Jane Harrison was smiling, even as a tube of dark-red blood flowed into her chest from a bag above her head. An upbeat nurse was taking her vitals.
“You’re going to have more energy coming soon,” the nurse said, over the wheeze of a blood pressure cuff expanding.
“I better!” Harrison joked.
She was getting a transfusion, but in the past she’s gotten chemo in this same simple room at the Phoenix Indian Medical Center. PIMC treats people from all federally recognized tribes, and it’s a place Harrison knows well. The 72-year-old Navajo spent more than three decades here as a nurse, before she found a lump in her breast in 2011.
“They told me I have cancer,” she remembered. “No, can’t be me. I was in total denial for about nine months. I couldn’t say I have cancer. I wouldn’t say it.”
That surprised her. Her response was about fear, she said, about old ideas she thought she’d let go. Growing up on the reservation, in the tiny community of Lower Greasewood, she was taught not to talk about herself, especially not about her body. She’s sure now that she knew people back then who got cancer. But no one ever discussed it.
“Greasewood is so isolated - it’s way out in the boonies - that they didn’t go to the doctors,” she said. “They just died. Mostly, it was women who died.”
Cancer rates are actually lower for Native Americans than the general population, according to Centers for Disease Control and Prevention. But once diagnosed, they’re more likely to die of the disease. Providers say that’s because they often don’t seek help soon enough. That’s why Harrison is always telling people not to ignore their health.
“When your body says, ‘Something is wrong, I’m tired, go check me out,’ do it,” she said, with authority in her voice.
But that can be more of a challenge than a choice. There isn’t even a word for cancer in Navajo. For many patients, PIMC is the only place they can receive free cancer care, even though they may live two or four or six hours away. Many don’t have a car. Or a phone. Or electricity. But if they can make it to PIMC, they have a tight-knit group of care providers in their corner.
It includes Tim Mathews, a nurse practitioner who has been here for decades, and knows importance of always listening to his patients.
“The first thing I say to them i: 'You’re in charge.'"
Mathews, who’s non-Native, said his team gives state-of the-art cancer care, which includes a partnership with the well-known Mayo Clinic. But trust is really what drives this place. Many of Mathews’ patients grew up in isolated communities, with complicated relationships to the federal government and Western medicine. So their trust of PIMC is hard-won.
“It is the gold nugget, it is the diamond that we have,” he said. “And it’s taken many years to build, and you guard it, you realize how important that is.”
It’s what convinces people to come back, Mathews went on, and to follow through with treatments. Ultimately, he hopes it will also be what changes the perception of cancer in Native communities. He always tells patients the same thing.
“You now have a responsibility,” he said. “Your challenge to give back to the community is to talk about your cancer.”
Jane Harrison isn’t the only one who has taken on that challenge. Her childhood friend Julie Allison, who’s visiting her at PIMC today, is a breast cancer survivor. The 69-year-old recently went home to Lower Greasewood for a five-day healing ceremony. The final day included sand painting on her back, which meant she had to take off her shirt. Allison remembers standing in front of old friends and neighbors, and showing them - for the first time - her left breast was gone.
“It may look weird to a lot of you, but in order to heal myself, I needed to do this,” Allison remembers saying.
Then she heard sniffling.
“And I look around, and I could see that some of the women were crying. Even the men, they had their head down,” she said. “After that, I felt fine. I said, ‘OK, everybody knows now. Just take your bra off.’ So I did.”
She got so many hugs afterwards, some from people she didn’t even know. One man walked up to her saying his daughter-in-law had gone through the same cancer. But he hadn’t really understood her experience until that moment, when someone finally talked about it.