(Above: Moise Miller, with the help of a few family members, has just completed the concrete foundation for the new basement in his new home. I have never seen human beings work that hard and so joyously.)

Walking Moise did carry, shovel, plow and climb all day; I wonder how he can stand up at all. But it turns out he is human. He is also in considerable pain.

So Moise and I have another issue for us to navigate, something else that reveals our differences, approaches pain and suffering.

My struggle to understand him and help him as a friend continues. This is built into our relationship.

And why wouldn’t it?  I feel so close to this man, yet I am frequently reminded just how very different we are. I am once again reaching out to him as gently and firmly as I can to get him to a podiatrist and get an X-ray. He may go; it is equally possible he won’t.

This is a great challenge in a friendship between two such disparate people. Another adventure in the great adventure that is Moise Miller.

I scored two “victories” today; I gave Moise one of my old wallets to replace the torn and disintegrating one he carries around the country on his bus and train trips. He must have 500 cards in that wallet, all of them with the phone numbers of people he might need to call for a ride when he gets off a bus in the middle of the night somewhere in Ohio or Pennsylvania.

He agrees it is time to get rid of some of the cards.

He accepted a used but well-designed wallet without argument. “I think this will work for me,” he said. “Thank you.”

I also finally got him the precise winter boots he has always wanted but never bought.

This was the fifth boot I got for him after buying and returning four that didn’t quite meet Amish standards in style, history,  and color. I’m glad I stuck with it.

It felt good.

But as is inevitable, a new issue has come up that is important to me and would be to most people in our English world.

This will require great patience, tolerance, and forbearance from me.

Pain and suffering aren’t the same things to the Amish as they are to me. I suspect Moise is in considerable pain much of the time, sometimes more than others.

The Amish mistrust the same health care system that has saved my life more than once.

I might be expected to watch a friend I love suffer in considerable pain for years, for even the rest of his life. That will be difficult for me.

I’m speaking about what appears to be a rotator cuff injury in one of Moise’s shoulders that is getting worse.

There is hardly a dull moment in my friendship with Mosie; I suspect he sometimes wants to throw me in the stream behind his house. But there are also sweet and powerful moments; I so enjoy our time together riding around our little universe.

Today, he even paid me the compliment of falling asleep in the car as I drove him home from the bus station. For me, that is a sign of trust and comfort. I was happy to see him finally let go and rest. I guess I am a Step-Father.

I drove to Glens Falls to pick him up at the bus station. Of course, we had to go to a concrete factory and then Loews’s on the way home while he haggled on behalf of the new home he was building.

At the concrete shop, he was jubilant when he came out and got into the car. He wanted to buy six iron chimney cleaner doors; they wanted $48 for each one, he told me, smiling. “I said what about $46 for eight iron windows?,” he said.

“They said we can give you  $47. I said, well, how about if I buy eight iron windows (some for his brother-in-law) and you sell them to me for $46.” They agreed.

He was delighted. “It is a good deal, isn’t it, Johnnie-Boy.”

I congratulated him, as nothing makes him happier than a good deal.  For someone who rejects capitalism in his life, he sure loves a bargain.

Moise is a master of gentle but unyielding negotiation. We went to Loew’s, but that was just to scout prices for the future, his favorite pastime apart from building or plowing.

I wanted to talk to Mosie while he was sitting still and in the car, and I thought it would be rough because it was something I felt strongly about, and he does too. But not in the same way.

It was about seeing a doctor and spending money on his health. I knew it would be a protracted struggle. But it was necessary to me, perhaps unwelcome to him.

The Amish will go to doctors if they have to, but they believe the American Health Care system is so complex and expensive, it would destroy their way of life. If you are Amish, you make hard choices in your love to keep the faith, and one such promise is to never get sucked into a system that will soak up all the money one needs to live.

The plain life is a life of sacrifice.

The last dozen times I’ve seen Moise, he’s spoken of increasingly severe strain in his right shoulder, a pain that began a couple of years ago while he was lifting something heavy.

It is so painful at times that it often wakes him up in the night, sometimes as early as 3 a.m.

He is worried about it. And some days, he is tired. If you know Moise,  you know that the very last thing he is ever likely to do is to complain about aches and pains.

He labors with his arms, shoveling, and lifting, pouring and smoothing concrete,  and hammering all day, every day.

He never complains about hurts or wounds or anything to do with his body, and I’ve seen him fall right off a ledge. He is 50 years old.

For him to talk about this almost every time we meet is a strong signal that he is in great pain and is worried about it. Or maybe, it is simply that he can say this to a friend.

On the way to the bus station Wednesday, I asked him for permission to see if there was an orthopedist around who might take a look at his shoulder and help him with the pain. For Moise to say yes, I should look around,  was a profound act of trust and openness for him.

I believe this was his way of getting help without really asking for it.

He could have – and has – said no. And there would be enormous obstacles for him entering the American Health system, with all of its costs, insurance issues, appointments and bureaucrat steps, questions, medicines, and forms. to him, that would be far worse than shoulder pain.

It’s just not the way the Amish do things. It’s not the way he does things.

Yesterday, while he was gone, I spent a couple of hours on the phone calling hospitals and private practices and nurses that I know.

Everyone pointed me to the Saratoga Hospital walk-in orthopedic center, open seven days a week from 8 a.m. to 8 p.m. It seemed perfect for Moise. He could go without an appointment (I offered to drive him.) There was a sign-in fee of $100, but I know he can easily handle that.

And he could ask the hospital for help in paying any additional costs. If you ask them, the nurses said, they very often help.

The doctors would examine him, most likely take an X-ray, offer a cortisone shot if appropriate. They would recommend further action, including surgery, if the injury warranted it. Most off, unless it’s an accident or severe fall, the doctors try cortisone, a pain reliever that works in many cases.

