Craft booths line the pathways leading up toward the main square. Cueca dance classes vitalize the tiled space next to a gushing fountain. Bands play flutes and guitars beneath the colorful balconies that overlook them, while farther out, a series of thatched red-orange roofs form patterns below the mountains.
Its vibe at once colonial and beachy, La Serena is the town in northern Chile that patient Shayna* grew up in.
Shayna is among the many patients I’ve worked with in my job as a Spanish medical interpreter. Our appointment today is a workers comp follow-up, designed for workers who, due to an injury at their job, can no longer work at the same capacity they once did. Some can’t work in any capacity.
The goal of these appointments is to decide on a treatment management plan, as well as determine work restrictions and financial assistance for patients while they are recovering.
As others have, Shayna regales me with colorful details of her past while we answer the questions in her pre-appointment packet — painting pictures of ancient churches sprinkling red-tiled roads, and Humboldt penguins waddling up and down rock formations a few miles off the coast.
It’s nice to hear them, given how prominent of a role pain now plays in many patients’ daily lives. Most lament the extent to which their injuries have reshaped their worlds — completely and what feels like irrevocably.
“I used to be active, but now I’m damaged goods,” one man before Shayna had said, his right hand squeezing the orange stress ball attached to his pen. “Who wants to hire damaged goods? No one.”
Shayna’s, too, has changed completely after suffering an injury at her job. Like others, she stresses how badly she wishes to be a productive member of society again; how trapped and ineffectual she feels inside a body that works nothing like the way it once did. Her financial situation has become precarious. The pain has put a strain on her relationships.
Shayna tells me that before the accident she would swim in her spare time. She once read, hiked, and volunteered at the food bank, among other activities.
She has far fewer hobbies now. It’s hard to find the time for them. Shayna’s life has reorganized around the energetically costly and time-consuming repercussions of her injury. Her daily schedule has been filled with doctors’ appointments, physical therapy, chiropractors, lawyers, psychological counseling, and acupuncture to manage both the pain and the logistics of her case.
On a scale of 1 to 10, one being the best, 10 being the worst pain imaginable, how bad is your pain right now? reads one of our first questions.
Shayna is at a seven and a half.
Does the pain wake you at night? I read aloud.
Shayna wakes anywhere from seven to 10 times. She can’t sleep on her right side (the one she was injured on). Every time she turns over, the pain pulls her from sleep into a jarring state of sudden wakefulness. Her sleep quality has been poor as a result.
What activities make the pain worse?
Moving hurts. Lifting, pulling, and gripping items has become difficult. Milk cartons fall from her hand. Using her opposite hand to compensate has gradually depleted its strength, too, over time. She takes medication daily to manage the pain — even though she doesn’t believe in, or want to be on pharmaceuticals.
“Afectan a otras partes del cuerpo, los medicamentos,” Shayna says. “Al menos eso es lo que yo creo.” / “They affect other parts of the body, these medicines. At least that’s what I believe.”
“How did you get injured?” reads the next question in our packet. It’s a pretty standard one in workers’ comp evaluations.
Answers have varied. Fell off a horse, was dragged around for several minutes until I could finally get it to stop. Run over by a forklift. Flipped over in a construction truck, have been among those provided.
Boxes I was lifting were too heavy; no one there to assist me, was Shayna’s response.
Exploitative and negligent bosses like Elon Musk contribute to not all but some of these injuries. At times they occur in part from a worker having taken on too many duties at jobs where, often, the labor assigned is physically demanding. Yet Shayna said that even though her last company worked the employees like “pack horses,” many still did what they were told — out of necessity.
“They will because they’re afraid to lose their jobs,” she laments. “They need this work. They need it to survive. They need it to keep their families afloat. Their employers know this.”
Another patient, Mariposa,* had shared similar experiences.
“I don’t know if I’d say employers intentionally mistreat or overwork their employees,” she acknowledged. “But I would say there’s often a lot more work, too much it seems, for one person to take on.”
