By Francis Baxley, MD

I’m a family doctor working at a small Navajo hospital in rural New Mexico. Our hospital is relatively isolated, and as a result, everyone’s scope of practice is larger here than it might be if we’d worked in an urban setting. For example, all the family doctors at our hospital cover shifts in our seven-bed emergency department, and because our community doesn’t have access to hospice services, we provide end-of-life care on our inpatient ward.

This has been exciting, but for me, only two years out of residency, it’s also been a challenge: I still worry that I’m not prepared for everything that might come through those doors. And even after two years, I’m still learning how the Navajo culture, and resource limitation in my community, impact the way I care for my patients.

This really hit home a couple of weeks ago when I took care of an elderly Navajo woman who’d been unwell for several weeks. She came in with her daughter, who translated for us. “What brings you in tonight?” I asked. I expected her story to shed some light on her condition, and point me in the direction of a diagnosis, as it usually does for most doctors, most of the time. Unfortunately, she didn’t have much to say: “I’m dying,” she said, and nothing more.