Photos by Lauren Stelling
Written by Geolani Widjaja Dy
Bijiibaa’ Garrison is a Diné (Navajo) surgeon, a tireless advocate for the underserved Native community, a talented Navajo rug weaver, and a selfless friend. As many of these stories begin, I couldn’t appreciate this subtext when I first met her. We had both arrived at the University of Washington from the East Coast anxiously anticipating the grueling journey of surgical residency ahead. I knew her as Bijiibaa’ from Harvard, an unflappable woman amid the chaos of the general surgery intern year. Always put together and one of a few women in our male-dominated class, she was intimidating to say the least.
I soon learned, however, that Bijiibaa’ bears little semblance to the mythified bitchy “woman surgeon”. She is quietly capable, sensitive to her surroundings, and unfailingly humble in a field plagued by stereotypes of arrogance and aggression. Surgery still carries vestiges of an Old Boy’s Club, even in the most progressive training programs. There are reminders familiar to every woman surgeon: being mistaken for a nurse, tech, health aid, or phlebotomist; enduring overt and subtle displays of misogyny in and out of the operating room; learning that often, crass comments and sarcasm are better tolerated by peers than authentic expressions of emotion.
In a field where burnout rates are high, Bijiibaa’ is truly protected by her family’s Navajo traditions -- respecting the human body, believing in the power of words to affect outcomes, choosing optimism. She invokes these values each day as she sets foot into the operating room. And through this, Bijiibaa’ has created a space and a voice for herself that is inspiring for women and people of color.
She traverses many worlds that are not readily apparent to others as an Indigenous woman, a surgeon, an activist, a wife, a sister and friend. Bijiibaa’s perspective has grown out of her persistence in the face of adversity, and she has helped me realize that we have more power over our experiences than we might think. The surgeon is always at the helm in the operating room, which has potential to be a stressful environment. I think back to a simple, yet powerful concept she shared: “It’s a privilege and big responsibility to be a surgeon. If I have a bad attitude, I can affect the patient and outcomes. It can be seen in how the operating team functions – a bad attitude can make the room chaotic. When you have a good working environment, you can have better outcomes for the patient.”
Bijiibaa’ invited me into her world, where optimism, integrity and kindness prevail, where cynicism and boastfulness are out of place. Bijiibaa’ has carved out a space for herself in that world, regardless of external pressure and expectation. Her lessons provide me a guide that shapes my own behavior, in and out of the operating room.
So - what's your life story?
I’m a member of the Navajo Nation and was born in picturesque Monument Valley, Utah. I grew up on the Navajo reservation in a biracial and bicultural family, which meant that I never truly fit in anywhere. This was a curse and a blessing that allowed me to live and navigate in multiple worlds. Education has always been important in my family so going to college was a no-brainer. I didn’t know what I wanted to study, but became intrigued by the medical field after I met a Native American physician for the first time. Prior to that I never imagined becoming a doctor was possible coming from the Reservation. My Navajo grandparents were traditional healers and medicine people, but I knew our medicine wasn’t accepted in the broader world. I studied for the medical school entrance exam and failed miserably. I wondered if I was smart enough. I ultimately landed an internship in Senator McCain’s office where I learned more about the complexities of Native policy that affects the everyday lives of Native peoples. I completed a research program at the NIH and re-took the MCAT. My scores improved and I was ultimately accepted to Harvard Medical School where I later graduated with my medical degree; the first in my family. I completed my General Surgery training at the University of Washington and am now working in my dream job at the Alaska Native Medical Center in Anchorage as a general surgeon serving Alaska Native and American Indian patients.
How do you think others see you?
Quiet and reserved. I’d like for people to see me in a positive light; not intimidating or aggressive. In my personal life, I tend to hold back if I don’t know someone. Relationships are important, and creating a relationship is more meaningful than just talking to have my voice heard or being the loudest in the room. I hate attention.
In my work life, I think people see me as caring, compassionate, organized, and fair to the people around me and my patients. You can still be effective, generate confidence, and work well with your team without being overpowering.
How do you see yourself?
