Hektoen International

A Journal of Medical Humanities

Closed mouth, open heart

Ellen Hitt
Tucson, Arizona, United States


Entrance to health department on an Indian reservation

One of the many beautiful symbols of the Pascua Yaqui Tribe, marking the entrance to their health department. Photo by author, Ellen Hitt

As a child, my life was uprooted every three years. I said goodbye to my friends, my school, and life as I knew it as my family moved across the country. Every so often, I even said goodbye to my dad as he left for a deployment; this was the life of a child with two parents in the military. As challenging as it may sound, I became accustomed to this lifestyle. I learned to cherish the opportunity to see the world and meet new people, and most importantly, I began to understand the importance of leading a life that is dedicated to service.

I chose to pursue a career in medicine. After my first year of medical school, I had the opportunity to do a rotation on a local Indian reservation. I arrived bright-eyed and bushy-tailed, with pure intentions of making a difference in the lives of others. With knowledge of health disparities and the social determinants of health, I was eager to educate patients, advocate for social programs, and change the trajectory of people’s lives.

On my first day, I attended a health department meeting with the tribe’s council. As I made my way towards the conference table to take a seat, my preceptor stopped me. “The table is for the council members only,” he told me. “Sit in one of the other chairs and they will invite you to the table on their own accord.” Embarrassed, I took a seat in one of the free chairs. I was disappointed in myself, thinking, “What if my preceptor hadn’t been there? Despite my good intentions, I would have offended the council. Why hadn’t I been more observant?” Lesson learned, I pushed these feelings aside and shifted my focus to the meeting.

I was astounded by the tribe’s health initiatives. They had programs for diabetes prevention, mental health counseling, addiction treatment, and much more. I quickly realized I did not bring any expertise or insight they did not already have. This was, in fact, their own tribe. They knew their history, people, and culture better than I ever would, and as a non-tribal member entering their health department, I was not the answer to their problems. It was at this point I began to understand that in order to make a difference, I needed to redirect my intentions towards listening, learning, and lending my skills to their goals.

As I continued my time with the tribe, there was no shortage of impactful moments, one of which was a morning I spent chatting with some of the nurses. As we touched on the issue of “noncompliance,” the nurses explained the importance of meeting patients where they are. Too often, they said, doctors come to the tribe and counsel patients relentlessly about taking their medications and making lifestyle changes. Tired of being lectured, patients stop returning to the clinic. A single mother with diabetes, for example, might come to the clinic as instructed to monitor and treat her diabetes. However, she is not willing to take any medications, and cannot afford healthy food options. While this example highlights the need for programs targeting access to affordable medications and healthy food, at that moment, the nurses explained, the best course of action is to determine what the patient is willing and able to do for her diabetes rather than lecture her about noncompliance. She might, for example, be willing to take a walk with her children each night and cut out soda. These tiny victories, achieved by listening, understanding, and forming relationships with patients, are the realistic vehicle by which healthcare providers can really make a difference.

During one of my last weeks with the tribe, I met a patient who I particularly enjoyed spending time with. She was an elder of the tribe, seeking natural remedies for her chronic pain. She told me stories of her childhood, her parents, and the history of the tribe. She described the times she had felt most connected to God, and the details of her experience being hospitalized from COVID-19. “I almost croaked,” she said laughing. She relayed her appreciation for her healthcare team and acknowledged how busy they must have been, but also brought up how she was not given a shower during the time she was there. “Not showering was contributing to my illness,” she explained. It was at this point I really began to understand the impact this had on her. This patient, like many others, had cultural beliefs surrounding her illness and how she wanted to be cared for. After my interaction with her, I vowed to always try to understand my patients’ culture and preferences and spend the time to accommodate them whenever possible.

My experience with the tribe was a huge wake-up call. Understanding culture is critical in being able to serve others. As healthcare providers, even with the best of intentions, we need to rid ourselves of our egos and take the time to listen and understand above all else. With this understanding in mind, I hope to continue in my training and career with a closed mouth and an open heart.



ELLEN HITT is an ASU graduate and a second year medical student at University of Arizona COM-T. Because of her military upbringing, she has always had a strong desire to serve others, leading her to pursue a career in medicine. She is an aspiring OB-Gyn who hopes to work with underserved populations and a recipient of the Primary Care Scholarship at UACOM-T. As the president of Families and Partners Club at UACOM-T, she is passionate about fostering a family-friendly culture in medicine. She currently lives in Tucson with her husband, Tony, and her eight month old son, Beckham.


Summer 2021 |  Sections  |  Doctors, Patients, & Diseases

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