At times the employers have them do “yucky labor” that isn’t in the job description. For example, Shayna once worked in a 12-story building with a floor dedicated entirely to liposuction procedures. The trash cans on this floor overflowed with fat and “cosas feas,” she says (“gross things”).
She and her coworkers were often asked to empty these bins on their own.
“Es mucho trabajo para solo una persona. Y no nos pagan más. Y los trabajadores no dicen ‘no’, porque no quieren perder sus trabajos” / “It’s lots of work for one person to take on. And they don’t pay us more. And we don’t say no, because we don’t want to lose our jobs.”
Shayna’s frustration is palpable as she calls mierda on this. She even asks me to write this word down, verbatim.
“Mi-er-da,” she enunciates, glancing over at the paper to ensure that I have.
When we get to the work history portion of the questionnaire, I discover that in addition to holding a degree in engineering, Shayna has also worked as a financial adviser.
She is not alone in this experience. Arriving in the U.S. to find that their qualifications don’t translate is a somewhat common predicament for immigrants. Unable to secure work in their field of study, they then take on lower-paying jobs that don’t challenge them intellectually and just barely pay a living wage.
Surgeons in Mexico shift to picking apples in the U.S. Architects become servers. Another patient, who obtained a law degree back in Peru, now works in the U.S. as a ranch hand. Yet another moved from Colombia with an engineering degree, but has worked as a nanny and house-sitter for the last twenty years.
With or without a higher degree, the general experience of navigating immigrant status in U.S. culture proves additionally challenging.
Shayna left her home country to provide her kids more easeful lives. She and others moved to escape political unrest; insecurity; spontaneous violence that could erupt in the streets without warning. They moved despite both the challenges of living as an immigrant in this country and the fact that — as they disclose to me — the U.S. may never feel fully like home.
Even still, some have found that life on U.S. soil — the California Bay Area in particular, with its exorbitant cost of living — presents just as many challenges.
Shayna can’t say whether her current situation or the one she left behind is worse. All she knows is that life has been a struggle, especially after the pandemic.
“Prices are going up,” Shayna lamented, shaking her head. “One day of work to fill my gas tank. I want to go back. But this life is all my kids have known. They don’t want to leave.”
A question about social support in Shayna’s questionnaire leads us to discuss the adjustments her friendships have undergone following her injury. Many friends have had difficulty relating to what she’s gone through and continues to endure, which leaves Shayna feeling isolated.
One told her to “just think positive” and “try to get out more.”
This comment especially stung given how active of a person she’d been prior to her accident. Her friend seemed to not truly grasp the reality of her situation, implying that her inactivity resulted from personal choice and lack of willpower.
Sadly this isn’t uncommon. It’s hard for many of us to wrap our heads around invisible illness and injury that don’t adhere to a tidy before and after recovery narrative — in the U.S. especially, where linear progress and individualism are highly valorized.
Meghan O’Rourke touches upon this in her book The Invisible Kingdom: “We are bad at recognizing the suffering of others unless we are given clearcut clues and evidence. And so invisible illnesses often go unacknowledged, while less serious conditions get attention.”
“Man, you can’t do anything anymore,” the able-bodied friend of another patient, Manny,* once said to him following his injury. The two were on a beach picnic trip, and Manny had been unable to carry the cooler from their car to the picnic spot due to his pain.
Like Shayna and other patients, Manny has opened up about the hurt of confiding in friends only to be met with dismissive remarks such as these.
Hearing them both recount these experiences brings up the issue of both personal and systemic invalidation.
It’s hard to interpret when I see doctors invalidating patients in similar ways; luckily, today’s doctor (we’re called in shortly after answering this question in the packet) listens to and validates Shayna. They exchange frequent laughs and smiles. The air inside the room feels lighter and easier to breathe.
