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Macmillan Childrens Publishing Group

A Warrior of the People

How Susan La Flesche Overcame Racial and Gender Inequality to Become America's First Indian Doctor

Joe Starita

St. Martin's Press



The Arrow


It’s five A.M. on a midwinter morning, the mercury stuck at twenty below. Overhead, a canopy of constellations spills across the clean winter sky, the quarter moon a slim lantern hanging above the vast, black, desolate prairie.

She’s walking to the barn, through the snow, layered in muffs, mittens, and scarves. Still, her ears are numb, her face frozen, her breathing labored.

She steps inside the barn, carefully placing a small black bag on the buggy seat. For a time, if it were less than a mile, she would just walk. Then she took to slinging the black leather bag across her saddle, making house calls on horseback. But bouncing across the rugged terrain took its toll on the glass bottles and instruments, so she eventually bought a buggy, bought her own team.

Inside, her two favorite horses wait impatiently, snorting thick clouds of steam into the ice-locker air. She grabs their harness, hitches them to the buggy, guides them out of the barn. Then she climbs in and gets her chocolate mares, Pat and Pudge, heading in the right direction, their ghostly white vapor trails hanging in the frigid blackness.

It’s early January 1892, a month her people call When the Snow Drifts into the Tents. The woman in the buggy, the one lashing her team to move faster, is a small, frail twenty-six-year-old, a devout Christian who also knows her people’s traditional songs, dances, customs, and language, a woman who just recently acquired 1,244 patients scattered across 1,350 square miles of open prairie now blanketed in two feet of snow—a homeland of sloping hills, rolling ranch land, gullies, ravines, wooded creek banks, floodplains, and few roads.

The air crushes her face, stings her ears. She pulls a thick buffalo robe over her shoulders to buffer the subzero winds, lashing the horses’ flanks again and again until the buggy picks up the pace, its wheels moving over one ridge and then another, through deep drifts covering the remote hillsides of northeast Nebraska.

In the darkness they keep moving, keep going, and all the while, over and over, her mind keeps drifting to the same recurring thought:

Can I find her?

Will I get there in time?

*   *   *

They were known as the Omaha–Umonhon. In the language of her people, it meant “against the current” or “upstream,” and their Sacred Legend, their creation story, said the Omaha had emerged long ago from a region far to the east, a region of dense woods and great bodies of water.

“In the beginning the people were in water. They opened their eyes but they could see nothing.… As they came forth from the water they were naked and without shame.”

In the beginning, in their eastern homeland near the Ohio River, the Omaha encountered many problems. Having emerged naked from the water, they were cold and wet and hungry, and so—meticulously and methodically—they began to look for solutions, and by and by, they found them: clothing, fire, stone knives, arrows, iron, dogs. Over time, they emerged as a practical people, a people who craved progress, who time and time again looked to conquer hardship and inconvenience with a straightforward determination, with their own ingenuity and technological innovations.

Century after century, perhaps beginning as far east as the Great Lakes, the Omaha followed a mosaic of waterways—first to the west and southwest down the Ohio and then west and northwest up the Missouri. By the middle decades of the eighteenth century, they occupied large swaths of land in northeast Nebraska and northwest Iowa, where they eventually established permanent villages along the banks of America’s longest river.

In their Missouri River settlements, the Omaha lived in both igloo-shaped earth lodges and buffalo-hide tipis. Their village was divided into ten clans, and each of the kinship clans had a specific duty when it came to the tribe’s most important event: the spring planting ceremonies. Each spring, usually by the middle of May, the women in the village flocked to the fields along the floodplain and began the ritual corn planting, seven kernels to a hill. Soon, varieties of beans, squash, and pumpkins also found their way into the fertile soil.

*   *   *

This was her land, their land, the land of her people, and now she was riding across it in the dark and bitter cold in the month When the Snow Drifts into the Tents. Below the snow lay the prairie, an endless carpet of grass that had nurtured herds of buffalo once estimated at more than forty million. Her people believed the buffalo had been a gift from Wakonda, and the great beasts had helped sustain their way of life for several centuries. But now, as the nineteenth century wound down, the endless wild herds—slaughtered at first for traders, then by railroad mercenaries and sportsmen, and finally as an instrument of government policy—had been reduced to fewer than a thousand, reduced to near extinction.

But her people were still there, still living on their prairie homeland, where many had eventually come to learn a harsh lesson of life on the American Great Plains: Adapt—or perish.

