgeon:
Dr. Lori Arviso Alvord

by Jane Westberg

Dr. Lori Arviso Alvord is the first Navajo woman to become a surgeon. Currently she is the associate dean of student affairs and minority affairs at Dartmouth College Medical School. Also, as an assistant professor of surgery, she teaches medical students and residents and cares for patients.

For many years, Lori Alvord knew that she had to tell two stories. The first story is about how a girl from a remote town in Dinétah was able to travel across cultural, class and educational borders and become a surgeon in a medical world whose doors have been closed to minority people for most of its existence. The second story is about how ancient tribal ways and philosophies can help a floundering medical system find its way back to its original mission: healing.

In "The Scalpel and the Silver Bear," Dr. Alvord and Elizabeth Cohen Van Pelt beautifully intertwine these two stories. The themes are so universal and timely that the book is well on its way to becoming a best-seller. Both Native and non-Native readers are finding inspiration in Alvord's journey.

Lori Arviso Alvord grew up in the small Navajo community of Crownpoint in a family without money, power, or influence. Although her parents did not have college degrees, they encouraged her and her two sisters to get an education. Lori made good grades in high school. She allowed herself to believe that she might some day hold a college degree, but her college plans were modest. And, Alvord writes, "I resisted any larger dreams, for fear they could not come true."

A Navajo student attending Princeton University told her about Princeton University and Dartmouth College. At that time, Princeton had only five Indian students, but Dartmouth had 50, so she applied to Dartmouth. At age 16, Alvord was accepted into the freshmen class at Dartmouth. She was one of only six in her high school class of 58 students who went on to college. In addition, she was the first graduate of her school to become an Ivy League student.

Fitting In
Despite the relatively large number of Indian students at Dartmouth, Lori experienced culture shock: "I thought people talked too much, laughed too loud, asked too many personal questions, and had no respect for privacy. They seemed overly competitive and put a higher value on material wealth than I was used to."

At Dartmouth she began to honor and cherish her tribal membership. She realized that tribes provide connectedness, a blueprint for how to live, a feeling of inclusion in something larger. In the years that followed, she would even come to understand that tribal membership is central to mental, spiritual, and physical health. She realized that community and tribe not only reduce the alienation people feel, but in doing so, stave off illness.

During college Alvord missed traditional clothing, ceremonies, and her favorite foods. However, she and the other Native American students created a group that nurtured and supported each other. They had their ceremonies, and a campus powwow that brought the Native and non-Native communities together as one.

As she thought about the sororities and fraternities on campus, she wondered if the non-Indians students were trying to claim or create tribes. She also wondered if the wild parties that involved drugs and sex might be unconscious attempts to recreate rituals and initiation ceremonies.

Walking a Lonely Path
Alvord graduated from Dartmouth with a major in the social sciences. However, her fascination with the human body led her to a research assistant position with a medical researcher. One day, her boss asked her if she had ever thought about going to medical school. Lori didn't think that she had what it took, but after much reflection and hard work, she successfully completed some science courses and then applied and was accepted into the prestigious Stanford University Medical School.

In her medical school class of 86 students, Lori was one of only three Native Americans. Once again she was lonely and found it difficult to be competitive and to draw attention to herself. She was accused of seeming remote and disinterested. Yet it was hard for her to behave any other way. Silence is a normal part of Navajo communication; words are used sparingly and weighed carefully. It took her a long time to be comfortable with the non-Navajo style of learning.

During medical school, Alvord had to deal with Navajo taboos. Dissecting a cadaver during the anatomy course meant breaking the taboo against touching the dead. Examining and operating on patients required breaking the taboo against touching another person, especially a person one does not know. Asking patients sensitive and probing questions required breaking the taboo against asking personal questions.

She knew that she wanted to be a surgeon and that she wanted to help her people. This meant not only continually going up against these taboos but also facing other obstacles. At that time approximately 4% of practicing surgeons were women. Further, there were only a few Native American surgeons in the world, none of whom were women.

Understanding Bonds
Lori received help in dealing with these formidable obstacles by Dr. Ron Lujan, who guided her through periodic rotations at Acoma-Canyoncito-Laguna Hospital near the Navajo reservation. He became her mentor, friend, and later, her colleague. With his guidance, she was accepted into the very competitive surgical residency program at Stanford.

