Friday, May 26, 2006

A couple months ago, Jason once again uttered the words, “You haven’t read (insert book title here)?” This time it was a book by Anne Fadiman, “The Spirit Catches You and You Fall Down”. The entire book is captured in a few lines: A Hmong Child, Her American Doctors, And the Collision of Two Cultures.

I liked the book because I like anything that explores the psycho-social aspects of any culture and the history of that culture. I really like to learn about cultures different than my own. I liked the book because it makes you look below the surface. It makes you squirm against prejudices you perhaps weren’t even aware you had.

I liked the book because the author tried not to lay blame, but to find a way to bridge the gulf between cultures.

I liked the book.

But I found myself having to constantly be aware that I was reading it with my Western Medicine is best prejudices. I am part of the medical community. I was schooled right here in the good old USA and received probably only a smidge more education on cultural differences than the medical students.

This is a story primarily about the doctors who made decisions about the child, Lia, who is central to the story. They made the decisions they thought were best for the medical care of the child. They thought the parents were non-compliant. There was a bad outcome, which may or may not have occurred whether the complex medical regime was followed to the letter or not.

This is my complaint: while the doctors were portrayed as caring competent professionals who were only doing what they thought best, the nurses were portrayed as mean and angry, only interested in having a quiet, compliant patient.

Okay. Here’s the thing. Nurses have a degree of responsibility that is completely out of line with their degree of authority. If anything goes wrong with any patient at any time, it is the nurse’s fault. (I know of a nurse right now who is fighting an official complaint made against her for not providing adequate pain medication, resulting in a patient’s suffering – she was late giving a dose because another patient’s heart had stopped and she was performing CPR. Where was another nurse to give the dose for her, you ask? There were only two of them for the 20 patients; they were both doing CPR until help arrived.)

So, you have a child in the hospital, with parents who don’t speak English, with no translators available, physician orders that the parents don’t want to have followed, orders that are reasonable for patient care, so the nurse is bound by law to follow them, add to it the other four or five patients that that one nurse is caring for. Sure the nurses are frustrated. But the constraints placed on them by law and their licensing board were not explored it any shape or form, they were the only bad guys in the book.

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