In late June, when the crops had taken root and begun to mature, the entire village broke camp, fanning out across the western plains for the annual buffalo hunt, a critical time to lay in a good supply of winter meat, a plentiful stock of hides. By late August—the month When the Elk Bellow—the Omaha were on the lookout for a sign, for something blossoming on the endless plains outside their tipi village: the prairie goldenrod. Year after year, this had been the signal to tear down the tipis, pack up, and head back to their Missouri River homeland, where abundant fields of ripened corn, beans, squash, and pumpkins were now ready for harvest.

For the women in the village of the Upstream People, their many jobs and tasks had one ultimate objective: to preserve and conserve life. But that life was often hard, a ritualized cycle of physical labor the tribe depended upon to stay in sync. Season after season, year after year, it was women who prepared the fields, planted the seeds, harvested the crops, tanned hides, lugged water, gathered wood, maintained the tipi, collected wild plants and herbs, cut buffalo meat into strips, cooked food, quilted, sewed, bore children, and raised the family.

Omaha women—like many others in tribal encampments scattered across the Great Plains—commanded positions of great respect within the social fabric of the village and held a good deal of power within the tribe. Over time, men and women acquired an equal standing within the delicately balanced rhythm of Omaha tribal life.

In their traditional villages, men did not look down on women or treat them as inferior. If a task proved too difficult physically, the husband would often help out. And before making any important change or doing anything that would affect the family, the husband first consulted his wife.

In 1869, seventeen years after publication of Uncle Tom’s Cabin, Harriet Beecher Stowe offered a contrasting view of the relationship between men and women, a view she saw as commonplace for traditional wives in nineteenth-century mainstream America. “The position of a married woman,” she wrote, “… is, in many respects, precisely similar to that of the negro slave. She can make no contract and hold no property; whatever she inherits or earns becomes at that moment the property of her husband.… Though he acquired a fortune through her, or though she earn a fortune through her talents, he is sole master of it, and she cannot draw a penny at all.… In the English common law a married woman is nothing at all. She passes out of legal existence.”

Among the Omaha, it was women who managed all household affairs and who owned the lodge and all its contents. They were free to marry whomever they wished, could reject parental suggestions, and had the power to divorce. If a woman decided to end a marriage, she often placed all of her husband’s belongings outside the lodge, an unmistakable sign that their union had ended.

From early on, young girls were never left unprotected. They were not allowed to go far from the lodge unless accompanied by an adult. And in many Indian tribes, a girl’s first menstruation often was an important event, something sacred, something to be celebrated—an honor recognizing her passage into womanhood, forever binding her to the fertility of Mother Earth. Some tribes also believed that menstruating women were spiritual beings so powerful they could be called upon for enlightenment, for guidance, for advice. Sometimes they left their homes during the heaviest four days of the cycle and stayed in menstrual huts with other women, engaged in lively discussions across a variety of subjects, often about their children.

Among the Omaha, children were sacred and there were ceremonies celebrating the arrival of a newborn. The people did not believe children were born with original sin or that they were even yet members of the tribe. Instead, they believed babies were living things who had entered the cosmos, joining all other living things. So on the eighth day, a priest conducted a ceremony welcoming the baby into the universe. Soon the baby had a pair of new moccasins, with a small hole cut into the sole of one of them. This was done so if a messenger from the spirit world, where the dead reside, should ever come for the child, the child could simply say: “I cannot go on a journey—my moccasins are worn out!”

The Omaha held a second ceremony once the child could walk, a ceremony that established the child as a distinct person attached to a specific clan with a recognized place in the tribe, a ceremony designed to give the child strength, identity, and self-discipline. In the Turning the Child Ceremony, the mother walked her child to a sacred tent, its entrance facing east, a fire burning in the middle.

“Venerable man!” the mother called out to the priest. “I desire my child to wear moccasins.… I desire my child to walk long upon the earth.”

Then she dropped her child’s hand and the child entered the tent alone. The priest guided the child toward the fireplace, saying: “I speak to you that you may be strong. You shall live long and your eyes shall be satisfied with many good things.” The priest then lifted the child by the shoulders and, facing east, turned the child completely around, repeating his words until the child had faced all four directions. The ceremony ended when the priest put the new moccasins on the feet of the child. The priest then made the child take four steps, symbolizing the journey to a long life.

Throughout the long journey of the Omaha people, as far back as anyone could remember—whether encamped in forests, along shorelines, or by riverbanks, in summer or winter, in tipis or earth lodges, hunting or farming—there was often a recurring question, a question that formed part of their identity, a question that seemed to be deeply embedded in the Omaha’s cultural lifeblood. It’s a question that had sprung from their Sacred Legend, one that had been asked over and over:

What shall we do to help ourselves?

