Using interpreters — repeating questions, verifying answers — it soon became clear to me that we do not share the same view of how the body works. Despite my credentials from the American Board of Emergency Medicine, I often have no remedy or relief for these patients' chief complaints, such as “The pain in my womb made my toes itch like fire and bugs.”
I do not have tests for these problems. I do not know the anatomical causes of these issues. Perhaps my answers for them should be neither western nor scientific. Perhaps I should be their shaman instead of their doctor.
I tried on this new role with a young male Guatemalan patient. His chief complaint: “Five months ago, I grew a knot on my stomach. This knot weakened my seed so that I cannot place a baby in my spouse's womb. Can you cut the knot off so we can have a baby?”
His genitourinary exam was normal, and his belly was benign. He did have, though, a tiny reducible left inguinal hernia. At first, I attempted to reassure him that a small inguinal hernia would not cause infertility, and gave many supporting explanations. He stood with his pants down, staring at me blankly. Clearly, my brand of medicine made no sense to him.
I gathered myself and remembered my plan to treat him as a shaman rather than a physician trained in western medicine. I tried to imagine that I was a wise medicine woman. Surprisingly, I assumed this mantle more easily than I had anticipated. I changed my posture ever so slightly and stopped running algorithms in my head. Instead, I stood silently before him and cleared my mind. Suddenly, as if by some sixth sense, I was seized by an awareness that he was suffering from erectile dysfunction.
The interpreter conveyed my query. My patient's bottom lip began to quiver, and he answered in a nearly inaudible whisper, “Si.”
My bottom lip began to quiver as well. I sensed his shame and embarrassment. I sympathized with his dilemma. But what to do? Would an inguinal hernia repair strengthen his seed as he had hoped? Modern medicine would say no. Could he afford to see a urologist for the problem? Unlikely.
Entering His World
What would a board-certified emergency shaman say to this naked man who had traveled so far for a cure? I felt a great deal of performance pressure; after all, I was not trained in invoking a shaman's spirits, and I consider an offering of false hope unethical. Again, I stopped my mental analytical chatter and attempted to enter his world.
I shifted my posture and emptied my mind again. Slowly, I felt a healing and supportive thought rise up from within the recesses of my soul, and then ... my ED cell phone rang, “Dr. Murphy, we need you in Room 44. We have a gunshot wound to the chest coming.”
“Thank God,” I muttered and quickly excused myself from this patient's room to manage the trauma victim instead, something I knew how to do.
My Guatemalan patient probably thought my medicine was weak because it was. All he got from me was two specialist referrals for his problems instead of the instant, magical cure he sought.
The ironic lesson for me was that I could more easily and confidently crack someone's chest than bridge the chasm between two cultures.
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