At the same time, the more unaware we are about where our cultural GPS is positioned, the greater the likelihood that we may expect everyone else to be just like us. Failure on the part of someone else to be like us leads one to conclude that something's wrong with those Arabs, or those Americans or those French. Then, we complain: why can't they be like us? Or why can't they just do it my way and by my rules? When the other guy doesn't play the game "my way" we might say, "you're either with us, or against us" and the unintended consequence is likely to be mutual, puzzled frustration, misunderstandings, if not outright anger between people and countries that often leads to war -- in short, a failure of cross-cultural understanding.

Take for example the life or death situation I faced in the American hospital when my father was gravely ill. When it came to dealing with my father in that context, I knew what was expected of me and how to act. Or so I thought. In fact, the way I was about to handle his wishes according to my role with all the rights and responsibilities I believed I knew, were wrong, especially in the context of an American hospital. I was not taught that in death we assign sacred roles and responsibilities to strangers with whom we have not built trusted relationships. As a Pakistani, I do not have an advocate at the hospital bed in a life or death situation. It is understood that I am that person. We don't have to go through the patient privacy issues with children or parents.

I learned that when it comes to health in the American context, Americans defer either to the spouse or an outside expert, like an attorney. In fact, Americans often turn to outsiders for help like talking to therapists regarding for personal problems; lawyer to settle their disputes. This is a reflection of two more dimensions of culture at work beneath the iceberg: American Individualism versus Collectivist (about 80 percent of the rest of the world, including mine) and Transactional (deal-based) culture (US) as opposed to mine which is Relationship orientated.

Do we think about who will call the shots about a gravely ill parent if we are not a native? I never thought I didn't understand the cultural laws of my adopted home (America). I did very well in building my career and by adopting the Western mindset and life style. And however much I am a product of both the Eastern and Western mindsets, when it came to a life and death situation that involved my Dad, my Pakistani mindset kicked in and, to my surprise, American laws circled right around me to his legal next of kin, which is considered his wife, even if she's not his first wife or his children's mother.

Although I successfully brought my Dad home from Yemen in good health to Washington D.C., the authority I had "over there," did not apply "over here" in America. I couldn't advocate for my Dad's health without his prior written consent to appoint me. This time, as he was headed for major surgery, Dad and I both realized that according to American law, his (second) wife was considered his legal guardian and next of kin, with complete authority to make decisions, not me. 
My father opted for an arranged marriage after my mother passed away in 1995. According to Pakistani custom and Islamic laws, this second wife has rights but they do not exclude existing children from their rights. Now she was in complete charge of my father's health which made me feel culturally, emotionally and psychologically, powerless.

Conscious Competence

The cultural insecurity I felt, coupled with the shift in my role about my Dad's health care, made for a situation that was ripe for misunderstanding. I realized that not only was cross-cultural training an absolute necessity, but that even if we think we have some degree of intercultural competence, we can't know all that we do not know.

Even if we are aware of how to culturally "style switch" and to "relate, regulate, and reason" synergistically, with the adopted culture, our psycho-social-emotional IQ must also be "fit." Together they form a holistic approach for handling situations. (We get the word "manner" from the Latin word for hand or "mano.")

My Dad died in September 2012. This was the most poignant moment of culture shock for me because even though I have lived in America for 25 years, I was shocked to learn that I was powerless to make decisions that may have yielded a different outcome for my Dad. He may or may not have lived. I cannot bear to think what may have been. This reflection is not about the laws or customs of one culture being better than another. My Dad may have not lived no matter which country he was hospitalized in. That's something any child would have to deal with. We all do the best we can.

But I can't help but wonder, as I look back on across my landscape of loss, could this tough cultural lesson have been easier? Perhaps, if I was more aware of the unseen dimensions of our humanity at work, like culture, personality, and emotion things might have turned out differently. Maybe not, but I do see now, with the gift of hindsight, how each one profoundly influences behavior in ways I could hardly imagine.

It's an understatement to suggest cross-cultural training become a requisite to immigration -- anywhere, not just in the USA. With this knowledge base for immigrants and expats, no matter where in the world they intend on living they can embracing the full power and magnitude of their influence on our behavior, and navigate the tricky roads that lay ahead, such as the implications of what is custom versus law. Perhaps we can "re-engage more directly in a new democratic bargain as opposed to being trapped by systems that are too big to control," as former Prime Minister of Greece, George Papandreou suggested in his recent TED Talk at the 2013 Global Summit.