How shall we better ourselves?

*   *   *

The bones in her face and ears ached from knifing through the numbing air. They’d gone three miles but had another three to go, maybe more, the horses pounding up steep, snowy hills, pounding down the back side, snorting heavily, clouds of steam littering the air.

The darkness had started to fade a little now, the snow on the distant hills faintly blossoming in the soft winter light.

She stood up in the buggy, scoured the prairie in the dim dawn, looking for a solitary silhouette, looking for an outline perched on the distant horizon. But she couldn’t see it, so she sat back down and whipped her team, yelling at them to go, to keep moving.

She has to make it. She has to find the one-room cabin somewhere on this frozen winter prairie. Though years apart, she and the young girl inside had gone to the same school—the same normal and agricultural college in Virginia, where after the great war they had sent the sons and daughters of black people and the sons and daughters of red people to learn how to become more like white people.

She can’t let the girl down. She can’t let all the others down, the ones who pushed so hard, all the time, to get her papers filed, her payments made, her books and clothes and housing and train fare taken care of. She can’t let them down. But most of all, she can’t dishonor his memory.

She cannot let her father down.

*   *   *

Their Virginia school was about 130 miles from Monticello, home of the third president of the United States, a restless, thoughtful, complex philosopher, lawyer, architect, and amateur scientist who had long harbored dreams of expanding the fledgling nation’s borders to the Missouri River—and far beyond.

In Jefferson’s view of democracy, the lands between the Mississippi and the Rockies, which the Louisiana Purchase had just made available, would become a bedrock of educated citizen-farmers, men and women who would create a new world order, who would become the foundation for a stable, prosperous, industrious, moral America.

So it wasn’t long before her people—and many other tribal people long braided into the geographic fabric of the Great Plains—began to see the pool of fur traders, explorers, and adventurers start to expand. And with it came more and more government agents, more soldiers and peace parleys, and more and more treaties gobbling up more and more of the original native lands.

Francis La Flesche, the nation’s first Indian ethnographer, would later note a feeling that was beginning to spread among the tribal villages scattered between the great rivers and mountains:

“The white people speak of the country at this period as ‘a wilderness,’ as though it was an empty tract without human interest or history. To us Indians it was as clearly defined as it is to-day; we knew the boundaries of tribal lands, those of our friends and those of our foes; we were familiar with every stream, the contour of every hill, and each peculiar feature of the landscape had its tradition. It was our home, the scene of our history, and we loved it as our country.”

But by and by, the old way of life began to disappear—and in some years, so did the Omaha. The bustling fur trade up and down the Missouri, linking St. Louis with the Upstream People, had introduced something the Omaha could not fight, could not overcome, were helpless against.

By the time Lewis and Clark arrived in the late summer of 1804, wave after wave of epidemics had taken a toll, none more fearsome than the smallpox epidemic of 1800–1801. Sealed inside their earth-lodge homes, often living in three-generational units, the once robust, healthy people had no resistance to, no immunity from, the rapid, fatal spread of the disease, a disease that sometimes claimed entire families in a single week. By the time the disease had run its course, it was believed that more than half of the Omaha Tribe had died of smallpox.

In one form or another, these diseases would continue to stalk the people throughout the nineteenth century and beyond.

For the Omaha and all the others, the opening years and the opening decades of the nineteenth century all seemed to get progressively worse, step by step. For many of those years, the Upstream People were led by Big Elk, a chief of considerable strength, wisdom, courage, and insight. Among his people, Big Elk was revered for his visionary powers, for a unique ability to look down the road and foretell what the future might bring. And more and more as the decades wore on, as he saw more and more of the old way of life disappearing, his frustration and despair began to mount.

“I am like a large prairie wolf,” he said, “running about over these barren prairies, in search of something to eat, with his head up, anxiously listening to hear some of his fellows howl, that he may dart off towards them, hoping to find a friend who has a bone to divide.”

In 1837, as a guest of the U.S. government, Big Elk visited Washington, D.C.

Like those who had gone before him and the many chiefs who would follow, Big Elk returned from the urban East Coast to the rural plains of Nebraska a profoundly changed man.

With his own eyes, he had seen the flood of whites, in numbers unimaginable. He had seen their cities, their bustling stores and markets, their shops and schools, their government buildings and houses, their neighborhoods and neatly laid-out streets.

