Caring for the patient despite a vast difference in culture

I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, because she’s writing a lot of things.”

The staff at the hospital was multicultural to put it mildly. There was the lilting accent from Kerala State in India, the soft respectful dialect of the Filipinos, the clipped English of the British, and the English of all varieties from Egypt, Lebanon, Turkey, Sudan, and Texas. My Arabic was rudimentary so I would rely on a Palestinian translator but this morning I had Mohammed, my medical student. Mohammed was typical of the rising generation of young Shia Muslim students – bright, eager to learn but with a world view quite foreign to my Western eyes.  I had gradually learned that they see the world through the lens of their religion.  I respected that there was a lot of good intent in that but saw the inevitable clashes with Western ideas.

We had gotten into a discussion about what happens after death. I knew talking religion or politics in that part of the world wasn’t the wisest thing to do, but I couldn’t resist trying to reason with Mohammed. He had let me know in earlier conversations that he felt disenfranchised from the Royal Family. “Look Jim, the oil comes out of the ground literally from under our feet here, but all the profits go to Riyadh. There is no real income for me here. I can’t even afford to buy a wife.” He added, “The oil should stay in the ground, the Americans should go home, and we should follow the Ayatollah (in Iran).”

I really didn’t want to talk politics, so I pursued religion, “Mohammed, I view Allah as a merciful and a loving God (despite the extremists’ interpretation of the Koran). The ten commandments are in all religions. Don’t you think that all people who try hard to live a good life and show love to the neighbor would be welcomed into heaven? Mohammed had an unsmiling but sympathetic look on his face, “Jim, when you get to heaven and I’m at the right hand of Allah, I’m sorry but you can’t be admitted unless you’re Muslim.”

Despite our vast differences in culture, we respected each other and could cooperate well in patient care, in which Mohammed was excelling. We walked to the bedside of our asthmatic patient, Sanaa which means “brilliance” in Arabic. She seemed rather calm despite receiving no sedation over night in hopes of removing her endotracheal tube which tethered her to the ventilator. The vital signs were stable, the blood gases were good and she seemed very alert having written many pages with paper and pencil.

I assumed she would be writing out the usual questions: “My throat is sore, when will this stop, where am I, what happened, let me out of here, I want my Mom.” Actually, Mom was there at the bedside and all was peaceful. I asked Mohammed what Sanaa was writing and why she was so peaceful, “Jim this is not unusual. She has been praying as has the family. The prayers are to have Allah guide the doctors and nurses and to help her to be content with her lot. She has been writing poetry praising Allah.”

Sanaa, doing well, went home with Mom 3 days later.

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

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