Sam passed one of the only fresh grocery stores within 30 miles, where inflation had driven up the cost of produce. She slowed next to a roadside stand and saw a couple reselling off-brand soda, charging $3 for 12-packs containing 500 grams of sugar each. “Fill up for cheap,” their sign read.
The road twisted up a creek bed, and Sam stopped to check on a 43-year-old patient. She had cut her average blood sugar in half with Sam’s help, but her diabetes was still causing hemorrhaging in her eyes. “I brought you some exercise bands,” Sam said. “We’re going to get all Jane Fonda up in here.”
She went back to her car and opened another energy drink. “This job is like fighting gravity,” she said. Her younger brother had died in his early 40s of heart and liver failure. Her father was a diabetic who loved Wendy’s and drank several sodas a day. The father of Sam’s two children was prescribed opioids after a work injury, and then he spiraled into addiction. Sam had raised the children mostly by herself, worked three jobs and put herself through nursing school at night while driving her relatives back and forth to the methadone clinic. “I keep thinking I can fix people,” she said.
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Sam exercising with a patient.
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A schedule of when to take which medication on a patient’s wall.
She pulled up to see her last patient of the day, Harry Ray, who lived with his brother in a single-wide trailer tucked against an icy hillside. Next to the house were two gravestones: one for their mother, who died from kidney disease at 56; the other for their father, killed by diabetes at 61. Harry had lost his leg to diabetes in 2009, but with Sam’s help, he’d dropped almost 75 pounds in the last two years. She taught him how to organize his medications and manage his diseases. He took notes during each of their meetings and tacked them up on the trailer walls. “You are what you eat, big boy,” one of them read.
Sam checked his blood pressure and bandaged a wound on his skin. The house smelled of unkempt cats, but she brushed a bug off the couch and sat down to visit for an hour before saying her goodbyes.
“Now hold on a minute,” Harry said. “You’re not leaving empty-handed.”
Sam tried to protest, but he disappeared into the kitchen and returned with a small bag.
“I wouldn’t be alive without you,” he said. “I’m sorry it’s not much, but it’s what we’ve got.”
Sam gave him a hug and went back to the car. She opened the bag and found a single can of Sprite, a pack of Fritos and eight pieces of hard candy. She closed her eyes for a moment and then drove in silence out of the mountains, until she made it back into cell range and her phone started to ring. One patient had a temperature of 101.6. Another couldn’t seem to pee. Cora called to say she was experiencing chest pain.
“Why does it feel like somebody keeps stabbing me?” she asked.
Sam listened to Cora describe her symptoms as she squeezed the wheel. “When was the last time you ate a real meal?” she asked.
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Sam with a patient. Some days, she is just as much a social worker as a nurse.
Lunch had been a package of ramen noodle soup. So had dinner the previous night and lunch the day before. Cora hung up with Sam, checked her blood sugar and saw that it was 255, which was dangerously high. Sam had given her a pamphlet on heart-healthy foods, and Cora glanced at the list: avocados, pumpernickel bread, fish, blueberries, broccoli. She called out to her boyfriend, John Ratcliff, who was in the kitchen.
“Do we have any vegetables left?” she asked
“I doubt it,” he said, but he started to search the pantry and refrigerator. They had a bottle of mustard, a half-eaten microwave meal, a package of American cheese, a box of cornflakes and a bag of flour. This was what their kitchen often looked like at the end of each month, after they had used up their $380 in food stamps. The only accessible food within walking distance was at Pizza Hut, KFC, Taco Bell, Little Caesars, a dollar store and a tiny convenience mart where avocados sold for $2.99 each and a 12-pack of ramen noodles cost $2.50.
Cora turned on the television and saw an advertisement with close-up images of fried hash browns, steaming sausage patties and melting cheese, all on sale for a dollar. “Boy, doesn’t that look good?” she said. She muted the television and called into the kitchen. “Any luck?” she asked.
John came out holding a package of beef-flavored ramen. “Honestly, I’d rather starve,” Cora said.
John Ratcliff, Cora’s boyfriend, preparing a dinner of fried potatoes for themselves.
Toward the end of the month, John and Cora can barely afford to buy food.
