Those of us who walk between worlds see all kinds of gaps between the cultures we traverse. One thing that many cannot fathom is the level of fear and confusion that refugees and undocumented immigrants live with on a daily basis. What are they about to get in trouble for? What is going to hit them next? It pervades everything they do. The only other people I know who live with this worrying fear are children who were abused. Am I about to get into trouble? What is going on? Harm seems random, because it comes at random times and it makes no sense.

In asking a woman with terminal cancer if she would like to fill out an advanced directive or living will, she gets really scared. She is worried she will get in trouble with immigration if she signs anything legal, she explains. When her nurse tells her it is only for hospital use, so she can name her adult son to speak on her behalf, her face lights up with joy. “I didn’t know I could name him! I thought you were going to choose someone I don’t know who could make decisions for me! And I would get in trouble with immigration.” The nurse cannot understand how the patient can worry about this kind of thing with cancer looming, but the fear pervades every aspect of her life. The fear is always there.

An ultrasound during pregnancy shows that a baby has anencephaly. Most of the baby’s brain did not develop at all, just the brain stem area. The ultrasound reveals a face, and behind it is an empty space where the brain and the round back of the skull should be. The doctors tell the young patient that they will offer her an abortion. First, the baby cannot survive without a brain. Second, these pregnancies can last even 12 months without treatment, because the baby’s (missing) brain is involved in signalling the mother’s body that it is time to go into labor. This can be very dangerous or even fatal to the mother. They cover the informed consent form. Any questions? “Yes. Are you going to call the police on me?
Will I have to go to jail for this? “

Human trafficking victims who don’t dare to call police. Domestic violence victims who are told if they ask for help, they will get deported. Workers who don’t get paid and don’t dare complain. Miserable conditions that are so hard to fully grasp, still happening, all over. I even worked with a woman whose rapist told her that she would also go to jail for child rape if they got caught, because her mother let her immigrate with him to the US when she was 13 and he was 47, so she, the child victim, was equally guilty of rape, her told her. She never told the police. It came out in counseling. And she was really confused that she was not going to be considered a criminal. She was in disbelief. The therapist couldn’t understand. But so many things had been blamed on this victim. So many things had been her fault. This concept didn’t seem any crazier than so much else in her life.

And in less serious, more routine matters. How many of my readers need a note from a doctor if they take half a day from work to go to a medical appointment? My clients regularly request a note, so they don’t get into trouble at work. How many of you worry yourselves sick at arriving somewhere five minutes late, yet sit patiently for an hour in the waiting room, hesitant to even ask if you can get coffee while you wait, because you don’t want staff getting mad at you? How many find out the hospital has a program that gives uninsured low-income patients a discount that you qualify for, but don’t dare to apply? Being disempowered, being out of your known world, and the expectation of being treated punitively, creates a level of stress, anxiety, worry and fear that is hard to fathom, if you have never felt it.

These fears are not imagined. They are not silly. They are not based on ignorance. They are based on experiences. Repeated events that didn’t make sense. Because they were wrong. They were unfair and unjust. Let’s take this into consideration when we are explaining how things work to those who are most vulnerable among us. Let’s be aware and thoughtful in how we present things. Let’s not take for granted the things others cannot take for granted. Our kindness goes a long way. We can help to lift the burden of fear, if we are willing to take it seriously, and understand its foundations.