A Look Back: Cross-Cultural Paths in Medicine with Tania Kohal, MD

A few years ago, I recorded Episode 4 of The Last Zebra with Dr. Tania Kohal—someone I worked alongside, someone who understands how much of medicine happens in the in‑between spaces: the pauses, the side glances, the moment a patient decides whether you’re safe enough to tell the whole story.

Tania’s life has been a series of real border crossings: born in the UK, raised in California, trained in Detroit, then moving to Louisiana for fellowship. That kind of biography doesn’t just give you “perspective.” It gives you practice.

Practice at entering a room and reading it fast.

Practice at translating yourself without flattening yourself.

And practice at holding two truths at once: you can belong, and you can still feel like a guest.

There’s a theme from that conversation that still holds up: culture isn’t an accessory to care. It’s part of the mechanism of care. It shapes what people fear, what they can name, what they’ll tolerate, and what they’re willing to admit—especially when the stakes are high.

We often talk about culture as if it’s something the patient “has.” In reality, everyone in the room has it. The clinician, too. The institution, definitely. And if we pretend otherwise, we start mislabeling predictable misunderstandings as “noncompliance,” or “poor insight,” or that lazy catch‑all: “difficult.”

One line from the episode keeps replaying in my head: “This is about making a human connection.” (YouTube — The Last Zebra Podcast, Ep. 4)

That sounds obvious until you’ve watched how quickly modern medicine can sand the humanity off a conversation. We’re trained to move fast, to reduce language to checkboxes, to treat time like the only scarce resource in the building.

But a human connection is not a sentimental extra. It’s information.

It’s what tells you whether the patient is nodding because they understand, or nodding because they don’t want to look foolish.

It’s what tells you whether “I’m fine” means “I’m stable,” or “I’m ashamed,” or “I’m terrified.”

It’s what lets a patient say the thing they were raised not to say out loud.

And then there’s the weight. Tania names it plainly: “I think we have to feel that responsibility.” (YouTube — The Last Zebra Podcast, Ep. 4)

Medicine will teach you responsibility whether you want it or not. Sometimes it teaches it the hard way.

If you’re early in training, you may think the goal is to become unshakable. My experience is the opposite: the goal is to become steady.

Steady means you can feel the responsibility without letting it harden you.

Steady means you can sit with end‑of‑life conversations without turning into a robot.

Steady means you can recognize that your patient’s culture, faith, and family structure are not obstacles to “manage,” but realities to respect—realities that can change how decisions get made.

For a patient or reader, the takeaway is simpler than it sounds: bring your full context into the room.

Tell us what you believe is happening.

Tell us who helps you make decisions.

Tell us what you’re afraid of.

If you’ve ever felt like you had to “perform” the right kind of patient—polite, brief, grateful—consider this permission slip: clarity beats courtesy when your health is on the line.

And for clinicians, I hear Tania’s words as an instruction, not a slogan: be proud of who you are and your culture, because it will shape how you show up for other people. (YouTube — The Last Zebra Podcast, Ep. 4)

If this episode brings something up for you—an experience where culture helped you get better care, or where it complicated things—hit reply and tell me what happened. I read them.

Dum spiro, spero.

— Ugo