Where two worlds meet: The importance of cultural sensitivity in medicine

Bathed in golden light from the low afternoon sun, two figures sat on the edge of the narrow hospital bed, heads bowed before the small brass idol of Lord Ganesha. The smell of incense lingered in the air, remnants from a ritual they had performed that morning. My mother had lit the same incense sticks when I was growing up. I remembered the sweet fragrance clearly, as it blended in with the sounds from the morning aarti.

I stood at the doorway, taking a closer look at husband and wife. The woman, Lakshmi, was in her late 60s. The hospital gown had drowned her frail body, and golden bangles adorned her wrists. Beside her sat her husband, Prakash, with smile lines etched into his face, though he was not smiling now.

Lakshmi had metastatic breast cancer that had returned despite surgery, radiation and four lines of chemotherapy. This was her third admission to the internal medicine service that month, this time with a blood stream infection and unbearable pain.

Throughout the week, I had found myself stepping into her room without thinking, gently correcting the pronunciation of her name; making sure her pain was taken seriously even when she spoke softly; ensuring her vegetarian diet order was correct even though she barely ate.

These were small things perhaps, but necessary ones. They were the tiny shields I could use against the misunderstandings that so often accumulated with families like theirs. None of those moments were overtly malicious, but that was the problem. Individually harmless, yet layered together, they created quiet prejudice every time they stepped into the hospital.

Entering the room, I dreaded the conversation I was about to have. I had delivered news like this countless times, but never to a family so close to my own roots. With the sight of me approaching, Lakshmi grabbed the idol in front of her, holding it in her hands.

In that moment, I felt not like a physician but more like an interpreter – not of language, but of the space between two worlds: Western medicine and the cultural practices that shaped Lakshmi and Prakash’s life. I understood why Lakshmi reached for the idol; what these prayers meant. Without intending to, I found myself translating these gestures for the hospital staff around them.

I took a deep breath, the words catching in my throat. “I wish I had better news, Mrs. Pillai,” I started. “The scans show us that the cancer has spread, even more than before, beyond any further treatments at this point.”

I watched helplessly as their faces fell. “There must be something, doctor,” Prakash asked, his voice shaking. “Another trial? A new medication abroad? How could there be nothing after all that we’ve been through?”

I shook my head gently. “This is already her third admission this month, and each admission weakens her more. She is already in so much pain, Mr. Pillai. I am worried she doesn’t have much longer. I’m sorry there are no more treatments for the cancer we can offer her.”

He shook his head. “People fight against impossible odds all the time. Miracles happen. How can we stop now? We found a new priest. We are arranging for more poojas in India. You must know what they can accomplish,” Prakash said, desperation rising.

Earlier that day, one of my junior residents had wondered aloud whether the family “really understood” because they kept returning to their prayers. I had stepped in. “They understand,” I said. “This is just their way of processing.”

It was instinctive to protect their grief from misinterpretation. I wondered how many times during previous admissions someone had done this for them – if anyone had. I wondered how often they walked into this hospital, carrying not just the fear of the cancer, but the burden of having to explain themselves – the reasons why they prayed, why they deferred treatment decisions to doctors, why they still had hope. I wondered how many times their accents or their rituals had been met with polite dismissal. Being South Asian in a western medical system sometimes means translating yourself for others before you can ask for help.

I continued, “the love you hold for each other is undeniable. I wish there was more, but at this point, cancer treatment would only do more harm than good. We can continue the antibiotics, but I want to make sure she is comfortable, too. Of course you can continue to pray, the priests are welcome any time. Tell me what you need.”

Their grief was already unbearable, but I could feel how the hospital had made it heavier, asking them in a hundred invisible ways to mourn within the rules of a culture that wasn’t theirs. Moments like these remind me how essential cultural sensitivity is in medicine. I had watched other families fold their traditions away to avoid being judged. Lakshmi and Prakash had not done that, though I doubt it had been easy. Perhaps that’s why I felt such a responsibility to protect the space that they had created. We need training that teaches clinicians to recognize their nuances, to meet patients where they are and honour the worlds they come from.

Silence stretched between us before Prakash let out a sharp breath. “Will you come pray with us? We can ask the priest to come back tomorrow.” My chest tightened at the desperation in his voice. In that moment, I thought of my own parents, how they too would turn to prayers and poojas in times of distress.

Prakash’s tears flowed freely as Lakshmi wrapped an arm around him. I wondered how often he had allowed himself to be this vulnerable – how many times he had wept in solitude over these past agonizing years. With her other hand, Lakshmi tightened her grip on the idol, her knuckles turning white. She had remained silent until now. She closed her eyes and began to chant softly under her breath, her voice weaving through the air like a thread of comfort.

The words of the mantra were familiar to me, an ancient hymn my mother used to sing when nightmares haunted my sleep. I knelt beside them, offering my silent presence. I lingered there longer than I might have with a different family, finding it difficult to separate myself from this moment. I understood the weight of these mantras, the sacred idols, Prakash’s desperation, and the quiet resilience in Lakshmi. These were not just Lakshmi and Prakash’s ways of coping with the news, but they were also echoes of the traditions I had been raised with. It felt unnatural to witness this pain as an outsider when everything about it was so deeply familiar.

As Lakshmi’s mantra neared its end, I stood to leave.

“Thank you, doctor,” Lakshmi whispered, her voice strained. “Thank you for seeing us every day and spending so much time. We will pray for peace then, if a cure isn’t possible.” Her words settled over the room like a quiet truth. The sorrow was undeniably there, but it carried within it a fragile sense of acceptance. “Thank you for understanding us, what we do, and where we come from. We are glad it was you.”

“It has been my honour, Auntie,” I replied, holding her gaze. “I hope you find peace.”

As I stepped out of the room, the hum of the hospital surrounded me but something in me stayed kneeling beside them. On some days, this job feels like standing with one foot in each world – one world of evidence-based medicine and numbers, and the other of prayer, hope and memories of my own family. On days like this, I can feel how heavy the distance between those worlds can be.