Hektoen International

A Journal of Medical Humanities

Healing in the face of cultural devastation

Patrick Flynn
Los Angeles, California, United States

Portrait of Susan La Flesche Picotte
Portrait of Susan La Flesche Picotte, the first Native American woman to receive a medical degree. Source

In 1855, a young Crow boy, no more than ten years old, ventured to the top of a mountain in present-day Montana. Over the next two decades, the boy would rise through the ranks of his tribe’s political structure, ultimately being elected chief at the age of twenty-nine. But that evening, he was just a boy, participating in the traditional Crow practice of seeking a dream-vision.

Dreams held a sacred, prophetic place in Crow culture, often interpreted to dictate battle plans or inform diplomatic strategies. This boy’s dream, however, was far more dire; it foretold devastation, collapse, the end of the Crow way of life.1 The boy’s name was Plenty Coups. He was the last great chief of the Crow nation.

In the years that followed, Plenty Coups’ vision would come to fruition, gradually, tragically. The pattern is familiar: the U.S. government would ratify a treaty with the Crow, before promptly violating it and offering new, less favorable terms. By the end of the nineteenth century, the tribe was confined to a small reservation, its population utterly decimated. Notes the historian Frederick Hoxie, almost one-third of the 2,461 Crows recorded in the 1887 census perished in the 1890s, owing largely to the actions of white settlers.2 Shortly before his death, Plenty Coups observed, “When the buffalo went away, the hearts of my people fell to the ground, and they could not lift them up again. After this nothing happened.”3

In his book, Radical Hope: Ethics in the Face of Cultural Devastation, Jonathan Lear takes up Plenty Coups’ remark as a profound ethical concept. According to Lear, while this “breakdown of happenings” is a form of cultural death, it is not final. Its corollary, what Lear calls radical hope, is distinctly life-affirming.4 “What makes this hope radical,” Lear writes, “is that it is directed toward a future goodness that transcends the current ability to understand what it is.”5

Ten years after Plenty Coups’ fateful vision, some 800 miles away from the peak on which he received it, Susan La Flesche Picotte was born into the Omaha tribe. Her father, like Plenty Coups, was the last traditional chief of his people. And also like Plenty Coups, he was acutely aware of a tribal future colored by impending, seemingly inevitable cultural devastation. In the 1830s, after serving on a delegation to Washington D.C., he offered a frank warning to his peers: “There is a coming flood which will soon reach us, and I advise you to prepare for it.”6

If the dealings of the U.S. government constituted a storm for the Omaha people, La Flesche came into a world thoroughly saturated. Tribal members that survived the political turmoil, disease, and food shortages of the first half of the nineteenth century were relegated to a reservation, subject to forced assimilation.

At the age of eight, La Flesche would receive a vision of her own, not in the form of a dream, but rather through a direct experience of a world premised on the destruction of her people. Sitting at the bedside of an elderly, ailing tribe member, she watched as the woman’s family made desperate, futile calls to the white agency doctor who would never arrive. The woman died shortly thereafter. For La Flesche, the message was clear: “It was only an Indian,” she wrote, “and it [did] not matter.”7

La Flesche Picotte was bearing witness to the aftermath of cultural devastation—an entire people, exposed to new diseases and new weapons of war, cut off from traditional healing methods and necessary resources. The experience was also a call to action: “It has always been a desire of mine to study medicine ever since I was a small girl,” she would write, “for even then I saw the need of my people for a good physician.”8

La Flesche gained entry to the Woman’s Medical College of Pennsylvania, ultimately becoming the first Native American woman to graduate from medical school and practice as a doctor. At the age of twenty-four, she returned home to the reservation, serving as the lone doctor for both the Omaha people and neighboring Winnebago tribe. Assuming responsibility for well over 1,000 patients and a territory spanning nearly 1,400 square miles, she would light a lantern in her window to invite any and all that needed medical attention. “My office hours are any and all hours of the day and night,” she remarked.9 In 1913, two years before her death, La Flesche realized her life’s ambition of building a privately funded hospital on the reservation.

The author Saidiya Hartman tells us, “Care is the antidote to violence.”10 Susan La Flesche Picotte embodied this care, meeting unimaginable violence with empathy, healing, and a belief in the possibility of a more compassionate future.

In Radical Hope, Lear contends, “Courage is a state of character that is manifested in a committed form of living.”11 If we take this claim seriously, it follows that the mandate of courage is to confront historical rupture headlong, defiantly insisting on our capacity to reimagine what it means to live and live well. In their lives, both Plenty Coups and Susan La Flesche Picotte modeled this spirit.

End notes

  1. Jonathan Lear, “Radical Hope: Ethics in the Face of Cultural Devastation,” Harvard University Press, (2006): 66.
  2. Frederick Hoxie, “Parading through History: The Making of the Crow Nation in America 1805–1935,” Cambridge University Press (1997): 141.
  3. Frank B. Linderman, “Plenty-Coups: Chief of the Crows,” Lincoln: University of Nebraska Press, (1962): 311.
  4. Jonathan Lear, “Radical Hope: Ethics in the Face of Cultural Devastation,” Harvard University Press, (2006): 6.
  5. Ibid., 103.
  6. US National Park Service, Susan La Flesche Picotte, https://www.nps.gov/people/susan-la-flesche-picotte.htm
  7. Christopher Klein, “Remembering the First Native American Woman Doctor,” The History Channel, (2016).
  8. Ibid.
  9. US National Park Service, Susan La Flesche Picotte, https://www.nps.gov/people/susan-la-flesche-picotte.htm.
  10. Saidiya Hartman, “In the Wake: A Salon in Honor of Christina Sharpe,” Barnard College (2017).
  11. Lear, “Radical Hope,” 65.


  • Lear, Jonathan. “Radical Hope: Ethics in the Face of Cultural Devastation.” Harvard University Press (2006).
  • Hoxie, Frederick. “Parading through History: The Making of the Crow Nation in America 1805–1935.” Cambridge University Press (1997).
  • US National Park Service. “Susan La Flesche Picotte.” https://www.nps.gov/people/susan-la-flesche-picotte.html
  • Klein, Christopher. “Remembering the First Native American Woman Doctor.” The History Channel (2016).
  • Hartman, Saidiya. “In the Wake: A Salon in Honor of Christina Sharpe,” Barnard College (2017).

PATRICK FLYNN is a Communications and Development Associate at KDI’s Los Angeles office. At KDI, Patrick supports grant writing strategy, business development, and social media outreach. He graduated with a BA in Peace and Justice Studies from Villanova University.

Highlighted in Frontispiece Volume 14, Issue 1 – Winter 2022

Fall 2021



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