I didn't know much about my patient, a young man originally from Tibet, other than that he worked in a restaurant in Queens.
For most of my patients, their coming-to-America story is an intrinsic part of their medical history. It's certainly medically relevant in terms of what diseases they might have been exposed to, what nutritional, environmental and genetic factors might play a role in their health, but it's also such a key part of who they are that it's usually a central part of our initial interview.
But this patient was reticent, and I didn't push. He seemed to be a loner, self-sufficient, with a monk-like abstemiousness that made him seem older than 34. Without fail, he always arrived at the clinic with a container of fragrant Tibetan dumplings which he would press solemnly into my hands before I could begin the medical visit. These visits were not that frequent, since other than some acid reflux and low back pain he was quite healthy.
From 2002 to 2009 immigrants as a whole contributed an estimated $115 billion more to the Medicare trust fund than they took out.
One day he came to my office with a woman in her late fifties, whom he introduced as his mother. I was surprised and delighted to meet her because I had no idea that he had any family with him in this country. I'd envisioned him as a loner. He asked if I would look at a bump under her arm.
I examined her axilla gingerly and was immediately met with granite resistance. My heart sank as I worked my fingers anteriorly over a bulging stony mass in her breast. "How long has this been here?" I asked, trying to keep the doom out of my voice.
As my patient's story slowly unfurled from him I realized that there was so much I did not know about him. He was not a loner at all. He was married, with two young children. His parents lived with him, as well as an aunt. But no one was getting any medical care because they were undocumented and worried about deportation.
I also learned the he didn't just work in a restaurant -- he'd started the restaurant himself, and now employed several other people. He'd been a journalist in Tibet until he managed to get to America on a student visa, now expired. He was the only one who spoke some English, so he was the one who ventured to the clinic.
His reflux pills he gave to his father, who suffered from a gastric ulcer. The ibuprofen for his back went to his aunt, who had arthritis. And the "bump" under his mother's arm -- well that had been there for years, and it had indeed started out as only a bump. But she was too scared to come to the hospital -- she spoke almost no English and worried about deportation.