When he returned, the shaken chief, who had participated in some of the early treaty sessions, called the Omaha people together and told them of his trip east:

“My chiefs, braves, and young men, I have just returned from a visit to a far-off country toward the rising sun, and I have seen many strange things. I bring to you news which it saddens my heart to think of. There is a coming flood which will soon reach us, and I advise you to prepare for it. Soon the animals which Wakonda has given us for sustenance will disappear beneath this flood to return no more, and it will be very hard for you. Look at me; you see I am advanced in age; I am near the grave. I can no longer think for you and lead you as in my younger days. You must think for yourselves what will be best for your welfare. I tell you this that you may be prepared for the coming change.… Speak kindly to one another; do what you can to help each other, even in the troubles with the coming tide.”

More and more, Big Elk began to tell his people that the old way of life was doomed, that they could not continue to walk down that road. He told them things many did not want to hear, that they would have to change. That they would have to begin to try to understand the ways of the whites, to embrace them, to integrate some of the new ways into the old ones.

To adapt—or perish.

Before his death in 1853, Big Elk, the third member of his family to lead the tribe, faced a difficult decision: Who would succeed him as chief of the Omaha?

He knew he needed someone whose vision was compatible with his own. He knew he needed someone with strength and integrity. Someone who could begin to assimilate the Omaha into the new world order.

He needed someone like Joseph La Flesche.

*   *   *

Born about 1818 in northeast Nebraska, the son of a French fur trader and an Indian mother, Joseph La Flesche grew up among a new subgroup of mixed-blood children—children who emerged from the bustling trading post culture clustered along the region’s rivers, especially the Missouri.

As the nineteenth century unfolded, as more and more outside pressures threatened their shrinking world, the Indians needed weapons—guns—to ward off the threats and to hunt the very animals whose furs could be bartered for those guns. So the fur-trading posts became key centers of commerce linking the white and Indian worlds, as well as white fur traders and Indian women. Over time, their mixed-blood offspring, often with French surnames, began to populate the trading posts and eventually integrate themselves into business ventures, tribal affairs, and occasionally leadership positions within the tribes.

Even by mixed-blood standards, the young Joseph La Flesche lived a complex life, bouncing from one Indian village to another, observing different tribal traditions and customs, absorbing different cultures and languages. By an early age, he spoke Pawnee, Dakota, Otoe, Ioway, Omaha, and French. He also spent a good deal of time hunting and traveling with his French fur trader father, including several long trips down the Missouri to St. Louis, all of which afforded him a worldview uncommon to many others in that area, in that era. He paid close attention to the two different worlds. And he saw many things he would long remember.

Eventually, Joseph settled down and settled in with his Omaha relatives, and as a young man he took a job working at one of Peter Sarpy’s thriving trading posts just south of Omaha. At the height of the fur trade, these posts teemed with all manner of activity and characters. It was here, in the spring of 1833, that the post’s workers could have encountered the German explorer Maximilian, Prince of Wied, and his Swiss artist companion, Karl Bodmer, who had embarked on a twenty-five-hundred-mile trek by steam and keelboat up the Missouri to observe, study, and document—with journals and paintings—the colorful American Indians of the Upper Missouri.

And it was also at Sarpy’s trading post where Joseph La Flesche met Mary Gale, an engaging mixed-blood daughter of an energetic, strong-willed Ioway Indian and a U.S. Army surgeon, one of the first white doctors west of the Mississippi. Several years after her doctor husband died, Mary’s mother married Sarpy, so Mary ended up spending much of her childhood at the trading post where Joseph worked.

A number of years before meeting his wife, Joseph had begun to closely observe the customs of the Omaha, to absorb the age-old traditions, to carefully study the ancient rites and rituals. He also had made a conscious habit of cultivating friendships among the Omaha elders, of listening intently to their accounts of traditional ceremonies, of trying to understand exactly how the fabric of Omaha culture knit together—and what it might take to alter, to rearrange, some of the patterns of the tribe’s cultural quilt.

During all of his visits to the other tribes, throughout the long riverboat journeys to St. Louis with his father, in all he had seen and heard around the trading posts, Joseph had come to an increasingly unshakable conclusion: Soon, the overwhelming power and presence of the white man would suffocate his people, kill the old way of life once and for all. So if their people were to survive, a new one must be forged from the scrap heap of buffalo bones, land loss, ambitious settlers, Sioux war parties, devastating disease, and the white man’s whiskey. Something must occur, a fundamental shift in cultural values, for the Upstream People to overcome the powerful sense of doom and hopelessness that had begun to settle in and spread through village life.

In 1846, Joseph La Flesche and Mary Gale became husband and wife. By then, Joseph’s stock—his thoughtfulness, strength, and respectful commitment to learning tribal culture from the elders—had risen a great deal within the Omaha village, nowhere more so than with the one who mattered most.

