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52 3 Caring across Cultures Wald became deeply engaged with all the patients and kin she studied, but two cases were especially important to her.They lasted the longest and involved some of the most complex personal issues and family relationships. Examining those cases enables us to perceive how she and other members of the research team understood their roles, the types of assistance they offered, the values that informed the study, and the ways patients and family members responded to the care they received. This chapter explores one of those cases; the following chapter discusses the other. Wald first learned about Nunzio Rossi early in 1969 from his son Robert, who had arrived from southern Italy before the rest of the family and now owned a grocery store where Wald frequently shopped. A sixty-­ year-­ old construction worker, Nunzio had followed in 1960 with his wife, Allegra, and six other children. By February 6, 1969, when Wald decided to study the case, he had been sick for several months. Complaining of abdominal pain the previous summer, he had entered a community hospital close to his home. In November, his health had suddenly deteriorated, and he had been transferred to a ward at Yale New Haven Hospital (YNHH) for patients involved in research. There he underwent extensive bowel surgery. Because he had lost eight inches of bowel, he could consume nothing by mouth; instead, he received a mixture of coconut oil, wheat starch, and amino acids intravenously. A serious heart condition further complicated his recovery. Soon Caring across Cultures 53 after Wald began to care for him, he fell into coma, emerging two days later but remaining seriously ill. The case highlights the difficulty of studying an individual with an uncertain prognosis. Time after time, doctors predicted Nunzio ’s imminent demise, only to find they had erred. Convinced he should be considered a dying man, Wald insisted that his comfort be the top priority.But as he continued to survive,his doctors were able to justify their recommendations for aggressive treatment.The case also illustrates the problem of caring for patients and their relatives who spoke a different language and belonged to a culture that members of the research team viewed as inferior. Robert was the only family member fluent in English. The others had various levels of knowledge, but all felt more comfortable speaking Italian. Having traveled to Italy, Wald had acquired what she called “tourist Italian,” which she acknowledged was far from adequate. None of the other health professionals and researchers claimed even that much. Although a translator occasionally was available, doctors and nurses repeatedly expressed uneasiness about caring for people with whom they communicated imperfectly or not at all. “How I wish I understood Italian!” Wald exclaimed at a moment of extreme frustration. She tried to learn the language but admitted progress was very slow.1 The language barrier led the doctors,nurses,social workers,and researchers involved in the case to rely on either ethnic stereotypes or personal experiences with Italian patients. Italian immigrants had a reputation for being overly “emotional.”2 Because Wald continually urged patients and their families to express their feelings , her repeated use of that term in reference to the Rossis needs some explanation. When she stressed the pejorative connotations of emotionality, she meant that people were too volatile, could not think rationally about critical issues, and were on the brink of collapse. Soon after meeting the family, she announced that one of her primary goals was to resolve ongoing conflicts between Nunzio and Robert, enabling them to discuss mortality. A social worker involved in the case argued that her experience suggested that 54 Prelude to Hospice men “from that background” were unlikely to speak about illness and death. In response, Wald gave the example of a young Italian couple she had met at St. Christopher’s in London. After the wife learned she was dying, she and her husband were able to communicate and “work together in the most beautiful way.” Despite the many differences between the two cases, she intended to help the Rossi father and son collaborate equally well.3 Accounts of generational conflicts among Italian American families may help us understand their estrangement. Immigrant parents complained bitterly that their American-­ born children had abandoned traditional values and practices.4 Although Robert was himself an immigrant, he must have seemed very foreign to Nunzio. Robert had lived much longer in the United States, spoke fluent English, was far better...


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