Nicole Larson was the kind of person whose smile always made you want to smile back. It was only after a while that it struck you: She always smiled with her mouth closed.

It had been six years since Nicole last sat in a dentist’s chair, seven since her last full exam or X-rays. Childhood dental visits had been rare: Her parents’ low-wage jobs never had insurance, and after paying for rent and heat and food, there was rarely much left. As an adult, she worked long hours as a waitress and hotel housekeeper, but those jobs lacked insurance, too, and the meager pay always ran out before the month did.

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So Nicole learned to white-knuckle it through toothaches, popping handfuls of ibuprofen. She brushed constantly, rinsing with every oral rinse the drugstore sold. And she perfected a dimpled, twinkle-in-the-eye smile that always got a smile in return ... but didn’t require her to open her mouth.

But today all that was about to change. She had landed a new job -- still minimum wage, but this time with dental coverage. She sat in the waiting room, praying that today would be the day the pain finally stopped for good.

The dentist called Nicole into the exam room, poked and prodded a bit, and listed some treatment options. Nicole crossed her fingers.

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But then he stood up and shut her file abruptly, not even trying to hide his disdain. “Look, there are plenty of things we could do,” he said frostily, hand on the doorknob. “But if you’re just going to let everything go to hell like this, there’s really no point.”

And the door clicked shut behind him.

* * *

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It was nearly a year before Nicole even tried another dentist, too afraid of more humiliation, of being treated as if her condition was the result of some moral failing, instead of the logical outcome of a lifetime of low wages and no insurance.

But she couldn’t help wondering: What had made an otherwise nice, competent, community-minded, churchgoing professional suddenly morph into such a jerk?

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Americans, by and large, are a charitable bunch. Need canned corn for the food drive? Pairs of gloves for the church “mitten tree”? Dolls and bears for Toys for Tots? We’re all over it ... and we’ll probably give you three.

But our compassionate instincts have some blind spots, no matter whether we vote red or blue. It’s not because we’re heartless (well, usually, anyway). It’s rather because we so often don’t understand the back story to what we’re seeing, or the unseen factors in play.

The rude dentist wasn’t a cartoon villain; heck, most of the time he was probably a pretty nice guy. The problem was that he was utterly unable to imagine a life unlike his own, in which dental care wasn’t a given -- where if there are five things on the list of essentials and the money runs out after item four, you just can’t have number five, no matter how bad the pain. There was nothing in his personal experience to suggest the existence of such a life. He’d never imagined it, and no one had ever made him try.

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So he felt nothing when he crushed Nicole’s hope and pride in two short sentences; indeed, he didn’t realize he was doing it at all.

* * *

Fortunately, most of us are much more perceptive than that dentist. But there may be gaps in our experience that, despite our best intentions, leave us with blind spots about American families living in poverty. Here are a few things we may have missed:

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Hi, I’m right here

Maybe she wipes your child’s face at day care. Maybe he mops the floors at your church. Maybe she makes the beds in the hotel you stay at. Maybe he trims your shrubbery and mows your lawn. Maybe she lifts your elderly aunt in and out of her wheelchair each day at the nursing home.

Most middle-income Americans have no idea how many of the people around them every day are living in poverty. We think of “the poor” as only elsewhere, in inner cities or far-off trailer parks, anywhere but here. We tell ourselves that the poor are simply slackers who don’t want to work ... or that the only folks earning wages you can’t live on are teenagers working summers at McDonald’s, who will of course go to college in the fall.

But it’s not true. Fifty-seven percent of the families below the poverty line in the U.S. are working families, working at jobs that just don’t pay enough. They’re not teenagers, they’re not lazy, and they’re not somewhere else. (After all, if every McDonald’s employee is a high school student, how can I buy a Big Mac at noon on a school day?) These folks are childcare workers, janitors, house cleaners, lawn-service workers, bus drivers, hospital aides, waitresses, nursing home employees, security guards, cafeteria workers and cashiers -- and they’re the people who keep the rest of society humming along for everybody else.

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“Nah, it’s not for me! It’s for a friend!”

“Enjoy!” said the church volunteer gaily, heaving a large box of food into my arms. “That ought to keep your family going for at least a week!”

“Oh, it’s not for me,” I said quickly ... and then cringed because it sounded so much like a lie. (“No, really! It’s for a friend!”)

The volunteer smiled, nicely but skeptically. “OK ... well, have a good week.”

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Ironically, it really was for someone else, a nursing home worker I’d been urging for weeks to sign up for the food program. (I ran a small housing nonprofit serving low-wage workers for nine years, and we’d met through that organization. It’s also where I met most of the other people quoted in this article.) When she declined, I offered to pick up the food for her. How bad could it be?

So I was flabbergasted by my sudden, intense need to make sure that a total stranger -- whom I would never see again, mind you -- would not think I needed food from a food pantry.

But the nursing home aide was not surprised at all. “It kills something in you, no matter how nice they are,” she said. She’d been to one, once. “I hated it because I do everything I’m supposed to -- go to work every day, pinch pennies -- and still I had to stand there with my head down like I’d done something wrong, just because I make eight bucks an hour and it’s not enough. You feel so ashamed.”