Big Elk had taken a liking to Joseph. He trusted him, believed that the younger man had a vision aligned with his own and understood that the flood would sweep them all away if they didn’t compromise, if they didn’t begin to assimilate. So the powerful, respected chief of the Omaha increasingly took him under his wing and began to signal to others that Joseph would one day succeed him. Although the old chief already had a son, who, based on long-standing Omaha tradition, should succeed his father, the boy was young and sickly.

While the boy was still alive, Big Elk adopted Joseph, suggesting in word and deed that it would be Joseph who succeeded him as the Omaha’s new chief. About two years after the wedding of Joseph and Mary, Big Elk performed a traditional Pipe Dance Ceremony honoring Mary. Shortly after, a public crier proclaimed to the village that Joseph was now the chief’s eldest son and would succeed him. Not long after, Big Elk arranged to have Joseph placed in his own kinship clan—not his mother’s, which was the age-old custom. So step by step, the old chief methodically arranged passage for the younger man to succeed him, to carry out his vision. That younger man, according to the Omaha’s 1848 tribal census, was now officially listed as E-sta-mah-za—Iron Eye.

One afternoon in 1853, while the people were having a feast, Big Elk went out hunting and killed a deer. A few hours later, he came down with a fever. Big Elk sent for Iron Eye. “My son,” Big Elk said, “give me some medicine.” Iron Eye sent a runner to Bellevue for medicine, but it was a three-day journey, too long for the gravely ill chief. Feeling the end was near, the old chief again called for Iron Eye. “My son, I give you all my papers from Washington, and I make you head chief,” he told the younger man. “You will occupy my place.” Shortly after the old man chief died, E-sta-mah-za became one of the Omaha Tribe’s two principal chiefs. From that time on, the last recognized chief of the Upstream People struggled for much of his adult life with the central issues that had first brought him into Big Elk’s fold:

How could he, their new chief, find the right balance between who they were then and who they had always been—and who they must now become? How could they become white enough to survive in the new world order, but red enough to retain a cultural identity, a strong sense of who the Omaha were? How could they learn to walk the red and white roads simultaneously?

For many years, there was much he had come to admire about white culture, and he was not shy about proclaiming it as the new chief of the tribe.

“The white man looks into the future and sees what is good,” he told his people. “That is what the Indian is doing. He looks into the future and sees his only chance is to become as the white man.”

That sentiment was not shared by everyone in the tribe, and it eventually led to a bitter division within the Omaha, a conflict over accepting new ways or embracing old ones, a split that pitted the more liberal “Young Men’s Party” against the older conservatives.

But not long after becoming chief, Joseph La Flesche wasted little time in leading by example—in showing the tribe the path he believed would lead to the survival of the Omaha, the same one he and Big Elk had often discussed.

In short order, he and members of the Young Men’s Party cut hundreds of logs and hauled them to a sawmill. Then their chief hired white carpenters to build him a large, two-story wood-frame house, thought to be the first Indian wood-frame house west of the Missouri. The others in his camp soon followed suit, building smaller wood homes for their families. Next, La Flesche began laying out roads, fencing a one-hundred-acre tract, and dividing it into smaller shares so that each man in the village could have his own plot to farm.

Later, he took a similar approach with his children. He and Mary had four daughters, and Joseph later had three more children with another wife. He saw his children, and all Omaha children, as the tribe’s future, and he strongly believed their future was at risk if they remained shackled to the past.

So La Flesche forbade his sons to have their ears pierced and his daughters to participate in the traditional Mark of Honor Ceremony. Among the Omaha, it was customary for fathers who had achieved a certain status for hunting prowess or peacemaking skills to place the mark of honor on their daughters. The mark reflected the father’s accomplishments and signified that the girl was the daughter of a chief or of someone of high social standing within the tribe. The mark often consisted of a sunspot image tattooed on the forehead and a four-pointed star on the throat, the points representing the life-giving winds from each of the four directions. Often, the Mark of Honor Ceremony occurred around noon, when the sun was at its highest point in the sky. But La Flesche wanted no such markings, no tattoos of any kind, for his children.

“I was always sure,” the chief would later explain, “that my sons and daughters would live to see the time when they would have to mingle with the white people, and I am determined that they should not have any mark put upon them that might be detrimental in their future surroundings.”

Yet he was equally insistent that all of his children know all of the Omaha’s traditional ceremonies, songs, beliefs, values, and customs—and that they all spoke the Omaha language, the cultural glue that kept their Indian identity intact.

