The Gap I Carried Into Teaching
When I began teaching paramedic students three years ago, I brought twenty years of clinical experience into the classroom. I brought a working knowledge of protocols, of patient presentations, of the particular rhythms of emergency work in Ontario. What I did not bring, or did not bring in adequate measure, was an honest account of how I had failed certain patients and why.
The curriculum I inherited did not ask me to bring that account. Paramedic education in Ontario, like most clinical professional training in Canada, is built on a biomedical model that privileges technical competence, procedural mastery, and what the field calls clinical decision-making. These are real and necessary skills. They are also incomplete. A program that produces technically proficient graduates who cannot recognize intergenerational trauma when it presents in the back of their ambulance will cause harm, even when trying to help. I know this because I was one of those graduates.
The gap is structural. Paramedic education operates largely through what Freire (2000) calls the banking model, depositing approved knowledge into students who are expected to receive and reproduce it. The knowledge being deposited is Eurocentric and biomedical. It measures a patient's problem against the standard of the Western body in crisis and offers interventions calibrated to that standard. It does not teach students that wellness looks different across cultures, that healing involves relationships and land and spirit as well as oxygenation and perfusion, or that a patient's behaviour in the back of an ambulance may be shaped by a history of institutional violence that the paramedic's uniform makes worse. Battiste (2013) calls this cognitive imperialism, the maintenance of one knowledge system as the only legitimate frame of reference, operating through the daily practice of institutions that do not recognize what they are doing.
The Patient I Did Not See
Reading Indian Horse, I kept returning to the middle section of the novel, the years of Saul's deterioration, the drinking and the wandering and the inability to stay. These are the years when Saul would have been most visible to a paramedic. These are the years when he would have been the person on the stretcher.
I have been on those calls, responding to Indigenous men in their forties and fifties, outdoors in winter, intoxicated or appearing to be intoxicated, occasionally aggressive, frequently uncooperative with the clinical assessment I was trying to conduct. I have watched police officers lose patience. I have felt my own patience thin. I have written patient care reports that described the presentation without asking the question that Indian Horse eventually forces: what happened to this person, and when did it start, and how long have they been carrying it?
Saul in the middle section of the novel is not simply a man who drinks too much. He is a man whose grandmother was taken from him, whose language was beaten out of him, whose body was violated by a person in a position of institutional trust, and who has spent decades managing an experience he cannot name. Statistics about Indigenous health disparities are available, and I teach them. Research confirms that First Nations patients arrive by ambulance to emergency departments at disproportionate rates, and that both patients and providers identify systemic barriers to safe care (Taplin et al., 2023). But statistics do not create the felt understanding that changes behaviour under pressure. Story does. Jarvis and Gouthro (2019) argue that fiction media generates imagination for empathy, a kind of knowing that reaches beyond intellectual understanding into something that functions more like recognition.
Two Gaps, One Story
The structural reasons for my failure as a paramedic are not personal failings dressed up as policy problems. Two gaps in particular define what paramedic education in Canada is not yet doing, and Indian Horse speaks directly to both. Research has documented that First Nations patients and paramedics themselves identify significant gaps in culturally safe emergency care (Taplin et al., 2023).
The first is the absence of trauma-informed and culturally responsive pedagogy. The abuse at St. Jerome's was the educational content, not a deviation from it. The school was designed to create a particular kind of damage, and it succeeded. A paramedic without trauma-informed training encounters the legacy of that damage in clinical practice and interprets it through the wrong lens. The patient who flinches when touched by someone in uniform, who will not make eye contact, who gives short or evasive answers to assessment questions, is a person whose history with institutions in positions of authority has taught them that compliance does not produce safety.
The second is the absence of community collaboration and Indigenous leadership. St. Jerome's was imposed on Indigenous peoples without their consent, their participation, or any genuine regard for their knowledge. The New Dawn Centre, where Saul begins to find his way toward healing, is Indigenous-led, community-centred, and grounded in the relational knowledge systems the residential school spent years trying to destroy. The difference between these two institutions is a difference in who holds the authority to define what wellness means and what the path toward it requires. Paramedic programs that develop Indigenous cultural safety content without the genuine collaboration, leadership, and accountability of the Indigenous communities they serve are repeating the logic of the residential school. Research mapping current approaches to Indigenizing curriculum at Canadian universities identifies community collaboration and Indigenous intellectual sovereignty as the most meaningful drivers of genuine structural change and notes that most institutions have not yet achieved this (Brunette-Debassige et al., 2022). The TRC's Calls to Action 23 and 24 call specifically for healthcare training developed with Indigenous communities, and most paramedic programs have not meaningfully responded to this call (TRC, 2015).
What I Bring to My Classroom Now
I am not exempt from any of the failures I have described. I am a settler educator working within an institution that sits on Indigenous land, teaching a profession whose culture was shaped by the same colonial assumptions I am now trying to name and dismantle. My positionality does not disappear because I am aware of it. Paris (2021) argues that being and becoming a culturally sustaining educator requires a willingness to divest from settler logics, not as a one-time declaration but as a continuous practice of examination and correction. I am in that practice. I am early in it.
What Indian Horse gave me, and what I want it to give my students, is a specific and irreplaceable kind of knowledge. It gave me a face and an interior life for the patient I had failed to understand, and a story that reaches backward through everything I thought I knew and reorganizes it. This is transformative learning in Mezirow's (1997) sense: not the accumulation of new information, but the restructuring of the frame through which a learner interprets experience. Brookfield (2019) writes that antiracist adult education requires educators to help learners move from discomfort to accountability. The discomfort is what the book produces. The accountability is what I am asking my students to carry into clinical practice.
Indian Horse teaches that capacity. It demands it. And that is precisely why it belongs in the classroom.
Whose Stories Are We Teaching?
Saul Indian Horse does not get a clean ending. He gets a beginning, the fragile, expensive, hard-won possibility of a life reconstituted if not fully repaired. He moves north at the novel's close, back toward the territory his grandmother came from, back toward the land that was his first teacher before the school arrived to teach him that he had nothing worth knowing. Wagamese does not promise that Saul will be healed. He promises that Saul is still moving, still reaching toward something. For a man who has carried what Saul has carried, that is the most honest form of hope available.
This is the note I want my students to leave the classroom carrying. The patients they will encounter in their careers, on streets, in rooming houses, in doorways, in the back of ambulances in January, are not problems to be processed. They are people who are still moving. People who have survived things that would have ended most of us, and who have developed, out of that survival, a relationship to institutions, to authority, and to strangers in uniforms who arrive claiming to be there to help.
My students are going to encounter the same patients I encountered. They are going to be on calls at three in the morning with people who are in pain and who do not trust them and who have very good reasons for that distrust. I cannot give my students twenty years of experience before they graduate. But I can give them a book and a film that compress something essential about those twenty years into a story they can carry with them. I can give them Saul's grandmother teaching him the names of things in their own language. I can give them the ice at St. Jerome's, and what it cost him to skate on it. I can give them the silence that held the unspeakable thing for decades, and what it meant when it was finally named. For every paramedic student who carries that story into practice, the beginning of cultural safety is already there.