Why do we bother to knock? We’re doctors. It’s our clinic, our hospital, our space, isn’t it? But our mentors taught us that tacit gestures give the appearance of permission. Permission to barge into cramped exam rooms and into the expansive lives of our patients.

In his Field Notes essay “A Limp and a Death at Eagle Butte Reservation” (Fall 2017 Intima), Nathan Szajnberg drops us straight into his earliest doctor moments as he barges into the lives of the Sioux. In his twenty-four hour, sun-up-to- sun-up tale, we peer over his shoulder on his wildly adventurous first day. Before he ever gets a chance to “knock,” Life, Death, and Humor knock first. We’re as off-kilter as the young Szajnberg, who must navigate the capricious nature of gravity, desolation, and morbid illness on the rez.

Szajnberg, a New York Jewish doctor, landed on the High Plains of South Dakota like a gefilte fish out of water. I can relate. As a fellow New York Jew, and erstwhile comic-turned-surgeon, I landed in 1993 on the vast Navajo Nation. With the full weight and force of a barely dry diploma and the unearned certainty of a young surgeon, I, too, arrived without knocking. I came to treat kids. Navajo kids. Funny thing that.

My comeuppance came early and then often. In my first clinic foray, I spoke to the parents of a swaddled baby, who most definitely needed surgery. Years in comedy taught me timing, delivery, and style, but despite my best efforts, not a single pair of eyes in that packed room looked my way. Floor, window, ceiling, just not at me.

Patricia, my newly assigned nurse, and a Tewa Indian, leaned against the open doorframe. She uncrossed her arms and motioned me outside. Out of earshot, she said, “You’re talking to the parents. They don’t make the decisions, Silly. And you’re the doctor, to look you in the eyes would be impolite.”

“What? Why?”

“They’re Navajo,” she waved her hand in a that-says-it-all flourish. “Talk to the Grandma-ma tucked in the corner. She’s your ‘equal.’”

Besides the irreplaceable Patricia, who knew?

In my short story “Sammy’s Still Screaming” (Fall-Winter 2025-26 Intima), I explore this cultural divide and the intricate language of unspoken words. Both Szajnberg and I learned that cultural pitfalls happily await the uninitiated. And the biggest barrier to care—is not seeing the barriers.

Customs and culture dictate structure. A surgeon never cuts without learning the anatomy. She learns where things lie and how they’re connected. Lessons one through five, and on to a hundred, are the gift of cultural mistakes. Opportunity in peril. Young doctors are young for a blink, and they age with their patients. My advice to my young colleagues: knock first and then, most importantly, listen for the response. Listen for their story. In story lies the cure.