The Yale Journal for Humanities in Medicine    

An Immigrant's Tale

David Ennis, M.D.
david.ennis@bhsala.com

First, you have to remember that when I began taking care of Mrs. Garcia there were few Hispanics in the area. I suppose that there were a few living around the textile mills in the northern part of the state. But there were no tiendas nor taquerias, stores which have now become so common a part of the landscape that they are not really noticed. In most parts of the state, it was much as it had been for the past 200 years—you were either black or white.

An oncologist at my hospital was treating Mrs. Garcia for AML, administering one failing regimen after another. The drugs that she was given wrecked her physically and left her profoundly immune-compromised. She had lost her hair, and her mouth—and presumably her entire GI tract—were red and ulcerated. Her treatments and their complications resulted in her spending most of the year in hospital.

Given the scarcity of Hispanics in the area, Mrs. Garcia was perceived to be exotic and became a sort of celebrity in the hospital. The nursing staff, none of whom spoke Spanish, adopted her and would sometimes visit her on their off-days, bringing forbidden treats from their kitchens and glossy picture magazines. We physicians would torture her with our halting, “esta Susana en casa” high school Spanish, which seemed to impress the staff more than the patient. At least we felt better.

But there was something else about her, something that transcended mere exoticism. She seemed to spark some innate impressions of our own families’ pasts. We all had some image of men in caps and women in scarves staring through grainy fog at a grainy Statue of Liberty, as in an old New York Times picture. She became to us then an embodiment of the immigrant pasts—the young parent braving the vast unknown, moving to a strange and threatening land for the betterment of herself, but most especially of her family.

Despite her numerous admissions to the Oncology Unit for febrile neutropenia, I knew little about Mrs. Garcia. She answered most questions briefly or with a simple smile. She lay day after day in a dark room in one of the older parts of the hospital. Her window looked out across an asphalt roof at a brick wall. The room itself was essentially bare except for a mass-produced “sofa picture” of some vaguely Mediterranean landscape. On the shelf by her bed rested a photograph of a young girl, who looked to be about 5 years old. A crucifix with a bleeding Jesus stood nearby. The television was always tuned to the lobby channel, where she could watch others come and go as they visited their friends and relatives. Occasionally, someone would wave or make a funny face for some other patient somewhere else in the hospital.

Her AML remained refractory to therapy and the inevitable finally occurred. I came to hospital one morning to find her room empty: she had just been transferred to the MICU. There I found her intubated, restrained, and surrounded by the critical care team. Her blood pressure remained low despite all interventions. Her platelet count, already low, had plummeted and she was in DIC. Blood oozed from her nose, her rectum and from the array of tubes piercing her skin. As we struggled to stabilize her, the staff from the Oncology floor began to gather in the room.

She died. No one could prevent it. The nurses and a few doctors wept and returned to their other duties. No family was waiting.

Over the next few weeks, as new tragedies replaced the old ones, we began to forget about Mrs. Garcia. Some patients died, mourned by families and friends; most went home or somewhere. I suppose one could not dwell on the loss of a single patient, when one cares for so many desperately ill others.

Several months later, the physicians and the hospital began to receive letters from the insurance company. Our Mrs. Garcia was not actually the Mrs. Garcia mentioned on the insurance card. Our version had somehow assumed the real one’s identification. The insurance company wanted its money back.

We all felt angry, betrayed, taken advantage of. All of that time, sadness, and expertise wasted on a lie. Some swore never to take care of another Hispanic. Others were just angry. Negotiations ensued with the insurance company and a compromise was reached. I do not remember what it was exactly, but it involved some return of funds. Everyone seemed satisfied; everyone got some money.

Over time, the sorrow and the anger were forgotten, as was Mrs. Garcia. I never knew the woman’s real name. I never knew what happened to her body. Her family had apparently left and could not be found.  We had all wept for Mrs. Garcia. But no one wept for that young woman who died anonymous and abandoned in her blood-soaked sheets.

Published: September 11, 2007