Working While Poor and In Pain in the United States
First off, let me make one thing clear. This diary is about the United States and other so called first world countries. If you are poor and in pain and living in a third world country, your pain will not be treated. Period. Because international drug policy says that morphine (which is dirt cheap) is much too dangerous to put into the hands of health care workers in poor countries. They will divert it to the black market (we are told). And so their patients dying of cancer get acetaminophen and a pat on the hand and a “Maybe if you were good in this life you will be reincarnated into a new life in a more prosperous country and you won’t have to suffer this way next time.”
Ok, enough about our neighbor’s problems. Let’s talk about our own problems. What’s that you say? You are not poor? You are not in chronic pain? And none of your friends or family are poor or in chronic pain? That’s what we call denial. Or willful blindness. Because the woman waiting on your table at Waffle House has two eroded knees. She can barely hobble out of bed each morning, but she spends all day on her feet for tips and minimum wage. She pours your coffee with a smile, even as her hydrocodone wears off. She won’t take another pill until she gets home. It is going to be a long day. The doctors want her to get knee replacements, but she does not have insurance. And if she gets insurance, she won’t be able to afford to take off work for the surgery, because she does not have disability insurance. The hydrocodone allows her to go to work each day so she can pay the rent and buy gas and groceries and take care of her kids.
She knows her doctor secretly thinks of her as a drug addict. She has seen the pharmacist roll his eyes when she comes in for her monthly refill of hydrocodone. She does not list her pain medication when she sees other doctors for fear of what they will think. Because pain is shameful and people who get treated for pain---unless they are children (innocent) or cancer sufferers (unfortunate)---are weak and selfish and should be ashamed of themselves.
Your Waffle House waitress is not alone. The woman working the cash register at Walmart has carpal tunnel syndrome. If she slows down while checking you out, you fume. You tap your foot. She is going as fast as she can---she can’t afford treatment for her carpal tunnel syndrome so she relies on pain medication to get through the day---but your time is valuable. If she can’t keep up, Walmart should fire her and hire someone younger and healthier---
An aside. The recession of 2008-2010 was a godsend to industry which adopted a first hired first fired policy. A fair number of 40 and 50 something middle managers with some seniority and a good salary and benefits with health problem found themselves downsized and reduced to waiting tables, flipping burgers and checking groceries. Jobs that were much more physically demanding than the jobs they lost, jobs with no benefits. That’s how I met them. I was doing family practice at a county clinic at the time. I met a lot of people who had always had good jobs and good benefits until the recession. For the first time in their lives, they had to hold their noses and seek publicly funded health care. And among their many medical problems, chronic pain was often near the top as a barrier to returning to the high paid with benefits work force.
But enough with the up close and personal. What about the public health? What about our right to live in a country where there is no drug addiction problem adding to crime and the rising cost of uncompensated health care? What about our right to make sure that no pill pushers sell our babies prescription drugs without a prescription?
The medical director of a large, county funded clinic for the uninsured stated publicly that “Poor people should not have their pain treated with opiates. They will be tempted to sell their medication.” That doctor was not being cruel. She was looking out for the public health. She was determined to stop the flow of drugs at its source---the waitress who works at Waffle House. The cashier who works at Walmart. The former realtor who kept putting off her knee replacement surgery when she had good insurance because she did not want to miss work but who started slowing down because of the pain so she got downsized and now that she is out of work and has time to get her knee replaced has no insurance, so all she can afford is pain medication. I’ll bet you didn’t know that woman is a (potential) drug pusher. Public enemy number one.
Good news! The GOP is looking out for your kids. One Republican is floating a plan to have Medicaid stop paying for opiates. Cut off the supply, that will dry up the demand. Several states have already capped the amount of pain medication that Medicaid covers. That should help with the awful problem of the working poor selling their pain medications. If we eliminate the ACA, a lot of people will lose their Medicaid benefits, making it even harder for them to obtain pain medication—and if they can’t get medication for their pain, they won’t be tempted to sell it. If we dismantle the Veterans Administration which treats a lot of chronic pain—being blown up by a land mine can have lasting, painful effects---that will further reduce the supply.
Poor people were not put on this earth to enjoy themselves. They were put on this earth by God to remind us that the wages of sin---and being born female or Black or Latino or joining the military and being sent off to fight in a foreign war---are suffering and poverty and pain. They were put on this earth to change the sheets in our luxury hotels and trim the lawns at our golf courses and clean dishes in our four star restaurants. And they will do all this while their knees, backs, hands are killing them, because their suffering is their atonement for the sin of not being born among the Elect. God loves the Trumps of the world and He hates the poor and every time a rich person crushes a poor person under his foot, God gets a great big grin across His bearded white face. Amen. So sayeth Calvin.
Yes, that was sarcasm. Now, some honest emotion. Be careful. What follows is true and may make you cry or at least want to punch something.
Put yourself in someone else’s shoes. A hard worker who, for no fault of her own, was standing in the wrong place when a truck at her job went into reverse instead of forward. She got crushed. Her neck was broken. Through some miracle, she was able to regain the use of her arms and legs, but from that moment on this 20 something lived in chronic pain. Her neck injury also made her blood pressure unstable. That plus her pain would drive her blood pressure up dangerously high.
One day, while in the emergency room for one of her hypertensive crises, she overheard the emergency room physician refer to her as an N-word junky. She left. She called her family doctor. In tears, she described what had happened.
The American health care system, the so called best system in the world failed that woman. It shot her in the heart. It made it impossible for her to ever trust a doctor again. Because that emergency room doctor was not looking out for her good. He was looking out for the public good.
There is no easy solution for the problem of opiate addiction in this country. But there is an easy solution to the problem is stigmatizing people who have real pain for seeking relief from their pain. You wouldn’t deny a poor asthmatic an inhaler because she might sell it. Why deny your Waffle House waitress treatment for her pain?
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