Yuriria

"Room 11, physical, patient nervous"

I never quite know what to expect when I receive the non-specific warning that a patient is nervous. And when she is a new patient, all I have to go on is the basic essentials: female, age 36. Could it be a life-long fear of doctors, fear of needles and pain, a fear of a bad diagnosis, or just the ever-present shame of one's own body exposed--to be expected from a woman seeing a male physician for the first time?

I have all of 15 seconds to ponder this, before presenting my best culturally correct greeting, Hello, Yuriria, buenas tardes, reaching to shake her hand as I test which language she will answer in. In her Spanish response, she obviously is from the Caribbean, the clipped end consonants being a dead give-away. But also, her light skin makes the Dominican Republic, with it's strong African heritage, less likely. Indeed she is from Havana, Cuba, the only child, born and raised in a middle class, educated family. Her wide smile and pleasant demeanor hides her nervousness for the first few seconds.

Yuriria, would you tell me about your medical history? She's actually been very healthy. She has one child age 9, and otherwise the only significant factor is her overweight. She distorts her face and averts her gaze as she describes how she weighed 134 pounds before coming to the US, but since arriving has gained some 70 pounds. She has tried, but has been unable to lose it. Working long hours in the factory-bakery, she doesn't have time to exercise, is always too tired when she arrives home.

Sensing that she is ashamed about her overweight, I decide to engage her in distracting conversation about Cuba while I do her exam. She accepts this ploy, and occasionally I intersperse the conversation with details about the normalcy of her exam. By the time I get to her pelvic exam, we are deep into a discussion of whether Cuba is really that bad and she is telling me about positive aspects of modern Cuban life, such as universal health care and free education. She had no idea before moving here how difficult it would be having to work 6 or 7 days a week in a factory while raising a young child. This was certainly not a part of her experience growing up somewhat consentida, or spoiled as the only girl in her family.

I tell her, Yuriria, you are really quite healthy. Your transition to the US has left you much more overweight than if you were living in Cuba ( you have not done something shameful!). But you can change your habits to protect against the danger of overeating, and under-exercising. Remember how you had to go shopping every day by foot, perhaps taking the tram, in Cuba? You had no car? There was not always enough food to go around, and never an excess?

With lab slip in hand, successfully dressed, Yuriria is obviously relieved. I am also relieved that I have been able to put her at ease and her shame has retreated. Whether I will be able to help her find a healthy lifestyle to restore her to her previous health, while caught in the vortex of underpaid, overworked factory job is not going to be easy. The cards are stacked against us.