The Emergency Physical.

S he has never been seen in our office before but called this morning wanting an appointment " right away " for her Pap smear and physical. Maria is 32 years old and is employed as a housekeeper at a local hotel. She has had three children and is healthy. As I listen to her I learn she is an immigrant from Guatemala, that her children are back home, and that she moved here 4 years ago to join her husband, whom she had not seen in 8 years. She is not worried about illnesses— no diabetes, her parents are alive and well, and all her children are healthy. Menses are regular, birth control is " mi marido se cuida " (my husband takes care of himself). I ask if there is anything else I should know or if she has any other worries. She says " no, " but I see " it, " a fleeting expression as if a small fast-passing cloud just veiled her eyes (Figure 1). It is a moment of pain and sorrow that comes and goes so fast I could have missed it if I had been looking in a different direction. " What else? " I ask. " Maria, " I say softly, " is there something else? " Her eyes fill with tears, and the expression of anguish returns. Now I can see so deeply that I realize there is no bottom to this pain. I sit down again, closer to her now. She weeps as she shares a story: " It had been too long. I wanted to see my husband; he had a good job and became a foreman. The girls are older now, my mom can take care of them, and if I join him here and work, we can both put the girls through a better school, build a house back home, maybe they can become doctors in Guatemala. Doc-tora, it was time for me to join him in the US. I missed him. " Her tone is that of a plea. She talks as if asking to be forgiven for the decisions she made during her family's quest for a better life. " My husband paid for my trip. But the men, there were five of them. They crossed us from Guatemala through Mexico all the way to the United States. We were 17 men and women …