No Stinkin’ Green Card
My first appointment is with Leopoldo Gomez, age 49, a right-handed man who complains of right shoulder pain. He has completed a detailed intake form in English impeccably; the reason for his visit is five year’s shoulder pain.
He is married. The Gomez’ have lived in the US for over 30 years. They have four grown children, all college graduates, all employed, and 6 grandchildren. His recent family history includes a diabetic brother, and a maternal aunt who died after gallbladder surgery. The remote family history reveals no documented chronic health problems except people who died of ‘old age’, and several violent deaths incurred in the Mexican revolutionary turmoil of the early last century; in many ways it is the history of a USA created by immigrants.
He and his wife have ‘green cards’ and their children are native born citizens of the US. He came to Arizona at 19, speaks with a very slight accent; he uses rather stilted, studied grammar, so carefully constructed it is slightly distracting.
He has always worked in construction. His wife was a full time homemaker when the children were small, but now works regularly cleaning houses. They have never had health insurance, but have lived cautiously, avoided risky behavior, and been fortunate; no one in the family has experienced costly illness or injury. The Gomez’ appear to be an integrated and acculturated immigrant family; they are Americans.
We review his history together and address the chief complaint:
Right shoulder pain, worse with activity, off and on, gradually improving over 3-6 weeks, but easily re- injured.
There has been no history any specific injury.
“It gets better if I rest the shoulder and worse if I do overhead work. Sheet-rock? Overhead painting? Forget it!
Examination supports the history, and is clearly consistent with a chronic rotator cuff injury. A finger-stick blood sugar is 102 two hours after carb thick breakfast.
“Did you ever hurt it at work? Or report a work injury?
The country is experiencing another quadrennial zoonotic outbreak of politics, and he refers to it obliquely, saying:
“No. If nominated I won’t run, if elected I won’t serve.
But I am too focused to pick up on the humor and reply dryly,
“Why? You have that right. Also, if you are not able to work, you’re entitled to disability insurance payments.
“For a minor injury, Worker’s Comp, even if I could get it, won’t pay my overhead; house, car payments, travel, food. You know the drill.
“I don’t have unemployment insurance.
“I thought everyone who works has comp injury and disability insurance.
“I’m paid in cash. During the past few years, since ’09, I don’t ever confess to having a green card. Never. So I don’t pay disability insurance.
“I wouldn’t get the job. And they’d deduct taxes, unemployment, disability, social security, and some other stuff I can’t keep track of.
“What if you get injured at work?
“I can’t afford minor work injuries like this one.
“I can only get work here and there, short periods, for different employers. If they decline responsibility for minor injury, so does their insurance. I’d have to find a lawyer to accept the case without a big payout. Ha-Ha-Ha.
“What about more serious injury?
“Like losing an arm or breaking my back? Illegal or not, it’s covered. Not that it’s any bargain.
“Well, it’s something, don’t you think?
“It can be. But I know people with significant but not totally incapacitating injury; they, go through years of delays, denials, and a long series of waiting rooms-medical, chiropractic, physiotherapy, lawyers- all likely to cancel an appointment without notice or any consequence except to the injured worker, who is powerless.
“Yes- I sometimes see the evidence: a 2 inch high stack of tattered and worn business cards from lawyers and bureaucrats and ‘providers’.
“What you don’t see is the years of family stress related to loss of income, maybe bankruptcy, maybe depression, divorce.
I reflect that my failing to report a possible work injury may be illegal too. Yet my patient objects to the report, and the work relation is uncertain, so abide by his decision.
We review the common ways to control Leopoldo’s symptoms by avoiding work that makes them worse, by using injections or medication, and physical therapy. I give him a brochure about exercises for rotator cuff injury. I advise ibuprofen prn and provide on line sources of information, suggesting he return whenever needed.
Now when I see people in a Home Depot parking lot seeking work, it reminds me that perhaps the ‘illegal’ worker, and his ‘illegal’ employer have an illegal advantage during these hard times. It is as if they were to say:
“Green Card? We don’ need no stinkin’ Green Card!”
But Leopoldo would use proper English. Better than me. OK, better than I.