Decade after decade, La Flesche struggled to keep threading an elusive bicultural needle, one that he believed would ensure the success of his children, the survival of his people. And year in and year out, he continually stressed to his children that there was one key value they must all adopt from the white man: education.

Education, he preached, was the key. It could help save their people. It’s what could unlock the American Dream.

Education is what we can do to help ourselves—to better ourselves.

Over time, Joseph La Flesche’s eldest daughter would become one of America’s earliest, most prominent Indian civil rights leaders. His son, the nation’s first Indian ethnographer. Another daughter became a teacher. And there was his youngest daughter, Susan. As a small child, she had witnessed the death of one of her people and the indifference of the white doctor to her death. It was something she would never forget.

*   *   *

It’s a little lighter now and she thinks she’s gone close to five miles, but she still cannot see the one-room home, cannot find it. It’s still cold, so cold her face and ears are still numb. It hurts so much she wants to cry, and it makes her feel even more alone, more fragile, more vulnerable. She’s scared. There’s too much time to think. She feels the prairie closing in, the urge to panic closing in. She wonders if it’s her fate to die alone on this prairie, to die an old maid with no husband or children, with no family to comfort her in her final hours.

She’s had these thoughts before, many times, and had expressed them in letters to her sisters back home when she was alone and away all those years on the East Coast.

Alone in her buggy, alone on the empty, frozen prairie, alone in her dorm room in Virginia or her rented room in Philadelphia, she often felt out on a limb, isolated. There was no one she could turn to, no one to confide in, no cultural signposts to follow. No one else like her to consult with, to help her on her journey. So she kept going, as she always did, kept moving through the early-morning light, through the snow, looking for a sign of life on the endless sweep of prairie.

Among the tribes of the Great Plains, and throughout much of America, it was not unusual for Indian women to become part of the tribal medical community, to be important healers. The women of the Upstream People knew many of the wild plants and herbs, and so they would take their daughters out on the prairie, along creek banks, or in mountain valleys, teaching them about the various roots, herbs, leaves, and flowers and how they could be used. For winter colds and flu, brewing the leaves of wild sage into a tea. A burning rope of braided sweetgrass for asthma. Boiled yucca plant roots for shampoo. Sweet flag roots for upset stomachs. Cattail roots for dressing burns. The root of the wild rose for rinsing inflamed eyes. The medicine bag of the traditional medicine woman often had cures for a variety of ailments—native cures for poison ivy, constipation, fevers, chills, toothaches, and snakebite.

But the traditional way was not the one her father had chosen for his youngest daughter. He had sent her off in another direction, sent her off on a much different path, an often lonely path with no footprints.

In 1847, Elizabeth Blackwell became the first woman in American history to get accepted to a medical college. It hadn’t come easily. Rejected by every institution she applied to, Blackwell eventually gained entry to a small school in rural New York—but for all the wrong reasons. The Geneva College medical faculty assumed it would never happen, so they put her admission up for a vote by the male students. The male students thought it was a faculty prank, so they voted to admit her as a practical joke. When faculty, students, and local townsfolk all realized the magnitude of their misconceptions, that she was serious, they were aghast.

Initially, Blackwell was forbidden to observe or participate in any classroom discussion or demonstration of medical issues. Those demonstrations, it was determined, were unfit for a woman. But Blackwell persevered and worked hard, and in 1849, the twenty-eight-year-old graduated at the top of her Geneva College medical class, becoming the first woman in U.S. history to earn a medical degree.

Yet when the class valedictorian later applied for a job in New York City, she discovered not a single hospital or clinic would allow her to practice.

The reason was simple: She was a woman.

And for half of the American population, that sentiment would remain a major hurdle throughout the nineteenth century—and far beyond.

“In the evolutionary development of the race, women had lagged behind men, much as ‘primitive people’ lagged behind Europeans…,” an American scholar would later note of the prevailing nineteenth-century beliefs. “It followed, therefore, that women could never expect to match the intellectual and artistic achievements of men, nor could they expect an equal share of power and authority. Nature had decreed a secondary role for women. The great principle of division of labor was here brought to bear: men produced, women reproduced.”

The Victorian era, spanning the last two-thirds of the nineteenth century, came to embody—most notably within the conservative, religious confines of the eastern establishment—a fixed viewpoint of who women were, what they should become, and where they belonged in the social and moral firmament.

It was a viewpoint championed almost exclusively by an entrenched power structure of white Christian men who dominated every aspect of American life—a power structure that left little to chance when it came to defining a woman’s role and declaring its expectations for white women.

