cultural disconnect

I've been struggling with differences in viewpoints as I begin working
on the malnutrition ward. In general, the malnutrition ward is where
many, if not most, of our patients die, but it is also the ward where
you feel the most helpless. Up to 80% of our in-hospital deaths have
malnutrition as one of their diagnoses, if not the primary diagnosis.
You see and treat children who badly need food and hydration, and yet
you have to struggle and struggle to convince the parents to do anything
to save them -- place an IV, feed them properly, put a feeding tube into
their stomachs. I honestly can't understand their viewpoint at all, but
it is frustrating when their children die. I don't know if it is
apathy, or a feeling that we are treating them too aggressively, or
something else, but when the children die, it's very difficult for me.
Similarly, I accidentally ended up making a cultural faux-paux today
while I was covering for another doctor who's had to go get his visa
sorted out. We have a patient who's been struggling with upper GI
bleeding and we did a laparatomy on, which revealed inoperable cancer.
This was 8 days ago. The surgeons went to talk with the patient and the
family, and I assumed everyone was aware of what was going on. Today he
began to have worsening vomiting with blood, and I had a discussion with
him about where we should go from here, because we didn't have medicine
or surgery that would help or cure him. Turns out, the family had
refused to tell him what was going on, but was waiting for the 'right
time'. I'm all for preparing someone for bad news, but waiting 8 days
while someone is dying seems a little cruel and goes against all that
we're taught and learn to value in medical school about patient choice
and informed consent. There's a paternalism embedded in the culture
which is hard to understand at times, and although I regret
circumventing the family's wishes, I don't regret letting the man know
what is going on. But it's a situation where you don't even realize how
different your viewpoints are until they come head-to-head like that.