I see myself as someone who balances and lives in many different worlds. I’m half Navajo, half white, and I grew up on the reservation always as the outsider. It was not easy. I was embarrassed about being white because my dad was one of the only white guys in town, so kids would tease me. In an urban setting, people don’t know who or what I am. Sometimes it works in my favor because I can slip in and out of different societies and aspects of life without others automatically labelling me. But when I go home to one of the reservation border towns, I feel the overt racism because they know I’m not white.
Why do you think the perspectives are different?
I don’t let people into my inner core of my identity easily. People may see me as being quiet and shy, but there’s a lot more to me that people wouldn’t necessarily understand. Some childhood friends from home who are full Navajo don’t experience some of the things that I have -- I know I am privileged compared to them because of my color. Until college I was ashamed to be half white, but now I recognize that some of my successes are because of white (non-Native) privilege.
I’ve seen both ends of the spectrum in terms of wealth and poverty. On my dad’s side, my relatives have summer and winter homes, and my cousins have attended top private schools and have access to the latest fashion, foods, and hot vacation spots. I didn’t realize we were poor until I experienced how people lived off the reservation, seeing my cousins’ homes versus ours. But I also realize we had more than many in my Navajo family. We had a home with running water, a reliable vehicle, and were able to travel by airplane. My mother’s Navajo side lived in a traditional Hogan - a wooden structure with mud walls, a dirt floor and no running water or electricity.
When is it hardest to balance those different worlds?
Being back at home is hardest. I haven’t lived on the reservation in 18 years. Now, when I go home I see the racist environment my family lives in. I see my Navajo mom and Caucasian dad treated differently.
It’s also difficult in the medical world when I have Native patents who are intoxicated, belligerent, or loud and I see my colleagues treat them with a bit less respect than they do other patients. I feel protective of Native patients; they could easily be my own family members.
How aware do you think your parents were of your seeing yourself in two worlds?
I’ve never actually talked to them about it. I’d be too ashamed to ask because it makes me sad to think back to how I saw my dad and how I was embarrassed to be seen with him. I wonder what he’ll think if he ever reads this interview?
When do you think you transitioned to feeling pride in your father’s identity?
My dad taught biology and public health at our tribal college. He dedicated his career to working with Navajo people and has lived on the reservation since marrying my mom. When I was 18 years old, I attended a SACNAS (Society for Advancement of Chicanos/Hispanics and Native Americans in Science) conference where he received an award for his mentorship and work to expose Native students to scientific research. It wasn’t until then that fully understood his impact and legacy.
When did you know that you wanted to serve the Native community?
In college, I had no idea where I was headed. The turning point was when my mom was diagnosed with diabetes. Diabetes was so common on the reservation and it wasn’t until then that I realized it was preventable. Around then, I also met a Native American woman physician who led a program called Indians in Medicine. My focus changed to healthcare, but I still didn’t think becoming a doctor was attainable. Nobody from my community grew up and became a doctor.
What led you towards surgery?
When I started medical school, I was interested in primary care because the Native doctors I knew were in primary care. But I was secretly excited during my surgery rotation – the operating room (OR) was so foreign.
When I was operating felt like I was doing something taboo, because in Navajo culture we aren’t supposed to ‘enter’ or cut somebody’s body, But I couldn’t shake the excitement of potentially fixing or curing someone with my hands. I remember walking out of the OR elated and seeing a picture in the hallway of Shiprock, an iconic Navajo rock structure, advertising the Brigham and Women’s Indian Health System volunteer program. I thought, it would be amazing to be a surgeon for my people.
How have Navajo beliefs impacted your path towards a career in surgery?
It’s been a struggle because some of the biggest Navajo taboos are about being around death, and manipulating someone’s body. Going against some of our strongest cultural beliefs made anatomy course very difficult. When someone dies, the good things go with the person’s soul and all the bad stays with the dead body. If you touch the deceased person, all the bad things can affect you. I had to have a different take on it – rather than seeing surgery as taboo and entering someone’s body, I focused on caring for the patient and developed a deep respect for human life and the human body.
