When Cultures Collide

Mukta Panda, M.D. and Barbara J. Gray

Amy lay on the hospital gurney, her oily dark hair matted against her
face. She was 23 years old. Her boyfriend paced the room. In a tearful voice
she told the story of a long history of injection drug abuse. Her two kids had
been taken away from her. She had a few months to clean up before going to
court to get them back. She had an appointment for rehab, but couldnt get in
until next Tuesday. They had called everywhere, the boyfriend insisted. He
pulled a grubby list out of the pocket of his torn jeans. He finished rehab
himself two months ago, and insisted that he was clean. Amy claimed that she
wasnt here for drugs, but was here to get help with the withdrawal symptoms.
As Amys story tumbled out, I wondered how the doctor would respond. In my
experience as a medical student, the usual line from frustrated physicians about
drug abusers is less than compassionate: Drug seekers will crowd your
waiting room, take up all your time and youll never get paid has been the
refrain. Rarely have I heard a physician talk about the flip side of this
discussion the addicts side, with the difficulties of getting real help, the loss
of family and any possible livelihood, and the sky-high relapse rate.
Amys story was complicated. Losing her kids, if true, gave Amy reason to stay
clean. The boyfriends experience with rehab either added validity or posed a
risk, depending on your port of view. Was any of it true? Had the pair been at
every ED within a hundred miles, wheedling drugs from overworked physicians
dispensing drugs in order to get through patients?
I tensed as I waited for the physician to answer, sure that I was going to hear a
less-than-compassionate, narrow-minded, small-town view, perhaps with an
echo of the anger Id heard from other docs when they talked amongst
themselves. My own big-city bias colored my assumptions. Id made
assumptions about the level of compassion and understanding I expected from
a rural physician in the midst of an Appalachian area nearly torn apart by drug
use and abuse.
What I heard next surprised me. I didnt expect this physician to reach across
the divide that separated him from Amy: a divide across age, a culture of drug

abuse, and a habit so expensive that it probably required illegal activity to

support. The gulf between Amy and the doctor was miles across.
The doctor listened to everything Amy and her boyfriend said. He asked a few
questions. And then he sat back, looked at Amy, and started to speak. He
astonished me with his direct manner which Id not experienced in the
south. He told Amy he would help her, on several conditions. He told her he
would bounce her out of this hospital if she returned with any drug-seeking
behavior. He reminded her that her kids future depended on her actions. And
then he proceeded to tell her what help he could offer.
From my perspective, this was a positive encounter. Amy had been treated
respectfully. The doctor remained within the guidelines he apparently had set
for himself, and still reached toward helping the patient. He had told her he
couldnt fix anything, but he could help alleviate some of her symptoms.
What about Amys view of this encounter? I stopped by later to check on
her. She was still tearful, but she felt that her story had been heard. She
appreciated the medical help to get her to rehab. The boyfriend chimed in that
he thought theyd get tossed out of the ED for even asking, but theyd come in
because he couldnt stand to see Amy suffer. They had to try something.
I learned something that day. I learned the power of my own assumptions can
be overwhelming, and they can misguide me. I learned that even the most
unlikely cultural bridges can be crossed.
I saw that honesty is required on both sides of a cultural gap, and a leap of faith
is required to cross it. Amy took that leap to reach out to the emergency
department of a small-town hospital. The doctor was open to Amy and her
story, and receptive to the possibility that truth lay within it. Trust was required
on the doctors part to offer Amy treatment options. Both Amy and the doctor
were open to the chance that the other would hear what each had to
say. Perhaps honesty, openness and a leap of faith are the best prescription
when cultures collide.
About the Author Barbara Gray was a fourth-year medical student at LincolnMemorial University and am currently undergoing the application process for
residency. Published: October 2, 2010