We had both just gotten home for the holiday when Dad calmly announced to the dinner table, “Your uncle has had a heart attack.”
An explosion of questions and half-eaten rice erupted from my brother, an emergency-medicine resident, and me, a second-year medical student.
“He’s doing great,” my father reassured us. “They’ve already sent him home from the hospital. We would have told you sooner, but we didn’t know any of the details. It is hard to keep tabs on your uncle when he’s on the other side of the world.”
Our uncle Manouchehr was indeed fine. He had two stents placed at a first-rate Iranian institution and was feeling much better. This was, however, his first extended run-in with conventional medicine, and he was left feeling run down. The next day, we called him via Skype to see how he was doing. There was no lack of suspicion from my brother as to the quality of health care while abroad. He asked to go over my uncle’s prescriptions, and sure enough, two medications that are considered standard of care in the United States—beta-blockers and ACE inhibitors—were missing.
When my brother tried to explain to Manouchehr that he needed additional medications, my uncle let out a long sigh. Manouchehr doesn’t like pharmacy. He doesn’t understand it. He’s fond of telling my brother and me that we are squandering our talents by becoming drug dealers. And while for the most part he is kidding, his jokes are an expression of a very real frustration. In Iran, where my uncle grew up, herbal medicine was practiced in most households and generally held as a point of pride for Persian-Iranians in the face of a bourgeoning Western medical industry. Still, instead of trying to manage this cultural divide, my brother had attempted a hasty justification for his recommendations based on his knowledge of randomized controlled trials, clinical guidelines, and expert consensuses.