Which is why the line at the local food bank is but a small slice of all the struggling families in a given area, she added. Most are at home trying to make a box of noodles last two nights instead of one.

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Unfortunately, the emotional toll of poverty is not limited to the food bank. Low-wage families often get dirty looks for using food stamps in the checkout line (which is especially galling if -- like many food stamp recipients -- you’re employed and just need a small supplement to make ends meet).

And they often work in jobs that don’t garner much respect in the first place. They’re treated as replaceable, invisible or both.

Think about it. Right now, you could easily name your doctor, your kid’s teacher and a prominent local business owner. But, quick: Can you name the lady who cleans your office? The school janitor? Any nurse’s aide in your grandmother’s nursing home? Any waitress or cashier, anywhere?

If you held one of the latter jobs, what would that mean for your sense of yourself, of how much you were worth? Sure, we all have days where we feel unappreciated at work. But most white-collar workers get at least the occasional nice performance review, bonus, or thanks.

But nobody ever praises a cleaning lady for polishing the faucets extra well, as Barbara Ehrenreich illustrates memorably in her classic book "Nickel and Dimed." Hotel housekeepers only hear from the boss if they’re suspected of stealing. Garbagemen have folks look right at them and not even see them at all.

Day after day, it has an effect, no matter how much confidence you were born with, or how much bravado you project. I remember sitting in the home of a hotel housekeeper as her phone rang and rang. “Do you want to get that?” I asked. “No,” she said, “it’s my son’s teacher.” “You’ll just call back later?” “No,” she said again.

At first I was flabbergasted (she’s trying to help your child!). But as we talked, I realized that, unlike a middle-income parent, she didn’t see the teacher as a peer, reaching out to discuss a matter of mutual interest. She saw the teacher as an authority figure -- another higher-up telling her she was “less than,” another boss telling her she’d screwed up, this time as a parent. What looked for all the world like apathy and defensiveness turned out to be a profound lack of confidence and a tattered sense of self-worth.

(After many more conversations, she did eventually call back, and I am proud to report that she regularly attends parent-teacher conferences. But I was struck by how profoundly I -- and, I suspect, the teacher -- had misunderstood her perspective.)

What you see is what you expect

When researchers at Princeton University showed two groups of viewers the same video of a little girl answering questions about school subjects, they told the first group that her parents were affluent professionals. They told the second group that she was the daughter of a meat packer and a seamstress.

The girl, named Hannah, performed right at grade level on the videotaped test, answering some questions correctly and missing others. But when asked about her performance, the first group, primed to believe she was wealthy, felt that she had performed above grade level. The second group, primed to believe she was not, felt that she had performed below.

It was the same video, mind you -- the same girl, answering the same questions in the exact same way. But their conclusions were totally different.

Sometimes we see what we’re looking for ... and what we’re looking for changes based on the context.

When a well-off child acts up in school, it is often assumed to be a health problem that requires medical attention or treatment. When a low-income child acts up, it is more often assumed to be “problems at home.”

“We eat dinner at the table at my house every night, I help them with homework, they go to bed every night by 9:30, and I take them to church every Sunday,” said Nicole, mentioned at the beginning of this article. “But when my son acts up and I have to meet with the school, that’s the first thing out of their mouths - -‘parenting problems,’ ‘problems at home.’ I hate that that’s their first assumption.”

Of course, sometimes maybe it is problems at home. But sometimes it’s not -- and sometimes middle-class and affluent families have family problems, too.

We have a similar double vision in other areas, too.

We want compassion and therapy for our friend whose depression spiraled into prescription-drug abuse, but expect the low-wage worker caught out by the loading dock with a baggie of Vicodin to be fired ... even though it’s the exact same thing. We call celebrities who drink and crash their cars “troubled,” but construction workers who do so “drunks.” Our society says middle-class seniors who transfer assets so they qualify for Medicaid nursing-home care are “just being practical” (there are whole legal practices built around helping them do it) ... but the thought of a low-income family doing anything to qualify for additional government assistance for food or heat or medical care makes us collectively lose our minds.

Somehow we are looking at the same situations, yet registering very different things.

The Ramen-noodle fallacy

In the living room of my first apartment, there was a mustard-yellow beanbag chair, a hand-me-down lamp and an ancient fake-wood-sided TV that made a loud kachunk when you changed the channel. I didn’t earn much, and joked that my unimpressive car could do zero to 60 in 10 minutes flat.

It could be tempting to say we “understand poverty” because of experiences like this, when we lived in small apartments or considered Ramen noodles a legitimate entree.

But it is not necessarily the same at all. A lot depends on what -- and more important, who -- is around you.

It is much easier not to panic about tight finances when Mom and Dad have a guest room you can always move back to (even if you never actually do). It helps if you have a medically trained friend you can call in a pinch, especially if you don’t have insurance.

It helps when Aunt Ginny can give you her hand-me-down furniture, or Uncle Bob will sell you his old but reliable car. It helps when there’s someone in your family who can advise you about applying to college or buying a home. It’s reassuring to know that, no matter how bare your cupboard, there will be a full spread of food when you go home for the holidays, and family and friends who can help you, standing in the wings.