To the male establishment, the Victorian woman’s place in society and fulfillment in life was to be found in husband, home, children, family, religion, and good works, more or less in that order. Middle- and upper-class women were expected to conform to this ideal. Lower-class and rural women were expected to aspire to it.

And this viewpoint was more than abstract conjecture—it often came with scientific underpinnings, as could easily be found in some of the most popular scientific journals of the era.

“Just, therefore, as higher civilization is heralded, or at least evidenced by increasing bulk of brain; just as the most intelligent and the dominant races surpass their rivals in cranial capacity; and just as in those races the leaders, where in the sphere of thought or of action, are eminently large-brained—so we must naturally expect that man, surpassing woman in volume of brain, must surpass her in at least a proportionate degree in intellectual power,” proclaimed the December 1878 issue of Popular Science Monthly.

An 1864 issue of the Journal of the Anthropological Society of London asserted: During menstruation, women “suffer under a languor and depression which disqualify them from thought or action, and render it extremely doubtful how far they can be considered responsible human beings while the crisis lasts.… In intellectual labour, man has surpassed, does now, and always will surpass woman, for the obvious reason that nature does not periodically interrupt his thought and application.”

Over time, women came to be viewed as second-class citizens in almost every aspect of nineteenth-century American life: They couldn’t vote, seldom held office (in public or private institutions), were given access to few jobs beyond those dealing with the care of children, the sick, or the elderly, and were not taken seriously on virtually any topic of public importance unless their views were ratified by men.

In short, seen through the lens of the white male establishment, a woman’s role was sharply focused. She should be pious and pure, remain supportive and subservient, bear and raise his children—and work hard to create a clean, warm, comfortable home, a safe and happy haven for her husband.

After all, what other options were there? What more was there to aspire to? It was clear their emotional makeup rendered them poor candidates for serious occupations, and they lacked the intellectual firepower for professional careers. So no need to spend money educating them. It would be a waste of time.

*   *   *

A white plume curling up into the sky.

The smell of a wood fire.

Squatting atop the next ridge, against the dim horizon, the dark silhouette of a small, crude home frozen against the pale winter sky.

That’s the one-room house, the one she’s looking for, the one with the sick girl. Late the night before, the sick girl’s young husband had made it to her office. He’d begged her to come and see his young wife. He’d given her some directions.

Now the husband greeted her at the door and led her inside. She saw there were three generations of the family living in the one room. She saw a clock sitting on a corner shelf.

And in a far corner of the room, below photographs fastened to the wall, photographs of some of the buildings at Hampton and some of her favorite teachers, she saw a young girl lying on the floor, her weak and elderly mother trying to prop her up so she could breathe. She’d had tuberculosis for more than a year, and now she had the flu and her breathing was soft and shallow, hard to hear except periodically, when she struggled desperately to take a deeper breath and her mother struggled to pull her up a little bit higher.

The young husband brought her a chair and she sat next to the girl.

“She looked up at me, but couldn’t speak,” Susan would later recall.

The girl was too weak, and their visitor asked the husband why they hadn’t come to her sooner.

He couldn’t leave her alone, the husband said. There was no one else who could lift her, who could care for her, and the old mother was blind.

It had been a bad winter for many. In the month before, December, she had treated more than 140 patients, the result of a flu epidemic that had swept across the remote reservation. Sometimes it had crippled entire families, families scattered many miles apart, and she had been out making calls every day that month, often in subzero weather, often leaving at eight in the morning and not returning home until after ten at night.

Inside the one-room home, she pulled the chair closer to the girl. She reached down and gently took the girl’s hand, and she could feel the girl’s fingers faintly trying to squeeze her hand.

“She was too weak to even whisper,” Susan remembered.

She reached inside her black leather bag and gave the girl some medicine.

After a while, the stimulants took effect and the girl was able to talk a little. She said she was so tired, so weak and hungry. The girl had not eaten in five days; no one had.

That day, she stayed two hours in the one-room house, as long as she could. She left all the medicine she had and promised she would return soon. Then she got back in the buggy and rode ten miles back across the reservation heading to her office, stopping in to treat other patients along the way, finally arriving home about five P.M.

Her team was exhausted, so she got a new team, found a sled, and stopped by to pick up her older sister and another young woman, both of whom had also gone to Hampton, both of whom were the young girl’s friends and wanted to try to comfort the girl. They loaded up the sled with milk and eggs and meat—and they rode all the way back to the one-room house on the frozen prairie.

When they arrived, they unloaded the sled, brought all the food inside, cooked a large meal, and fed the young girl and her family. The food and medicine had given her a little more strength, and she was able to talk to them a little bit.

