TY - JOUR T1 - Clinical and cultural conflicts JF - British Journal of General Practice JO - Br J Gen Pract SP - 122 LP - 122 DO - 10.3399/bjgp17X689653 VL - 67 IS - 656 AU - James Sherifi Y1 - 2017/03/01 UR - http://bjgp.org/content/67/656/122.abstract N2 - By some accident of genealogy, I recently found myself flying to an Arabian Gulf state to act as the next-of-kin and surrogate advocate for a relative who had suffered a catastrophic brain stem infarction. My uncle, a 71-year-old lifelong bachelor still in active employment, had been admitted to a private hospital with massive bilateral vertebrobasilar artery thrombosis. CT scans showed widespread infarction of the cerebellum, brain stem, and occipital cortex. He developed coning, at which time my sister, who lived in the region, was contacted to give consent for surgery. Having already discussed the details with me, she attempted to refuse but was told that this was not an option and that surgery had to be performed.The operation notes, which in part read like a Gothic horror novel, confirmed visible, widespread ischaemia with marked tissue oedema. The surgery report detailed debridement of visibly necrotic areas of the brain stem.I attended to find a body totally unresponsive to any stimuli, immobile, externally ventilated, parenteral nutrition in place, bladder catheterised. The neurosurgeon greeted us amicably but did become slightly confused when … ER -