Below is a narrative based on a true encounter I had as a Personal Patient Navigator in the Penn Center for Surgical Health. It has been deidentified to protect the patient.
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When I first met Esteban in the lobby of our medical center, I saw a short, unassuming, Hispanic man, adrift amongst the sea of people trying to get to the radiology suite, or to their clinics, or to the cafeteria to beat the lunchtime traffic.
I walked up to him and introduced myself; as his patient navigator, I helped him get emergency medical insurance and would be accompanying him through his care. He did not immediately reciprocate this warmth, instead reticently nodding his head. His gaze avoided mine. Ouch.
As I shook his hand, I noted his calloused hands and dirt under his nails. Dressed in a worn grey sweatshirt with black sweatpants, all but reinforcing his working-class status, Esteban may have felt uncomfortable. Here he was in the middle of our new medical center, an ostentatious display of architecture, glass, and fine art. It is perhaps one of the most beautiful buildings in Philadelphia. But through all the corridors, there are people working day and night to ensure the healthcare of people most in need. And this purpose is what makes the center so beautiful.
As I walked Esteban to his clinic appointment, I tried to break the ice. “How was your drive in? Did you find parking?”
“Not bad. My brother-in-law drove me in.” he replied, quietly.
“That’s good. Where did you drive from?”
“From my work in South Philly.”
“Oh, where do you work?”
“Phil’s Diner” he replied, curtly.
As we checked in at the clinic and sat in the waiting area, I decided to press on. “How long have you been in South Philly?”
“Twenty-one years. Since 2000.”
“Do you like it?” I queried.
“Yes. When I first came here 21 years ago the neighborhood was very dangerous,” he reflected. “There were gunshots every night.” He then breathed a sigh of relief, “But, now, it is much safer. Thank God.”
Pleased to have him engaging me, I asked “And where were you before that?” Esteban paused. He glanced at me, his eyes meeting mine for the first time, and grinned shyly.
I learned Esteban was born in a small village in central Mexico. In 2000, at the age of 14, he left his family to cross the border. To do so, he borrowed $1,800 from his uncle. The onerous campaign involved driving up to a remote portion of the border with a group of coyotes – people who smuggle immigrants across the border. They climbed over the fence. Once on the other side, the group walked 4 hours to a pickup car in the desert. Carefully avoiding border patrol, the car drove them to Tucson, where Esteban took a train to Phoenix. From there he took a one-way flight to Philadelphia.
I stood bewildered. Never before had I heard a first-hand account of crossing the U.S.-Mexican border. It was a treacherous passage, especially for a child alone, all done in hopes for a better life.
A nurse took us from the waiting room to the exam room. After she collected Esteban’s vitals, I became curious about his social structure. – “Esteban, do you have family here?”
Indeed, he has a wife and three kids. He met his wife when he was 16 and she was 18. They have been together ever since. They have three children. The eldest son, 18 years old, is a “good kid” and is enrolled in community college. “He likes history,” Esteban gushed. The younger ones are 9 and 3 years old.
His story was uplifting. It was the quintessential American dream! He came to the country as a boy, grew into a man, met his love, raised a family he was proud of, and gave them opportunities he never had himself. Warmed by the tale, I continued “Wow! What does he-”
“ALL RIGHT what do we got here!”
I was cut off by the jovial surgeon and his nurse bursting through the door. “Hello, nice to meet you all. I’m Dr. J and I’m the hernia guy!” In all this conversation about Esteban’s life, I had nearly forgotten he came to our center to care for his painful inguinal hernia.
I sat attentively as the surgeon and his patient went through the ever-important history and physical. Esteban had been dealing with his nagging hernia for years. At least once a week the pain flared to a debilitating 9 or 10/10. No amount of Tylenol could abate it. Standing all day at his physically taxing job, Esteban admitted, definitely contributed to his flare ups.
As the surgeon asked Esteban to lower his pants to see the hernia, I jumped back. His hernia was the size of a grapefruit! “Yup, this is a big one” the surgeon commented. As he gingerly reduced it, Esteban winced in pain.
The surgeon explained his operative plan. The surgery would take place in a month. Afterwards, Esteban would need to take at least two weeks off to ensure proper healing. Esteban tensed; there was apprehension in his eyes. The surgeon also sensed something was awry. “Is that going to be a problem?”
Esteban slowly shook his head, “No sir, no problem.”
The surgeon went on and explained that, while surgery is a transformative experience, it required strict adherence to guidelines. There would be no benefit if Esteban dismissed the recovery time and suffered a complication. Esteban eventually expressed understanding and agreed to make time off from his work.
As we left the clinic, I turned to Esteban and asked why it took so long for him to seek care for his hernia if it had been bothersome for years. His response left me crestfallen.
Last year, Esteban’s wife suffered a stroke due to an underlying arteriovenous malformation. She almost died. Thankfully, she was able to receive lifesaving surgical care to remove the malformation, but it left her disabled. Over the last year, she had been undergoing intense physical therapy and speech therapy, with the hope she can look for work soon. Thus, Esteban has been the backbone for his family, raising his three kids on his own.
To do so, Esteban works six days a week. He often goes to work early in the morning, relying on his eldest son to take the younger ones to school. When the kids come back from school, Esteban comes home to cook them food, only to go back to work for the evening shift. He does all this to be paid $500 a week in cash, the entirety of which supports him and his family. With his circumstances, his hernia had to be deprioritized.
It dawned upon me that Esteban was worried about his recovery period because he cannot afford a two-week reprieve from work. That would dissolve the only source of income for his family.
“Esteban, don’t worry about the two weeks after surgery. We will help you.” The hero in me made a blanket, unsubstantiated promise. His eyes perked.
**
Fortunately, I found the appropriate infrastructure at our medical center to support Esteban. I am grateful that the resources exist at our institution to provide comprehensive services for our patient. But it breaks my heart that this is the most our society is doing for Esteban.
Esteban has done everything possible to build himself a genuine life in America. Emigrating here as a child, he found work for himself. He avoided the rampant trouble that plagues his neighborhood. He raised a family he has kept together for 21 years. He continues to care for his disabled wife and three children. He works a physically demanding job for less than a living wage. He has even tried to obtain legal status for years, but has been unable to do so. Therefore he has none of the protections granted by the American Disabilities Act.
Is Esteban less American than any of us? Does society not rely on him more than those who inherit their luck? Will he always be bound by the circumstances of his birth? These thoughts raced through my mind as I walked Esteban out to the lobby where we began our journey.
“Was it worth it? Coming to America.” I asked solemnly.
Esteban gave a sigh, one with a hint of defeat, and a sly grin. “If I could do it all again, I would have stayed in Mexico, stayed in school. I miss school.”
We shared a moment of pensive silence. The juxtaposition of my life with his was all too apparent. Esteban had faced enormous adversity to build his life and was scraping by. He longed for a life back in school. Here I was, given the privilege to attend over twenty years of school, a privilege my friends and I often scorned.
In the end, Esteban expressed his desire to return to Mexico. He wants to take his family, reunite with his parents, and start a restaurant. He knows once he leaves, he can never come back.
It is frustrating that we can’t accept an honest, hard-worker such as Esteban. That our society is pushing him away. That he feels foreign in a country where he has spent the majority of his life.
When we reached the entrance, Esteban effused gratitude for my help in obtaining his insurance and guiding him during the day. No, I wanted to say, Thank you. I could not muster my emotions at the time. But my two-hour foray into his world was both enlightening and humbling. Our conversation was a welcome recalibration in my life, one that I hope to reminisce as I pursue my training.
We shook hands before he departed. This time he looked me in the eyes.
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