After facing a serious personal illness and completing her residency program, Alvord joined the Indian Health Service and worked at the Gallup Indian Medical Center, 50 miles from her hometown. She thought that she could easily fit back into Dinétah, but discovered that, because of the ways her education had changed her, returning was as difficult as leaving. "Although I was a good surgeon, I was not always a good healer," she states. "I went back to the healers of my tribe to learn what a surgical residency could not teach me. From them I heard a resounding message: Everything in life is connected. Learn to understand the bonds between humans, spirit, and nature."

Alvord was reminded of the concept of Walking in Beauty, which means caring for yourself mind, body, and spirit, and having the right relationships with your family, community, the animal world, the environment, earth, air, and water, our planet and universe. People, she decided, want and need medicine that connects rather than isolates.

Alvord discovered among other things that patients who went through sings and ceremonies were calmer and did better in surgery. "I needed the patients' spirits to assist me in surgery, and their minds should be relaxed and in a state of trust before they went to the operating room," she says. "They should be prepared to let me enter the sacred chambers of their bodies."

In time, Alvord learned, "The scalpel is my tool, as are all the newer technologies of laparoscopy, but my Silver Bear, my Navajo beliefs and culture, are what guide me." Alvord learned that she could draw both on western and traditional medicine, not only when caring for her patients but also when caring for herself.

Breaking Through
Alvord was not drawn to academic medicine, because so many of the academics that she met were competitive and formal. Unexpectedly, she was invited to become associate dean of student affairs at Dartmouth Medical School. Alvord knew it would be very difficult to leave her people and the beauty of the southwest. Then she considered the benefits: "For Navajo people, I would be breaking another glass ceiling, which might make it easier for others to follow a medical path in the future." Alvord could also influence prospective physicians and teach Native ways of thinking about the healing process. In addition, the Dartmouth community was welcoming, and the faculty and students were open to her ideas.

As associate dean, Alvord supervises admissions and four other programs. In a recent telephone interview, Alvord challenged the conventional approach of selecting medical students largely on the basis of their prior academic performance. "This approach," she believes, "can result in the admission to medical school of competitive, even cut-throat students. If we want our future physicians to be empathetic and altruistic, this approach is upside down. Other cultures, such as Native cultures, select healers who have demonstrated an ability to think and live like healers, people who are role models and communicate well with others."

Most of Alvord's patients in rural New Hampshire are not Indian. However, she still uses Native approaches without labeling them as such. She listens carefully, builds trust, and encourages patients to be active participants in their healing. Before surgery, Alvord works to ensure that patients are well-informed, relaxed and in balance in their lives and their world.

When Alvord teaches these approaches to her students, some students wonder how they can do this when they and most physicians are being forced to see more and more patients per hour. Alvord replies, "I do not know the answer. But what works for me, whether I have five or 55 minutes, is to give myself completely to my patient for that time. I listen to them and let them know that my attention is completely focused on them and that this is their time. It isn't the entire answer, but it helps."

What is her advice to Native people who want to go into the health professions? "Do it for the right reasons. One valid reason is the desire to want to heal. Another is the desire to be in a profession that helps make the world a better place. Healing is not necessarily physical healing. Healing might, for example, be spiritual healing. Healing is not limited to people. Some people try to help heal the environment. Healing is a way of bringing more beauty, harmony, and balance into the world."

Contemporary hospital and clinic buildings with square walls, harsh lighting, and cold chrome are not Alvord's idea of good places for people to heal. "I would love to see Native leaders in health care begin to design models of health care that include our culture, our way of thinking, our spirituality, our ways of interacting," she states. "Medicine men should be involved. The physical structure should reflect the ways that we see beauty, the art that we create. Perhaps it would have adobe walls and natural smells such as roasted green chili and fresh corn. It would be light- filled and warm, with generous and comfortable seating for relatives. There would be porches and gardens. In addition to state-of-the-art operating rooms and equipment, there would be a ceremonial space, for use by any who felt the need for it."

"Even the grounds on which the hospitals and clinics are built should honor the relationship that we have to the earth and to animals. For example the grounds might be farmland with horses and sheep." According to Alvord, who walks competently in both the traditional and high-tech worlds, "We need to reclaim our healing."

Available from:
The Scalpel and the Silver Bear
Bantam-Doubleday Books
1540 Broadway
New York, NY 10036
$23.95
($16.77 on Amazon.com)

Jane Westberg, Ph.D., is a clinical professor of Family Medicine at the University of Colorado Health Sciences Center. She is also associate editor of Education for Health: Change in Learning and Practice, an international journal of the Network of Community-Oriented Educational Institutions for Health Sciences.