I wish more people could hear the most frequent thing I hear immigrants of all ages and stations say, which is some version of “I want to work”. I can think of three distinct patients this week alone who had this on their minds, even with cancer spreading throughout their bodies. While doctors were thinking of palliative care and how to break bad news, these patients were thinking about work, needing to work, and wanting to work.

One sweet lady was past menopause, and had recently discovered that her symptoms were due to uterine cancer that had now spread to the small intestine and other surrounding tissues. The doctor carefully told her about her pathology results, plans for chemotherapy, and potential radiation. But her first question was whether she can work during chemotherapy. Her experience is mostly in working in the dirt around the roots, she explained, raking, digging, clearing the onion fields, and such. Her grandchildren were scolding her that she shouldn’t be doing that during chemo, because she could sicker. The doctor agreed. The patient was disappointed. She told the doctor she had been working steadily since she was ten, and she talked about how hard it would be to just sit around. “The time will hang so heavily on my hands, because these hands were made to work,” she told us, showing her calloused palms.

Another patient was telling us how much she loves her work sorting apples. She said it is so cheerful and she and her coworkers laugh and joke all day, even as they rush and hurry. She loves knowing all about the various species and classes of apples, and how to sort them so quickly. She loves reading the labels and thinking about all the places around the world that the apples are traveling. This patient is in such constant pain now that they are doing a procedure to numb the nerves to the major impacted organ. Her cancer is inoperable, but she really wants to know if she can be cleared to work. She wants to work, and she needs to work. When the doctor asked how he could help her, she asked for a doctor’s note so her boss would let her work. “He doesn’t think I am well enough, but I am,” she explained.

One young man has cancer in his jaw. His face is quite distorted and he is hard to understand. He had some of his teeth removed. He was using a wheelchair due to general weakness during his treatment. The doctors gently told him that the results confirmed that the cancer unfortunately had spread. There was nothing else they could do for him now beyond pain control. When asked if he had any questions, the patient wondered if there was any treatment that would let him get back to the farm, even one more season. He told the doctors that he thought he could work through the pain, if they could just help him get a bit stronger. “I work outside, so they won’t let me use the wheelchair there,” he explained. He knew he wouldn’t live long, but he just wanted to get back to work.

As an interpreter, the vast majority of my colleagues travel regularly to their home countries and other places. We travel to see, to enjoy, and to visit. As close as we are to the immigrant community, it is still hard for us to fully grasp their situation. We see it up close, we are with it, but we do not live it. It is still theoretical even to those of us who spend our days serving the immigrant community. Yet for our patients, the theory became practice. They have crossed borders and end up in high risk, low paid jobs in order to support their families. They face chemical exposure, harsh working conditions, and more. When they have accidents or develop illnesses, as they often do, their first concern is how to get back to work. My heart goes out to them.