He searched again and found a leftover bag of potatoes in the back of the pantry. He sliced them into cubes and doused them with salt. Sam had told him once that potatoes could cause a spike in blood pressure for diabetics, and that they were healthier when they were baked, but the oven was still broken. He filled a pan with oil and turned on a burner. “I found you some vegetables,” he called out to Cora.
They had been together for more than 20 years, and had taken turns as each other’s care givers. He suffered from seizures and had survived a quadruple bypass surgery. For the last decade, they had been measuring out their days to the relentless rhythm of her chronic disease: checking her blood sugar every few hours, decoding nutrition labels, taking six medications in the morning and five more with dinner.
He finished cooking the potatoes and stirred flour and milk together in a bowl. He dropped the mixture into the leftover oil to make what he called fry bread, Cora’s favorite. A few minutes later, he walked into the living room with two plates of fried carbs and a couple of Dr Peppers.
“This is so good,” Cora said. “Thank you. It’s exactly what I needed.”
They played a game of gin rummy and started to watch “Little House on the Prairie,” but Cora kept dozing off in her chair. She checked her blood sugar, and it was up to 270. Her mouth felt dry. She could feel the beginning of a headache. She tried to distract herself by playing a game on her phone, but her hands started tingling. “It never ends,” she said.
Her mother was diabetic. Her brother had died of complications from diabetes before he turned 60. Her daughter, 37, was already one of Sam’s patients. Her grandchildren were surviving mostly on processed school meals.
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John and Cora have been together for more than two decades, taking turns caring for each other when they are sick.
“I can’t remember the last time I felt decent,” Cora said.
“Maybe you should call Sam,” John said. Cora usually checked in with Sam at least once or twice a day, sometimes just to say good night, but now it was already close to 10 p.m.
“I don’t want to bother her,” she said.
The tingling persisted. Her headache got worse. A chill spread into her hands and then her arms. She slept for a few hours and then awoke to another day of Dr Pepper and ramen. By the next afternoon, her ankles were swollen, and her lips had gone numb. She called Sam, who was driving into the mountains to see another patient.
“I’ve got problems,” Cora said. “My lips keep going numb.”
“Your lips? Uh-oh. What’s your blood pressure?”
“I don’t know.”
“That isn’t good, Cora. I’ll be there in a few minutes.”
Sam drove out of the hills and back into Williamson, remembering the previous calamities that had brought her to Cora’s house and filled her patient file: “Pain in spine.” “Chronic pain.” “Neuropathy.” “Lower respiratory infection.” “Depressive disorder.” “Hypertension.” “Transportation insecurity.” “Obesity due to diet.” “Noncompliance with dietary regimen due to financial hardship.”
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“My lips keep going numb,” Cora told Sam.
But lip numbness was something new, and Sam ran through the possibilities in her head. Cora’s lips could have gone numb from eating too much salt, since one package of ramen included almost a full daily serving of sodium. Or maybe she was freezing cold and losing feeling in her face — especially if the power company had made good on its threat to cut off the heat for nonpayment. Or the numbness could be a sign of anxiety, an allergic reaction or even an oncoming stroke. “I might have to transport her to the ER,” Sam said, as she parked out front and walked up to the house.
Inside, the dogs were barking and half a dozen relatives were gathered in the living room. It was the first day of the month, and Cora’s extended family had loaded up two cars to drive with her to the grocery store. Sam gently pushed away the dogs and made her way to Cora’s recliner. “I’m so sorry about all this, girl,” Sam said, as she took out a blood pressure cuff and reached for Cora’s hand.
Her blood pressure reading was 146 over 80 — high, but not an emergency. Her pulse was normal. Her blood sugar was in the typical range. Cora said she was feeling a little better, and she wanted to go shopping with her children and her grandchildren. None of them had groceries. She finally had a little money to spend. If she didn’t take the ride now, it could be days before she had transportation to the store again.
“Cora, listen to me,” Sam said. “You have to take care of yourself first.” She told Cora that she should consider going to an urgent care clinic or at least resting until she felt more stable.
“They could take me around the store in a motorized cart,” Cora said.
“It’s up to you,” Sam said. She packed her nursing bag as Cora weighed another impossible choice in a country where one urgent need was sometimes eclipsed by another.
“I have to get us some food,” she said.