I appreciate doctors like these, who seem to accept the unpredictable and nonlinear trajectory of chronic pain. How the symptoms might leave temporarily only to return with a vengeance. They show understanding that, as Anne Berger put it, “a patient is healed not only by steroids or antibiotics but also by empathy — being made to feel whole, rather than distraught, as she exits doctors’ appointments” — and that healing is as much about listening to patients’ subjective experiences as it is about taking physical measurements and analyzing organs and body parts.
Patients deserve more of this. I’d like to think these sorts of interactions infuse them with (even just a modicum of) hope — not that their physical pain will resolve entirely, but at least that their predicament hasn’t fallen on deaf ears. Absent a magic cure, a doctor’s kind and supportive attitude can momentarily help at least on some level.
“We’ll keep you on the same work restrictions,” the doctor says to Shayna before she leaves.
Luckily, Shayna’s job has honored the restrictions recommended by her doctor up until now. But not all jobs do, prompting patients to get lawyers involved. Other jobs even let go of the worker entirely.
The doctor leaves for a few minutes; Shayna and I remain inside his office. A model of the human spine gently rattles against the tan-grey marble counter to our left as we wait.
Light spills into the room through the partially opened blinds, which Shayna peers out of from our ninth-floor window.
As we both look down onto the tops of downtown Oakland’s high-rises — then out toward the verdant hills in the distance beyond them — I think about all the humans I interact with on a daily basis. The strawberry pickers, the maids, the cooks, the factory workers, and the janitors among others. All whose lives had been overturned and fundamentally reshaped in a single moment.
I think about how my eyes are opened daily: to pain, to the harms resulting from a compulsory productivity mindset, and to the inevitable constraints confronting these bodies we all find ourselves inhabiting so arbitrarily — which our profit-driven culture often treats like liabilities once they begin to function less optimally (particularly those belonging to people of color and other marginalized groups).
Injured workers have been forced to come to terms with these limits earlier than most. They are saddled now with an ongoing condition for which no definitive cure exists.
It’s winter, and the trees outside (visible through the window) have shed most of their leaves. One or two still remain on each branch though, having yet to be shaken off. I think about how similarly, these patients were forced to renounce so much of their former lives and identities.
Often my work has me asking how we can help lighten the loads that each of us carries, even just momentarily. A fully satisfying answer eludes me, but the closest I’ve found to one is through presence. It’s through acknowledgment that no quick or easy fix exists (or perhaps any cure at all) — but that still we can sit with others in their darkness and pain. We can be there to help carry some weight, for however long our two paths continue to meet.
Of course, more needs to be done than just this. On a collective and systemic level, steps must be taken to prevent these injuries to begin with, or at least minimize their likelihood. Some are pure accidents. Others, though, could have been avoided.
If we can’t prevent them, then proper support — both financial and emotional — needs to be put in place for those now bearing the life-altering consequences of one. No person should have to hear what Manny’s friend said to him but sadly, too many regularly do.
We need more light on the collective and systemic limitations that contribute to predicaments like these.
A light on those confronted with choosing between their health and physical safety versus keeping their family above water in our unforgiving ocean of capitalism.
A light on the working-class men of color in this country who are saying they feel worthless without their ability to work, like all they’re doing on this planet is “using up air.”
A light on the danger of bosses seeking shortcuts at the expense of their employees, and who treat them as disposable like Musk does.
A light, even, on the arbitrariness of the way certain work is valued over others. Why are the jobs that so few people take pleasure in the ones so abysmally compensated? What consequences does our societal undervaluing of the rigorous and/or domestic labor most often taken on by immigrants have on this population?
According to research conducted by UC Merced, a majority of the state’s 2020 pandemic deaths among workers in high-risk industries such as warehousing, agriculture, food processing, nursing care, landscaping, and work in restaurants and grocery stores were Latino (68%) and immigrant (58%).
It’s time we stop treating the essential as expendable. These human workers deserve so much better.
*Names and certain details have been changed to protect confidentiality.•