1. Sniderman, Meg RN


There's more to patients than their suffering.


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Last summer I spent two weeks in South Georgia in my nursing school's Family Farm Worker Health Program. Involvement in the program fulfilled my community health class requirement, but that incentive didn't matter so much to me. The farm worker program was a chance to be among Latino immigrants, the population with whom I'd initially wanted to work, and to practice nursing in a new context: outside, under the open sky. My classmates and I stayed in Moultrie, Georgia, performing health screenings for the farm workers' children during the day and holding clinics for the workers every evening.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Lisa Dietrich.

On the last night at camp I wasn't assigned to a particular station, so I served as an interpreter, filling in where needed. We'd set up camp in a dirt parking lot, and dust rose with our movements and settled on every surface like a fine gauze. We'd unrolled a tarp and laid out clothes for the workers, and as they came through they picked through the pieces, holding them up for size. Soon night fell, and people switched on their headlamps and walked looking down at the ground. Battery-powered lanterns sat on tables, but the only constant light came from the mobile pharmacy van, which glowed in the night.


The night passed quickly and as smoothly as any other, and when no more workers arrived and the intake stations sat empty, we began packing our equipment and breaking down the tables. A young man approached and asked if we could see him. He seemed timid but otherwise healthy. Since it was late, I wanted to be sure we could help him, so I asked him what kind of problem he had. "I need eyedrops," he told me.


Eye problems are common among field workers from exposure to sun, wind, and airborne debris; however, before he could see an NP, we had to check his blood pressure, glucose, and hemoglobin levels, and the equipment was already packed. We rushed to gather the supplies, and to speed up the process, I moved through the stations with him as his interpreter. When we reached the NP, she asked for his medical history and current problems, and while she charted his information, he and I talked.


He told me that he was 21 and had crossed the border from Mexico four years before, with his father's permission but without his mother's. I didn't ask if he had a visa. He said he had no family in the United States; his five siblings still lived near his parents in Mexico. When I asked him why he'd come here, he said, "I guess I was bored as a teenager"-and then added, "I thought it would be different here."


The entire time he was with us he kept looking around, eyes darting back and forth and toward the truck he'd driven, which he told me wasn't his own. He shifted uneasily in his chair, and I felt the impulse to try to comfort him and tell him we could help. It wasn't an unreasonable thought, only foolish: though we may have held a loose authority in our makeshift clinic, he was able to navigate the surrounding area, and was more aware than we were of what it took to survive there.


I began to imagine what he might see: our blue scrubs and headlamps, our papers and instruments, all unfamiliar to him but superimposed against a land he knew intimately. After his consultation, he didn't want to stand out in the open, and he walked over to the truck to wait for his medications. I followed to make sure he didn't leave. Because he seemed so nervous, I asked if he had other questions or concerns he hadn't mentioned before. He looked at me very directly. "Yes," he said. I waited for more, thinking he might have held something back from the NP because they couldn't speak directly to one another. I steeled myself, expecting something difficult, but though he spoke earnestly, he said only, "I like you. You're pretty."


I smiled at him-and laughed at myself. I had made him into a tragic character, imposing hardship where I saw fit, but not seeing the whole picture. In certain ways he was a tragic figure-alone in this country, working long hours in poor conditions-but he was also a resilient human being, and to see only his suffering was to acknowledge only a part of him.


I saw then how easy it is to flatten our patients-to compress their personality into the framework of their needs. Those needs are never the whole story.