Respite from the American Dream

“Doctor, can you possibly help me fill out disability forms? So I can stop working?” Miguel asked. His cheeks were just slightly flushed as he sat wringing his hands, averting eye contact with me.

Usually, when someone asks me about filing for disability, I experience a fleeting moment of dread at the prospect of all the hard conversations and all the piles of paperwork that come with such a request.

But this question, coming from Miguel, surprised me.

“Miguel, you’re 69 years old,” I answered, “why don’t you just retire and claim your retirement benefits.”


Miguel looked at me, making eye contact for the first time during this visit, a furrow in his brow. I was familiar with his expressions, having cared for him and his wife over the past two years, and I could tell he was confused.

The first time I met him and his wife, Miguel seemed to me like a storybook character. He had thick calloused hands, leathered and engraved, each scar a marker of a different job he had held over the years. His wardrobe was a uniform:  a buttoned shirt with his job’s logo engraved over the left chest pocket and a pair of neatly pressed jeans. He carried himself with a confidence, saying to me with his body language that he had no use for doctors, because for the past sixty years he had patched himself up with each injury and he had gone back to work.

As it goes, over time I had worn down his defences enough to get to know him, and enough for him to ask me when he needed help. I could see it pained him each time he asked me for something, as if the years of tireless work had made it impossible for him to ask for anything.

Here he was today, asking me how he could stop working. I was only surprised he hadn’t asked sooner. When I first reviewed his knee X-rays two years prior, he had bilateral bone-on-bone arthritis so severe I was surprised he could stand.

“Doctora, pero cómo puedo?” His expression and his tone told me he wasn’t asking philosophically. He was asking literally. He wanted to know how to retire and claim his benefits.

Now it was my turn to look away. I looked down, lost in thought. Miguel was asking me for advice not just on regarding his health but also now his well being. He wanted to know how to retire while continuing to support himself and his wife as they aged.

This wasn’t a question that medical school prepared me to answer, but nonetheless I had the power of authority and the burden of being asked for counsel. So I asked Miguel a question I had no reason to ask prior: “Miguel, tiene usted papeles?”

Miguel answered and I learned that, fortunately for him, he is documented. He is a legal resident who has worked in the US for decades. But most of his family and friends are undocumented;  most are working using false identifications; and while all of them are contributing to Social Security, none of them could help Miguel figure out if, and how, he could claim retirement benefits. None of them knew if he qualified for Medicare.

Evidence shows that undocumented immigrants pour billions of dollars into Social Security annually, and few ultimately have the privilege of claiming those benefits. While the burdens of financing retirement are shared by all aging Americans alike, immigrant communities with poor access to resources often suffer the most.


Miguel was in my office, telling me in his way, that he was suffering. He had worked until he could work no longer, till his knees and his back gave out,  tirelessly pursuing his American Dream for decades. But he was tired now, seeking respite from the pursuit, and he needed help.

I promised I would try.

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