“Vanya, the plane is here for the patient in room three if you want to ride out to the airstrip with the EMS crew.”

It is dark outside as we step out under the star-studded South Dakota sky. I hop in the passenger seat of the ambulance, and we drive a few minutes away where there is a tiny green fixed-wing plane waiting in the darkness, lights flashing. I watch, buzzing with excitement, as the pilot and flight crew load the patient onto the plane, then quickly take off to fly to Sioux Falls for what would have been a five-hour transport by ground. We watch them leave and then head back to the Cheyenne River Health Center to finish our night shift.

I get back to my desk in the emergency department, an 11-bed unit and check in with the team. Our night crew consists of several nurses, one physician assistant, and one attending physician. There is one radiology tech covering the X-ray and CT machines in the hallway adjacent to the department. Past radiology, the hall leads to the eight-bed inpatient unit where there are currently four admitted patients. The rest of the complex is quiet, waiting for daybreak when the outpatient offices start stirring. I take some time to wander the silent hallways, passing by plaques written in both English and the Lakota language, stopping in to see the traditional healing room where family members can burn sage when a loved one dies.

A landing pad near the health center allows for small plane landings and takeoffs to transport patients to larger health care facilities. (Click to enlarge.)

The hospital, which was reconstructed in 2012, is part of the Indian Health Service (IHS). The IHS provides care to some 2.8 million American Indians and Alaska Natives in 574 federally recognized tribes.¹ It includes over 600 hospitals, clinics, and health stations on or near American Indian reservations. The Cheyenne River Health Center is in Eagle Butte, South Dakota, home to around 1,500 people, 85 percent of whom are Native American.² It lies on the Cheyenne River Reservation, home to the Cheyenne River Sioux Tribe. The IHS mission statement hangs on a wall at the front of the hospital: “To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.”

Back in the emergency department, I reflect on everything I have seen and done during my week here. I have been handed a fetal heart tracing to look at, something I have not done since my obstetrics/gynecology (OB/GYN) rotation in medical school. I have called the transfer center countless times to discuss cases with hospitalists and specialists. I have taken care of a mother and her son in the same week during two different visits and learned how close knit this community is. I have cared for a stroke patient who received tenecteplase and was whisked away in an ambulance. I treated a trauma victim who needed blood, something that exists in very limited supply here. I have seen countless patients suffering from alcoholism and depression, conditions that are unfortunately very common in the community. I have taken care of a 9-day old infant who had not received any care since birth. This is the privilege of learning what it is like to work at a critical access IHS hospital dedicated to the survival of its community.