Culturally Appropriate

The way different cultures deal with things, the way they think is profoundly different.

In our pre-field training we were taught. "The extent to which you succeed in cross-cultural work is the extent to which you are willing to make yourself uncomfortable."  

As an extension to that, they taught us some warning signs to helps identify when we were treading on the edge; they said:

"Do you feel angry, bothered, irritable?  Then think: are things around you, abnormal, wrong and bad?"

"If you are feeling that way, remember, most of the time what you are experiencing is normal, right and different - it's normal and right for the people around you."

Today my first clinic patient was a second opinion.  a 27 year old young man presented with a large upper abdominal mass, jaundice and lots of lymph nodes.  He also had bunch of previous testing which showed: a) widely metastatic cancer  b) that it was a cancer of unknown primary.  He was accompanied by an older brother and his uncle.  They wanted to know:

1. Where it came from. (I don't know and can't know with available testing).

2. Whether it was cancer. (yes)

4. Was I sure. (yes)

5. Was I 100% sure? (yes)

6. What was the prognosis.

Here I bumped up against our training.

It is not culturally appropriate for me to discuss the prognosis with the patient.  Instead, I'm to dismiss the patient with a thinly veiled excuse and lay it out for the family.  I like to then pretend that they will gently break it to him in their own way, but what really happens is that they tell him he's going to be OK and that the treatment I gave him (valium and painkillers) is going to make him better, but needs time to work.  This thinly veiled charade will continue until the day he dies.

That makes me angry.  It bothers me.  I feel irritable.  It's not normal.  It's wrong.  It's BAD.

ding ding ding.  Yep.  I recognize that.

Here this is normal.  Here this is the way it's done.  Here this is right.

The patient I send out of the room is from this culture.  He has been raised here and knows all the rules,  He understands what it means when I send him out of the room (and if I had any doubt about it, it was erased when I saw his face as he left the room, alone).  And he wants to be told he'll be OK. This is how it works here.