For the past three years, Dr. Scott Kelso has lived a topsy-turvy life. For two weeks each month, he leaves his home in Washington, D.C., to work the night shift emergency room in Fort Defiance, Ariz. The lifestyle and 2,000-mile commute isn’t for everyone, but it works for Kelso. His patients certainly agree; they call him Big Daddy Medicine Man.

Board certified in both internal and emergency medicine, Kelso was working at the Andrews Air Force base when he got an out-of-the-blue call. It was a recruiter at the Indian Health Service asking if he would be interested in a new challenge: practicing emergency medicine at the Tsehootsooi Medical Center in Fort Defiance, Ariz., the primary health care provider to the Navajo Nation.

There were good doctors at Fort Defiance, but not enough of them, and Kelso’s willingness to join the team was an answer to a prayer.

“I was curious when I started here—it was an adventure,” says Kelso. “But it works for me. I know it’s nuts, but I love it!”

Working at Fort Defiance was definitely a change from the hospitals Kelso was used to, but it has broadened his medical horizons, augmented his skills, and fostered a connection to the community he serves. At Fort Defiance, Kelso is likely to see almost anything, from dual stabbings (quarrelling brothers) and head trauma (from a cast-iron skillet wielded by an angry wife) to hypothermia (patient fell asleep outside in sub-freezing temperatures) to a severely altered state from eating a toxic lily (patient thought it was an onion). Luckily, Kelso is able to treat most patients in his ER, as the closest hospital with a trauma center is some 200 miles away in Albuquerque.

Unlike the ERs in urban centers, Kelso’s ER is a front-line operation. Everybody knows everybody else, so not a lot of time is wasted on paperwork, and because health care is a federal entitlement program for tribal members, patients are able to walk in and get treated quickly with no questions asked and no insurance hassles. Because there is little depth of field in the hospital—no cadre of resident specialists to refer patients to—Kelso actually gets to practice clinical medicine, a dying art in his profession.

“I see things here I wouldn’t encounter anywhere else,” he says.“There’s hanta virus, brucellosis, and even bubonic plague—a virus carried by prairie dogs transmitted to humans through flea bites. It’s unbelievable!”

Kelso has also relearned the art of connecting directly to his patients, many of whom may have walked for hours just to get to the hospital. He says, “People actually say ‘thank you’ here; kids recognize me!”

Moreover, he’s learned that Western medicine has its limits. Now, when Kelso bumps up against a patient’s belief in a more traditional cure—a sweat lodge, a hitaalii’s complex sand painting, or a sing—he backs off. He’s heard “Doc, you wouldn’t understand” more times than he can count. His first instinct is always to practice the medicine he was trained to practice, but with every shift, he is learning to appreciate another kind of medicine, a more spirit-driven healing art. “Who knows what really heals a patient,” he says with a smile and a shrug.

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