“It seemed so hard to die without seeing you girls,” she told them.

They stayed as long as they could, and then they told the family they had to leave, that the girl’s two former classmates were teachers now and had to get back for school the next day.

All three climbed back in the buggy and set off once more for their homes, riding for a long while through the dark and the snow and now it was so cold again.

The next day, and every day for the next two weeks, sometimes twice a day, she hitched up her team and got into her buggy and rode to the one-room house to be with the young girl. Sometimes she would bring food and cook all of them dinner, and sometimes, if the girl was having a bad day, she would spend the night.

Then one day Susan’s brother-in-law got very sick, then two more relatives, and then her elderly mother became dangerously ill, so she had to stay and take care of them, and, for three days, she could not make the journey to the one-room house.

But the husband never left the young girl’s side.

“He was awake every night and listened for the slightest whisper, ready every moment to lift her to a more comfortable position, seeming to know what she wanted even before she spoke,” Susan wrote.

On the fourth day, she got her horses hitched to the buggy and left once again on the long ride through the early evening darkness to see her patient.

The young girl was having a difficult day. She had gotten weaker, her breathing more difficult. All day, lying on a mattress on the floor, in the corner beneath her Hampton photographs, she stared at the door, whispering the same questions over and over.

Is Susan coming today?

Will she see me today?

Yes, her husband told her, she will come today. She will see you.

That evening, while the buggy was still making its way through the snow to her, in the corner of the one-room house, alone on the sprawling, frozen prairie, the young girl died.

*   *   *

It’s late evening, early autumn, and the lands she once crisscrossed in her battered buggy and buffalo robe have long ago given way to rich, ripe fields of corn and soybeans unfurling to the horizon.

On a slight rise overlooking the verdant fields, a mile south of where the poet John Neihardt lived before he met the Lakota holy man Black Elk, a feathery row of perfect pines stands at attention, sentinels guarding the southern flank, the only sound in the fading light the song of the meadowlark from a nearby fence post.

Inside the Bancroft Cemetery, fanning out across three acres, lie the remains of more than twenty-two hundred village elders, founders, bankers, schoolteachers, farmers, truck drivers, barbers, bartenders, young children, mayors, sheriffs, hardware owners, meat cutters, pesticide salesmen, families of great-grandparents, grandparents, and grandchildren. A visitor can walk down row after row and see their names: Zuhlke, Barber, Stahl, Hermelbracht, Canarsky, Schoch, Gatzemeyer, Bassinger.

Along the southern edge of the cemetery, toward the stand of pines, near the end of one row, a four-foot-high, simple granite headstone rises from the earth:

Susan La Flesche Picotte


In the language of her grandfather, the French fur trader La Flesche, her name means “the arrow.” And between her birth in the waning weeks of the Civil War and her final resting place, the trajectory of her life would encompass a span of experiences and a range of avocations unlike those of any other Indian woman before or since.

As a child born at a time when her people still lived in tipis and earth lodges, alternating between buffalo hunters and corn growers, she could never have known that one day she would deliver babies, suture wounds, cure fevers and colds, treat tuberculosis and influenza, ban communal drinking cups, insist on screen doors, and build a hospital in a remote, isolated corner of the Great Plains.

Back then, in the years after the transcontinental railroad and before the Little Bighorn, she could never have known that she would start a library for her people, translate legal documents, cook and deliver meals to the hungry and destitute, preside at funerals, deliver sermons, sing in the choir, and embrace the Native American Church.

That the day would come when she would attend plays, visit world-class museums, enjoy piano concertos, sit in on poetry readings, dance in summer powwows, sing traditional songs, and convey her people’s creation stories and rituals to the next generation.

That she would often go upstream, against the current, taking a train to Washington, D.C., to crusade against the injustice of federal policies that threatened to steal the land from her people, land they legally owned. About the many trips to the state legislature that she would one day make, the impassioned speeches railing against the whiskey peddlers preying on the Omaha, sowing disease and violence and domestic abuse everywhere they went.

About what she would accomplish on March 14, 1889—the day she graduated as valedictorian of her medical school class in Philadelphia, becoming the first American Indian doctor in the 113-year history of her country, thirty-one years before women could vote, thirty-five years before all Indians could become citizens in their own country.

As a young girl growing up on the rich soil of the Missouri River floodplain, Susan La Flesche could never have known that she would come to love her people so much that she would give her life for them. Would come to love her homeland so much that she could never leave it.

And now—resting peacefully near the perfect pines, on a slight rise above the lush, verdant fields, not far from the song of the meadowlark—she never will.


Copyright © 2016 by Joe Starita