How Poverty Hurts: Financial Insecurity Manifests as more than just Mental Stress.

Mr. T came in for a visit to address his back pain.

“I just have this terrible ache in my lower back, can’t seem to do anything to get rid of it,” he explained.

He was a middle-aged man, close to 60, his blue jeans worn at the knees and his sweater just barely covering the part of his belly where most of his weight sat. As he rubbed his flank, gesturing to where the pain was, his wrinkled and scarred hands betrayed a life of hard work.

He had tried a few remedies at home – some heat packs and some Tylenol, but couldn’t quite get relief from the back pain, he elaborated.

I was early on in my career but had already seen dozens of cases of low back pain – usually the result of various physical stress, worsened by obesity, bad posture and sedentary habits. I already had a “back pain spiel” for patients – an explanation about sciatica that I developed – the goal of which was to help patients understand the pain and what the process of healing would look like.

After I asked him a series of routine questions and did an examination, I started launching into my explanation about how physical therapy and time would be essential in healing his strained disc.

But Mr. T looked despondent. I realized,  a few sentences into my spiel, that he wasn’t about to ask me for an MRI or a stronger pain killer. These were the types of requests I had gotten used to expecting, having experienced that many patients were not always satisfied by the opinions of a physician who looked the age of their grandchild.

Mr. T, however, just wasn’t listening. His mind seemed adrift, his eyes staring off into the distance.

I glanced at his intake sheet and noticed a flag placed there by my nurse.

“You answered ‘yes’ on both intake questions here, I see. Sometimes this means you could have depression,” I said, then paused, leaving space for him to answer.

“Well, ya know, I do feel depressed,” he replied as frankly as I had posed the question.

“I kept thinking I was going to find work, but every job that I thought was going to materialize never did…I went to the unemployment office and still, nothing,” he continued, his eyes now fixed on his shoes, his fingers clenched in a fist on his lap.

“And now, I got nothin…I just got nothin…”

“I can’t imagine what that’s like,” I said,  leaning in and placing a hand on his shoulder.

“There’s an eviction notice on my door.”

He looked up at me, his eyes glossed over, a look of complete desperation calling out to me.

“I am anxious all the time, I can’t sleep, it’s hard to eat. I keep worrying that my landlord is going to call the police any day now and I’ll be in jail… I don’t know what to do…”

He sobbed.

I sat there and listened, and I let him sob.

The truth was I didn’t know what he should do either. He was depressed, and he was in pain – both spiritual and physical pain.  But, the cure for his pain was not a pharmaceutical one. The cure would require giving him stable housing and a sense of security. It would require giving him a salary in an unforgiving city where rent prices are prohibitive even for the middle class.

“I have worked in this city for twenty years…who knew it would all fall apart now…”

I realized then my place of privilege. I had never had to experience such foreboding.

“I am sorry doc, I don’t mean to waste your time with my problems,” he said – interrupting my internal stream of consciousness.

“No, I am sorry for what you’re going through,” I replied, having little else to say.

I gathered some resources, doing the best I could to get him connected to our teams in social work and case management and I sent him on his way.

He thanked me profusely as he left.