Reader response: Residency training: The need for an integrated diversity curriculum for neurology residency

I read with interest Drs. Rosendale and Josephson's¹ experience with the development and introduction of an integrated diversity curriculum within their neurology residency program. Through a recent experience, I realized the unmet need for cultural responsiveness training not just in the neurology residencies, but in the entire US health care system. A woman from the United Arab Emirates was admitted to the epilepsy monitoring unit (EMU) for intracranial EEG monitoring and resective epilepsy surgery. As per standing protocols of the EMU, it was recommended that she remain in bed at all times and use a bedpan for toileting. The next day, the overnight nurse told me that the patient became acutely agitated, requiring multiple doses of IV Haldol and Ativan to calm her down. Upon questioning the family, I realized that the cause of her agitation was the denial of the use of the bathroom and insistence of the hospital staff that she use a bedpan. Laws of Islam concerning ritual purity and cleanliness recommend steps be taken to avoid being soiled and defiled by urine and feces. Once the patient was allowed the use of a bedside commode, under close nursing supervision, her agitated behavior resolved.