I try to have a good attitude going into the operating room. It’s a privilege and big responsibility to be a surgeon. If I have a bad attitude, I can affect the patient and outcomes. It can be seen in how the OR team functions – a bad attitude can make the room chaotic. When you have a good working environment, you can have better outcomes for the patient.
What are some other ways in which your identity impacts your work?
In Navajo culture, what happens around you affects you and accumulates over time. When I’m starting to feel frustrated or burnt out from work, I ask my mom about how I can address this from a Navajo cultural standpoint. When I’m home, I participate in Navajo ceremonies and prayers to center myself and right the cultural wrongs that I did, such as being around death and dying during trauma surgery. Having patients die at your hands affects you subconsciously over time and can then impact how you treat other patients and your team. You become physically, emotionally, mentally, and spiritually exhausted. It can block your mind and you start to think negatively or become sloppy. I’ve had several ceremonies to set my mind straight again. An analogy would be people going to church and praying – this is my religion.
I also try to avoid speaking negatively about people, because even if you’re venting, there’s a lot of power in your words and speech. When you say something, it means something. This can be a challenge with Navajo patients because you can speak something into existence.
One busy night, I was called to see a patient with a necrotizing soft tissue infection. I briefly heard the patient’s story and recognized how sick she was. In my frustration and tiredness, I remember saying, “ We’ll need to get her down to the operating room soon or she might not make it”. When I got to her bedside, I recognized the patient and her daughter were Native American, specifically Navajo. I immediately felt embarrassed about how I spoke of her. We took her for surgery and then to the intensive care unit. Four days later, she coded - her heart stopped and we started CPR. It was awful. I explained what was going on to her daughter. Later in the day her family arrived and filled her room. They were praying for her and singing to her. In talking with her family, I found out that she and I were related in the Navajo clanship system. That night she transitioned to comfort care, where we stop all resuscitative efforts to focus on comfort, and she died surrounded by family. It made me think about the power of words. Even though our work can be busy and frustrating, I have to be mindful about what I say. I have guilt about it, but maybe the outcome would have been the same regardless.
What frustrates you about the way women treat each other in surgery?
In the operating room, I sometimes see that the staff don’t respect women surgeons in the same way they would male surgeons. For example, as a woman you might have to repeat yourself to have an instrument handed to you. For some reason, it often comes from other women.
This is known globally. As more women enter surgery it will change – having to change the culture takes seeing more women in the OR as a norm.
What do you think of this rhetoric that women have to take on traditionally masculine traits to succeed in surgery?
There’s danger in taking on traditionally “masculine” traits because you start being seen as a bitch, and any time you want to assert more authority you are labeled as a bitch. But it is actually based on how you treat your team members, micromanaging, not allowing for growth, being demanding to an unrealistic point that’s not helpful. It boils down to how you treat other people. I approach it too as not trying to overpower or overstep someone, sometimes it might not always work. Not taking it personally – if they don’t want to work with me for whatever reason, it’s them. There may be something else going on that I don’t know about.
What do you love about yourself?
My dedication to family and the people I love. It’s hard while being a surgeon but I think (and hope) my family and friends know that I try to spend quality time with them although I have limited time.
What don’t you love about yourself?
I have self-doubt when comparing myself to others, especially when it comes to being knowledgeable. I think part of that is human nature though and should be used to strive to be better.
Name one of your girl crushes, and the reason for the crush:
A current girl crush is Ashley Callingbull-Burnham. She is a First Nations native woman from Canada who was won the Mrs. Universe competition in 2015. After she won she became an important voice for First Nations people in Canada and even spoke out about the inequalities and disparities that affect Indigenous peoples in Canada. She’s beautiful and a model, but also connected to her Native community and she is strong and not afraid to use her voice to stand up for her community. She’s quickly become an inspiration for many Indigenous people all over the world.
What frustrates you about the way women treat each other?
Women treat other women poorly when they feel threatened or are jealous. I think it’s that simple. We should be supportive and inspired by women who are making the world a better place in all different facets of life and work.
What do you love about the way women treat each other?
Women can be extremely loyal and protective of those they love and care for. I’ve been so fortunate to have developed a family of close friends that include many powerful and inspiring women that I’m so proud of.