They are coming!! They are here!

Ellis Island stopped it's existence as a gate into this country many moons ago. The immigrant screening process is not centralized anymore and therefore not uniform for everybody. I am sure regulations and rules along with massive amount of forms to fill out suppose to help to screen out potential health problems in people trying to get a permanent residence. And I am quite sure all these measures are very effective in vast majority of cases. I have no inclination to criticize the government on the immigration issue (wrong blog!). What interesting is that with their potential and real diseases people bring their views on how things ought to be run as far as national health care as a policy, obstetrics as far as epidurals, and end of life paradigm as an ethical dilemma. I have just encountered a family of 69 years old gentleman from eastern Europe. Educated back in one of the former Soviet Republics (he was a university biology professor), with good sense of humor, very easy going and nice to interact with he was unfortunately diagnosed with end stage lung CA. Our oncologists were giving him no more then several months to live. And they were about to deliver that terrible news to him, as his family - the wife and two daughters called the oncology office and requested a meeting without his presence. At the meeting they were asking not to tell the patient the truth about his prognosis. As conversation progressed one of the daughters - a US trained radiologist - mentioned the interesting fact that back in their country terminal patient would be lied to - and it was not just a required by the communist government way of things, but rather well established medical and ethical practice. And it probably comes from widespread atheism in that part of the world (although it'd changing now), where death does not bring you to God, or anywhere for that matter. It's nothing less, then the ultimate tragedy. When we mentioned the fact that medico-legally doctors are obligated to tell patients the truth or what they think the truth is about their condition, family (without any hostility) brought up the issue of cultural differences, that must be respected as well from the legal point of view, as we respect some of the religious practices and don't transfuse blood to these patients even when we know it's in the best patient's interest. Go figure..