A Navajo Farewell

Eliza’s umbilical cord stump fell off while we were still in California. I stored it in a Ziploc with the intention of burying it, according to the Navajo tradition, in the red rock hills behind our home on the reservation back in Arizona. The umbilical cord is the physical representation of the three central relationships that orient a Navajo child in this world—to the mother, to the homeland, to the Holy Spirits. The navel is a lifelong reminder of the roots established before birth.

This year unexpectedly has turned out to be an unsettled one, full of turbulence and transition. It has been a time to define where we have come from and to envision where we are going. My husband and I have been pediatricians for the Indian Health Service for the past six years. We came expecting a fling; instead, we discovered the defining experience of our professional lives.

My father-in-law in California has suffered from a long-standing autoimmune liver disease that was so indolent we wondered whether the doctors had the correct diagnosis. This fall, he casually mentioned that his feet were swollen in the evenings. That seemingly trivial complaint heralded a precipitous progression to full-blown liver failure. He collapsed at home the day before Thanksgiving and was found to be in end-stage liver and kidney failure. At that time, Carlos and I were trapped on the reservation, anticipating the birth of our second daughter any day.

“How can I choose between my father and my child?” Carlos asked one sleepless night. But finally, the situation became so grave that we made the 14-hour trip west.

Two days after we arrived, we learned that a liver donor had become available. Carlos’s father was the alternate recipient. We spent a restless evening, and I woke in the predawn darkness, vaguely aware that I had been asleep for many hours. It had been too long—the liver had certainly gone to someone else. I felt as despondent as I have ever been in my life.

Just then, the phone rang. “Hello,” a woman’s voice said. “I am ____, calling for Gregorio Lerner. Another liver has become available, and he is the alternate.”

I felt as if God were speaking to me, this disembodied voice in the middle of the night, with the power to determine life and death. In the end, the team decided that the liver was better suited for my father-in-law, and he received a transplant early that morning. We had told him the intended name of our new baby, and Eliza was his first word after the breathing tube was removed. She was born in California three days later, into a world of newfound hope.

From the moment we first arrived at the reservation, we also knew that we would one day leave. Our brief stint grew into an extended stay, but we knew that eventually we wanted to be closer to family and to better schools. We renewed our job contract year by year, with the understanding that we could leave at any time. Each year, we signed without a thought, grateful that the time had not yet come.

But as Carlos’s father became sick and sicker, we started to consider leaving next fall, then this summer, and perhaps now, or maybe we were too late already. “We can’t stay forever,” Carlos said. “It’s better to go when we still want to stay.”

We came to the reservation with little consideration of our ultimate career goals. In fact, I thought myself a particularly unambitious clinician, all too happy to accept a small job in a remote area with few opportunities for advancement. All along, we thought that our reservation years would count little toward our future career. As I embarked on my job search, it was not clear what path I should choose. I struggled to envision myself in a more traditional career—academics, private practice. Nothing seemed to fit.

But opportunities found us. Carlos will join the pediatrics department at UCLA. His position will draw on the skills he has gained during the past six years as our chief of staff. I will join a free clinic in downtown L.A. that serves a community where 97 percent of the children live below the poverty line and 40 percent have been placed in long-term foster care. The most difficult aspect of the job search was acknowledging that Carlos and I have different career goals. Over the past 13 years, we have been medical students together, residents together, pediatricians together. Now our paths diverge.

We have buried Eliza’s umbilical stump next to our older daughter Macy’s, under a lone pinon tree along our favorite walk. The yucca is blooming now, simple white bells stretching high above the spiny underbrush, and the desiccated rocks are embraced by the fleeting scent of wildflowers. Carlos and I arrived on the reservation as two free spirits, exhilarated and itching for adventure. We depart a family of four, with two big dogs. The umbilical stumps will serve as our physical anchor to this land and to this experience. I am not ready to go, and yet it is time to say good-bye.

Ellen Rothman, HMS ’98, practices in northern Arizona on the Navajo Reservation.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.