It’s possible he could get a cortisone shot on the spot and be done with the pain for months, if not years.

There might be an MRI. The costs could add up.

This seemed the perfect option for Moise – he didn’t need to do anything but show up and ask for financial help if he needed it.

Moise, weary of any cost outside of the Amish community, peppered me with questions about what this would cost. And what cortisone was.

And how long the shot might last. And what was surgery like? And how long would the recovery be?

He was especially wary of  finding himself owing thousands of dollars for a treatment he knew nothing about. The Amish are forbidden to acquire debt. They pay for everything they purchase immediately, if they don’t have the money, they don’t buy it.

I said he would have to bring these questions to a doctor, not me. He would have to trust the system in a small and focused way. He wouldn’t need to see doctors all the time like me.

His stepmother had gotten a cortisone shot, he told me, and she said it was very painful and didn’t work; she wouldn’t get another shot. He was concerned about that also. The word of another Amish person carries more weight than anything I might say.

Money is a complex issue for Moise. He hesitates to spend a dollar that is not for something his family needs or their homes and barns and futures.

He believes he is obliged to help every one of his 13 children buy land and build houses and barns. That’s where his money goes, that’s what he works so hard for.

I was ready for his reservations.

I pulled over and read some research on my Iphone about cortisone. I told him exactly what it was and what it did and didn’t do. I also described the pain and damage he might suffer in his shoulder. that could bode poorly for the future.

My best suggestion, I said, was to let me drive you there. Talk to a doctor.

I’ll wait outside, and you go in with $100, I said.

You can explain your financial situation, whatever it is. I don’t need to know the details.

Saragota Hospital is known for its very generous financial assistance program; some people get treated for free or a fraction of what they usually pay.

When I called a nurse at the walk-in, she understood what the Amish can and can’t do; she’s seen some Amish patients. She knew Moise wouldn’t have an income tax form or a Social Security number and might ask for financial assistance (please, good people out there don’t offer any. That is not what he wants).

Why not just go and see what the doctor says? I asked.

If you don’t get this help, I added, you could one day lose the use of that right arm for any plowing or construction, the things you most love.  You’re too young for that, I said. And that would not be a gift to your family.

He said he worried about losing a whole day’s work.  This seemed like a small thing to me, but it wasn’t to him.

He was pleased when I told him they were open from 8 a.m. to 8 p.m. and anybody could walk in any time. “So we could leave the farm at 5 p.m. and get there by 6, and I could get in a full day’s work?”

Yes, I said, and you might have less pain in your shoulder as well. That could mean a lot more work.

Moise told me again on Wednesday that the pain in the shoulder is often so great he can’t sleep at night, and no sleep for Moise and a day 0f hard labor is a troublesome combination. He hasn’t slept the last couple of days.

He said, “I’m getting lazy, I guess,” but he was listening. He kept saying, “I’ll think about it,” but he kept returning to the subject, even when I dropped it.

I won’t pressure him about it any further. The idea is in his head.

Nor will I play doctor.

I know as I write this, people will send me a dozen or more treatments or cures or stories of no special relevance.

I won’t read them or pass them along. I’m not a doctor, and I won’t diagnose people online or  play physician; I’m just pushing for him to get to a real and see if there is anything inexpensive and straightforward that can be done to help him.

It is not for me to diagnose him or tell him what to do. My goal is to get him to talk to someone who can do those things. The rest is entirely up to him.

It is difficult for me to imagine any good reason to turn down this possibility to end his obvious pain. He’ll get a free ride to the walk-in, will probably only spend a few hours in the clinic. He will most likely get the opportunity to avoid surgery, perhaps for good, and can work with a hospital known for its good doctors,  generosity, and flexibility.

But of course, that is not the point.

The Amish are very willing to suffer for their beliefs and protect their family from us and our beliefs. They are rarely open to rejecting those beliefs.

One of their beliefs is that western medicine and its outrageous costs are a trap to be avoided. They know their survival depends on the simpler way in which they live.

They also believe we are meant to suffer as Jesus did; it is a holy offering in many ways, a sign of faith, a pathway to heaven.

Moise cannot imagine spending a lot of money on himself for any reason, even so, important a one. He will have to think and pray about it.

He says he would have no objection to taking his children to a hospital if they were very sick.

The Amish believe each of them is equal to every other one, and humility means thinking of others, not yourself. “Maybe,” said of his loss of sleep, “I’m just lazy,” he said again.  I didn’t say a word.

I believe in helping people; it’s what I do these days (I just got Fred at the Mansion some winter boots, he last bought a pair 20 years ago and was shocked by what they cost now.)

Moise did ask me many more questions than I expected. I could tell he was intrigued by the idea of going to a walk-in place, getting quick treatment, and feeling better. He lives for hard work.

I believe he will think about it and perhaps consult with his elders and friends. He said the Amish Church would pay the health costs of any Amish family who needs help. But he is a man of pride with a robust moral code, and he does not believe in asking for help.

I told him I was available any day but next week and any evening. He said what he usually says when he doesn’t intend to do something: “well, Johnnie Boy, thanks for that information. I’ll think about it.”

Most times that is the kiss of death. I didn’t get that feeling this time. So we’ll see how much pain he ends up being in.

As our friendship depends, the irony is that so do the things that separate us. I wouldn’t have dared to broach this with him a couple of months ago.

The friendship asks me to put my values and judgments aside and respect his. He would never urge me to see a doctor or go to the hospital, not if I was lying in the road gasping for breath. Once again, on the way home, he reminded me to make sure Maria knew that the

y are always there to help us, from digging out in the snow to hauling firewood.

That difference is what separates us and what divides us, the love connects us. What an exciting relationship.