TYPICAL At Thanksgiving last year, my uncle Ray wrapped his own hand at the dinner table. He had opened his palm on the edge of a broken tile that afternoon, finished the job anyway, and shown up with a paper towel balled in his fist. Between the turkey and the rice, he unrolled it, looked at the cut like it was a dent in a fender, and sent my cousin out to the truck for electrical tape. Three tight loops. My grandfather said, Still attached? Everybody laughed, and somebody passed the potatoes over Ray's arm.
I was a few months into nursing school. I had just learned how to check a wound for depth and infection, and I sat on my hands so I wouldn't reach for his.
Equipment
The men in my family work construction. My grandfather roofed houses for forty years. My dad and his two brothers hang drywall and set tile. They talk about their bodies the way they talk about their trucks, as equipment that belongs to the job. A bad knee is a cost of doing business. The body goes in for service when it won't start, and not a day before.
The one doctor visit I can remember my dad making on his own was the winter his back seized so badly he couldn't get up a ladder. He came home with muscle relaxers and a note saying to rest for two weeks. He rested for three days. The note went in the kitchen drawer with the warranties.
My grandfather can't fully close his hands anymore. He holds them out so the little kids can try to straighten his fingers and calls them forty years of shingles. He says it with real pride, and I understand why. Those hands kept a roof over his family. To him they're receipts.
A page on mental health for construction workers names physical pain and a stoic culture in the same breath. It's the most accurate description of my family I've read.
Chief complaint
In my health assessment course, the first question you learn to ask a patient is What brings you in today? The answer is the chief complaint. Our instructor told us to listen for what sits underneath it: the moment the person finally picked up the phone.
For the men I grew up with, I already knew. They don't have chief complaints. They have chief inabilities. I couldn't get up the ladder.
In our men's health unit, we looked at CDC survey data from 2015 showing that women were more likely than men to have seen or talked to a doctor or other health professional about their own health in the past year, in every adult age group except 65 and older. A 2019 Cleveland Clinic survey of U.S. men found that 72 percent would rather do household chores, like cleaning the bathroom, than go to the doctor. My dad would rather re-roof a garage in July.
I don't think the men in my family are careless about their bodies. My dad can tell you which morning his knee will be bad before he's out of bed. What they've decided is that the body isn't theirs to look after. It belongs to the work, and the work belongs to the family. This issue's lead essay calls that the provider trap.
My own ledger
I want to be fair to them, because I do the same math. I'm nineteen, the first in my family to go to college, and I cover what my scholarship doesn't by working twenty-five hours a week at a home improvement store. Since spring I've been chewing on the left side because of a cracked molar. The only open dental appointments are on Saturdays, and Saturday is my longest shift.
My dad gets paid by the job and has no sick days. A morning at the clinic costs him the copay, the morning's pay, and maybe the next job if the homeowner gets tired of waiting. When he says he can't afford it, he's doing arithmetic. The women in my family are in on it too. We keep the ibuprofen in the glove box and the heating pad by the recliner. Nobody at that Thanksgiving table was stupid. We were all running the same ledger, and on that ledger, pain is cheaper than a day off. We've been paying the cost of providing in knees and shoulders for three generations.
The cuff
This September I brought home a blood pressure cuff to practice for my skills check-off. I let the air out slowly and heard the first beat much sooner than I expected. I took it again on his other arm. Both times I got a number my instructor would have circled.
Must be the cuff, he said.
He'd also been sleeping in the recliner for a month because his right shoulder wouldn't let him lie flat. I'm a student, not a nurse, and I knew better than to diagnose him. I knew enough to feel a specific kind of helplessness, the kind that comes from reading the number yourself.
I did everything wrong first. I quoted my textbook at him. I got my mom to bring it up at Sunday dinner, my aunt joined in, and my dad went out to the garage until everyone left. Later I found a guide on what to do when he refuses to see a doctor that warns against exactly that.
The sentence
What finally worked was writing the appointment into his ledger instead of arguing with it. My dad replaces saw blades before they burn. He changes the truck's oil on a schedule. He already believes in maintenance. So I booked my own dentist appointment and asked for that Saturday off. Then I booked him a 7:10 a.m. slot on a Tuesday, before his first job. I practiced in a conversation rehearsal tool, set to my dad and defensive, until my voice stopped shaking.
Then I found him in the garage and said: Dad, I need you working for a long time, so I'm treating this like a work expense. You're in Tuesday at 7:10, before your first job. I'll drive. I'm getting my tooth fixed Saturday, so we're even.
He was quiet for a while. Then he said, Seven-ten is early.
I said, You're up at five.
He went. The shoulder is a rotator cuff problem, and he does his physical therapy with a band he keeps on the dashboard. The blood pressure was real. He takes a pill for it every morning now and calls it his oil change, which I've decided to allow.
If there's a man like this in your life, don't fight his math. Make the cost smaller: the hour before work, a ride he doesn't have to arrange, an appointment already booked so he isn't the one who has to call. Then offer something of your own in the same breath, so it lands as a trade instead of a lecture.
Uncle Ray is next. I'm bringing my cuff and a box of butterfly closures to Thanksgiving. I'll wait until he walks out to his truck, and I already know my opening line: Ray, I need you working for a long time. I'll drive.