I remember as a child gathering wild greens with my Cherokee grandmothers, 2 generations of them, and hearing the lilt of spoken Cherokee. I can still see myself listening quietly in the corner of the room while others came to visit my great-grandmother, a respected traditional healer. We were poor. There is no other way to say it. My mother carried water from a well in the middle of the field, and I remember before going outside to play in the snow that we wrapped bread sacks around our feet to keep them dry. But as a child, while life was hard and even harsh at times, it felt safe and constant.
I expected to experience much the same type of lifestyle while, as a medical student, I worked on a clinical rotation in the behavioral health department at the Pine Ridge Indian Health Service Hospital in South Dakota. What I found, though, was much different—children for whom life had become harsh, unpredictable, and scary. The family structure that historically had kept the children safe, in many instances had broken down. The tribal culture and social infrastructure that gave the family a foundation had begun to erode and was being replaced by drugs, violence, and gangs.
A 9-year-old boy I met, Sage, made me realize that multiple generations of lives have been altered because of the fragmentation of the community and family structure. He had been referred to Indian Health Service by his school because of conduct and behavior concerns. His heartbreaking story is made even more so by the fact it is not unique.
I arrived on the reservation and through the generosity of tribal members found a room in the little settlement of Wounded Knee, a few miles northeast of the town of Pine Ridge. Wounded Knee is famous in American history for the Massacre at Wounded Knee Creek in the winter of 1890, in which over 200 Miniconjou and Hunkpapa Lakota men, women, and children were killed by members of the US Seventh Cavalry.
In the aftermath of that massacre, an infant girl was found alive, shielded from the elements by her mother’s frozen body. She was named Zintkala Nuni (Lost Bird) and adopted by Brigadier General Leonard Colby, who then took her back East. He later abandoned his family while she was still a child. Lost Bird struggled to find a place of belonging and was expelled from several different schools. Eventually, she found work in a Wild West Show. In 1920, she died in poverty at the age of 29 in California. In recalling this story, I often found myself making parallels between Lost Bird’s journey and those of many of the children at Pine Ridge.
On the second day of my rotation, I left the hospital in Pine Ridge early in the morning to go to the Porcupine school. An hour later, I arrived at a collection of brick and metal prefabricated buildings. I pulled into the dirt parking lot and went inside, where I handed the lady at the front desk the slip of paper on which was written the name of the child I had come to see. I was told he was in the detention room. I walked into the room and found Sage sitting at a low, round table, dressed in a white T-shirt and jeans, with his head down, resting on folded arms. In front of him was a piece of paper with large penciled blobs of dark circles made so forcibly that the paper had torn in several places.
The detention room teacher looked up and nodded toward him. I asked her what had happened. She said he was disruptive in class, disturbing other kids and at one point had gone around the room taking pictures off the walls. I knelt down beside him. Sage didn’t look up. I introduced myself and asked if we could talk for a while. He didn’t speak. I asked the teacher if there was some place where he and I could talk. She directed me to an empty office. When I asked if he would like to go there, he stood up, head still down. As we walked, I commented on drawings taped to the walls and asked if any were his. Without looking up, he shook his head no. He looked like many American Indian children I had grown up with—slight in build, as my grandmother would say, deep brown eyes, and short, spiky dark brown hair.
The office felt warm and inviting. A small table sat on one side under a window that looked into the hallway. On the table were paper and crayons. Sage sat with his head down. I again introduced myself and asked what had happened that morning. He still said nothing. I told him he wasn’t in trouble. I only wanted to know what had happened and how he felt so I could help. He shifted in his chair and looked up through the window into the hallway.
I picked out a crayon and began drawing. He slowly did the same. Without speaking, he made lines and curves that soon became evident were the beginnings of a car. I asked him if he liked to draw cars. He replied, “This is my brother’s car.” With some gentle questioning, Sage told me he had an older brother and older sister but he didn’t see them very often. He didn’t live with them; he lived with his grandmother. When I asked about his parents, he said his mother was in prison. He didn’t see her very often but had once gotten to visit her on his birthday. He didn’t know where his father was. I remarked that it must get lonely not having his brother, sister, mother, or father around. He became quiet and without interrupting his drawing nodded his head yes.
Sage was proud of his brother’s car. With a smile on his lips, he told me that his brother let him help fix the motor once. As he talked, with great detail he drew flames going down the side of the car and paid particular attention to getting the right number of spokes on the chrome wheels. I asked what kind of work his brother did. “He sells drugs,” he responded. There was no sense of secretness or shame in his voice. It was a matter of fact. I heard from those living on the reservation that drug activity, cultivated by gang presence, was pervasive and touched nearly every child’s life.