When I met her, she was younger than I am now. I was responsible for admissions to our hospital that day, and the ER doctor called me about a woman with intractable bleeding. It had been going on for several months, but she was embarrassed and unsure. She hid the severity of her bleeding from her husband, until the day she passed out in the kitchen.
Ultimately, we diagnosed her with cancer, and she started down a difficult road of surgery, chemo, radiation, and more surgery. But they faced many hurdles beyond her disease.
She and her husband each had finished high school with the help of special education classes. They struggled to understand the complicated reality of her cancer, and the choices they had to make. He was on disability, but she had never worked, and she certainly was not able to now. They got by on his social security check, which was not enough to cover her medications.
Her family lived several hours away, and their relationship with his family was often combative. The steps into their home were rickety, and she couldn’t navigate them with her walker. They couldn’t rely on their old car to get them to medical appointments, or even to the grocery store.
Fighting cancer or any life altering illness or injury is hard even for those who are financially secure and have the support of extended family. For a moment, let’s put ourselves in the shoes of those who face an uphill battle just to get to neutral.
Perhaps we grew up with a parent who had an untreated mental illness or addiction, or who was abusive. Perhaps we face discrimination because of our race or religion or gender or sexuality or some other fundamental characteristic. Perhaps we struggle with poverty, and the attendant evils of housing and food insecurity. Perhaps we live in an unsafe neighborhood, or we cannot easily get to a grocery store.
How, then, do we eat right and exercise safely? How do we find and keep a good job if we have limited education or we don’t have reliable transportation? How do we communicate with a doctor if we don’t have a phone and can’t read very well?
All these things are part of the social determinants of health. Our health and wellbeing depend on so much more than the factors we can control. Living with chronic stress, particularly chronic stress we experience as a child, impacts our physical health throughout our lives and that stress can continue down through generations.
If we genuinely want to promote wellness, for ourselves and for our society, we must put ourselves in other people’s shoes and pay close attention to these underlying issues.
Debra Johnston, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota.
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