Chapters 6-7 describe the linguistic and cultural barriers between the Hmong patients and their American doctors. The older Hmong immigrants in Merced typically don’t speak English, and the translators have difficulty translating medical terms (that don’t exist int the Hmong language) for their patients. The biggest barrier, however, is cultural. Patient-physician relations are difficult because the Hmong don’t wish to disrespect their physicians by asking questions, so patients often leave the visit without any understanding of what their doctor said, what the recommended treatment was, or how to comply with it. The Hmong have no concept of the different internal bodily organs (except for the heart), as they don’t practice autopsy. Shaman training involves rituals to appease the spirits, not anatomy and physiology.
The gap between patients and physicians Fadiman discusses in this section reminds me of my discussion last week of the medical profession’s approach to death. Physicians, by nature of their profession, do their best to avoid death. Some physicians see acquiescence to death as a sign of complete failure, and think about death in terms of which procedures they could have done to save their patient’s life. Death is the enemy, in part because it reminds them of medicine’s limitations: they can fight death but ultimately cannot overcome it. Christianity, in contrast, offers an alternative. Through the cross, Christ overcame death forevermore. Those who believe in His sacrifice are granted eternal life in Him. From this perspective, death is not the enemy, but a part of life we accept when the time comes. Earthly death does not have the same sting, because it has lost its finality in the face of eternal life. Physicians coming from this perspective do their best to alleviate their patient’s suffering and encourage them to fight, but do not try to avoid death at all costs.
That being said, if one of my loved ones was suffering from an illness, the last thing I would want his/her physician to say is, “They may be suffering, but don’t worry- it’ll ultimately make them stronger. Plus, they have eternal life, so their earthly death isn’t all that bad.” I don’t mean to suggest that all suffering ought to be held as valuable, or that we ought to seek it out, but rather that when we are inevitably faced with it, we allow ourselves to feel the pain it brings. Christianity also allows people to recognize that in our suffering also lies the possibility of growing in understanding and closeness to God; it can teach us about ourselves, our loved ones, life, or God Himself. The question, then, is how to practically apply this idea. How much suffering do we let it as a way of recognizing it as a natural part of life? Conversely, how much do we shut out so that we don’t end up wallowing in it? How do we allow it to be a source of instruction without wallowing in it or welcoming it in all circumstances in attempt to ascribe meaning to something that may simply be painful? Can all instances of suffering be used for instruction? Is it even entirely healthy to try to make it so?
This alternate approach to death reminds me Fadiman’s quotation of Dostoyevsky’s Prince Myshkin. It points to an alternate way of looking at disease. He asks, “What is a disease? What does it matter that it is an abnormal tension, if the result, if the moment of sensation, remembered and analyzed in a state of health, turns out to be harmony and beauty brought to their highest point of perfection, and gives a feeling, undivined and undreamt of till then, of completeness, proportion, reconciliation, and an ecstatic and prayerful fusion in the highest synthesis of life?” (29) If we approached disease in this way, what implications would this have for medicine and the people it seeks to return to wellness?
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