All that stuff feels like background noise, right up until we stop and imagine what life would have been like without it. Sure, maybe we would have managed just fine regardless ... but maybe we wouldn’t have (and it certainly would have been more stressful).

It is one thing to be a brave, precarious little boat when you are surrounded by the Coast Guard. It is quite another when you are surrounded by boats sinking faster than you are, looking to you for help.

The magic belt that’s not so magic

The director of a New York nonprofit was sitting in a conference room, listening to her well-heeled board members talk about the organization’s low-income clients. They just need to tighten their belts! they kept saying.

“Yet all these women were sitting there with Gucci handbags that cost more than the clients make in a month,” the director recounted later. “And I thought, ‘You guys are going to lecture them about unnecessary spending? Really?’”

One can counter, of course, that you get to buy luxuries when you have the resources, which is true. But it does not necessarily follow that if money is tight, the only possible explanation must be your wild and irresponsible spending.

It might just be that there’s not enough money to start with.

I’ll never forget the first time I sat down with a nurse’s aide who was struggling financially, confident that with some commonsense “belt-tightening,” I could get her budget back on track. Just few minutes in, I started to sweat. She already shopped at Aldi and the Salvation Army. She had a pay-as-you-go cellphone, just for emergencies. She set her thermostat at 63 degrees. There was nothing to trim.

And when I added up her expenses and subtracted them from income, the resulting figure was $3. $3. The entire financial cushion of a woman working full-time at a societally useful job in the richest country in the world was less than the cost of a gallon of milk.

I was speechless.

She read my expression and smiled wryly, forgoing the “I told you so” I so clearly deserved. “I can’t ‘tighten my belt,’” she said quietly. “There is nothing left to tighten.”

There’s no give in the finances of a low-wage family: no margin for error, no wiggle room to account for the inevitable vagaries of life. Each day is spent tiptoeing along the edge of a canyon, knowing that the slightest breeze could push you right in.

Things that seem fairly minor to middle-income families -- an unexpected car repair, a high heating bill during a cold snap, a trip to the E.R. when little Connor breaks his arm -- are cause for total panic, because there’s no cushion to absorb them. Pay for that car repair and now there’s not enough for the light bill; forgo the light bill and now there’s a late fee; pay for all that and now there’s not enough for the rent.

It takes almost nothing to start a real avalanche.

My head started to hurt. People sometimes say folks are poor because they make “bad decisions,” but she wasn’t doing anything wrong (and society needs nurse’s aides, after all, so it seems reasonable to hope you could be one without worrying about starving).

What’s more, I could think of many middle-income and well-off people who’d made “bad decisions” without spiraling into poverty; the difference was just that they’d had the resources to fix them. (They could afford counseling and medication for the depression that sparked the alcohol problem, pay off credit cards just by trimming back on vacations and eating out. They could go back for a second semester after partying and flunking out, because it hadn’t taken their entire life savings to get them there for the first.)

But she had no cushion. There could be no surprises. She could not make mistakes. And she had to lead her life on the edge of a cliff -- holding her breath, trying not to panic, calculating tradeoffs about even the smallest expenditure -- every single day.

I had never realized that simply being poor, even on a good day, was so utterly exhausting.

Of Mickey D’s and cable TV

In the years I spent working with low-wage families, I realized that they were not struggling because they ate at McDonald’s or had cable ... but sometimes they ate at McDonald’s or had cable because they were struggling. This is an important distinction.

If you are a single parent working for low wages, you do not shop for fun. You do not go to the gym, go to the movies, remodel the kitchen, take a road trip, visit amusement parks, build a deck, go skiing, join a swim club, or sign the kids up for dance class.

Why? Because all of those things cost money, require items that cost money, or require a car reliable enough to go long distances. Your fun is limited to things that are nearby, cheap or free, that you can do after work when it’s dark and you’re exhausted, while supervising your kids at the same time. Other than reading, that sounds a lot like TV.

And while of course it’s cheaper and healthier to eat every meal at home, what if you’ve just worked 12 hours scrubbing hotel bathrooms, and the nearest grocery store is a bus ride away? Or what if it’s little Bobby’s birthday, and a Happy Meal is the only treat you can afford?

“What I had not understood until I found myself in true poverty is that it means living in a world of ‘no,’” writes Alex Andreou in the Guardian. “Ninety-percent of what you need is answered no. Ninety-nine percent of what your kids ask for is answered no. Cinema? No. Night out? No. New shoes? No. Birthday? No.

“So if the only indulgence that is viable, that is within reach, that will not mean you have to walk to work, is a styrofoam container of cheesy chips, the answer is a thunderous ‘YES.’”

Obviously none of this is cause to eat fast food every night or buy the fanciest cable package on the market -- and conversations about these expenses are worth having, respectfully, with struggling families. But sometimes choices that seem foolish from the outside make a lot more sense from within.

* * *

There are many prescriptions for combating poverty, but we can’t even get started unless we first examine our assumptions, and take the time to envision what the world feels like for families living in poverty every day.

“Compassion is a skill that we get better at with practice,” writes theologian Karen Armstrong.

It just takes a little imagination.