Perspective
Pursuing the American Dream
By Cesar Emilio Ercole, M.D., with Therese Zink, M.D., M.P.H.
A medical student learns about the human side of immigration.
As I picked up my morning fruit from the doctors’ lounge, I noticed the headline on the front page of the newspaper: “Illegal Immigrant Kills Passenger and Injures Daughter in Car Crash.” The driver, Rosa Hernandez,* was a patient I had seen in clinic days earlier. She was now the unofficial poster child for advocates of tighter borders and better background checks in order to prevent “those people” from coming here.
As part of my third year of medical training, I was spending nine months in the small Midwestern town where Rosa was living. Born in Detroit, I had learned Spanish at an early age from my parents, who grew up in Argentina. The clinic and hospital to which I was assigned served a large Spanish-speaking population, many of whom were undocumented. My preceptor, Dr. Madison, is fluent in Spanish and has a reputation for treating all and his willingness to manage separate charts—one with the real and one with the borrowed names and birthdates of the people who walk through the door.
Like many Midwestern communities that were settled by Scandinavian and German immigrants, this community was adjusting to a growing Latino population, many of whom are employed by the local meat-processing plants. Immigration and Customs Enforcement agents recently descended on the town, claiming they were looking for illegal immigrants with criminal backgrounds. Many people didn’t believe them and stayed home from work and kept their children out of school. One patient told me that she hid a frightened friend in her attic for two days. We had five clinic cancellations. Latinos were afraid to be seen on the streets.
I met Rosa, a shy 33 year old, two days before the accident. She sat in the exam room with her shoulders tense and legs crossed, waiting for her annual physical. She made only intermittent eye contact when I first asked how she had obtained her borrowed name. After reassurances about my sincerity, she appeared to relax. Her eyes beamed intensely as she described how she had carefully saved money in Mexico, then 12 years ago, walked across the border to California and bought her Social Security number for $1,500.
She explained, “No hay buen trabajo en México, es muy difficile.” (There are no good jobs in Mexico, it is very difficult.) She had worked under her assumed identity, choosing to delay marriage and children until a few years ago when she had laid aside enough money and had secured a stable job. Now she had a husband and a 22-month-old daughter.
I asked her about returning to Mexico.
She vehemently shook her head. “No hay las mismas oportunidades en México para mis hijos como las que hay aquí.” (There are not the same opportunities in Mexico for my children as they would have here.) Unlike some of the other patients who were undocumented, she wanted to establish roots here.
We discussed the views some Americans held of the Hispanic/Latino population. “Es muy triste,” she said. “The media and people tend to focus on those who are doing bad things—the gangs, the drug dealers. They don’t tell the stories of the hard workers, those who give back to the community.”
Undocumented Mexicans do not see themselves as doing anything malicious, although they might establish a false identity and fraudulently obtain welfare. They see those actions as necessary in order to obtain a better life. No hay las mismas oportunidades en México.
Two days later, Rosa was admitted to the hospital after smashing her pickup into a storefront at the local mall. I checked on her early the next morning. The nursing staff had read the front-page article. Many expressed concern for Rosa’s daughter and her passenger, a few judged her. One said, “She should get life in jail for her irresponsibility.”
During our brief encounter, I had come to know Rosa as a kind and industrious person. When I pulled up her labs on the computer and saw that her tox screen showed a blood alcohol level twice the legal limit, I was disappointed. I had such hope for Rosa. Now, I could only imagine the impending consequences.
Three friends surrounded Rosa in her hospital room as she blankly stared out the window, a much sadder version of the woman I had met only days before. She had just learned that her companion in the front seat had died. Her friends asked me questions for her: When would Rosa be discharged? When could she see her daughter?
“I’ll check,” I said, happy to do something useful. Over in the pediatric ward, Rosa’s daughter sat quietly in her bed. Rosa’s husband, also Mexican, was helping her with breakfast. Concerned for his wife, he asked when she would be allowed to see their daughter. I called Dr. Madison, who arranged for Rosa to visit her daughter and husband before we discharged her home.
A few days later, Rosa had a follow-up appointment at the clinic to have her stitches removed. She remained apathetic and despondent. Her main concern was getting an excuse for having missed work because of the accident. It was evident she did not grasp the gravity of what had happened and how it would change her life. I warned Dr. Madison about Rosa’s naiveté before he joined us. Gently, he spoke to her in Spanish about what might happen.
“¿Qué?” she asked.
“You will probably be arrested and charged because of your friend’s death, the alcohol, and property damage,” he explained.
That evening, the police did arrest Rosa. She was charged with seven felonies, including vehicular homicide, and later was indicted on two counts of fraud for obtaining welfare under a false name. Now Rosa is viewed as one of “those people.”
“You hear the news?” my neighbor asked as we brought our trash to the curb. “One of those welfare defrauders stole my tax dollars to buy a pickup truck, then in a drunken escapade crashed it.”
As Rosa sat in jail, the local paper started using her real name, and citizens debated the pros and cons of illegal immigration on message boards and in public forums. The other day I performed a physical on Maria Lopez,* who told me about her recent journey across the Mexican border, another worker to fill the void of those who are gone. MM
Postscript: Rosa’s daughter was seen in clinic for her 2-year well-child visit by another physician. She was accompanied by her aunt, who is fluent in English. Under home environment, it was noted: “Mom in jail, dad gone.”
Cesar Emilio Ercole wrote this while taking part in the University of Minnesota’s Rural Physician Associate Program during his third year of medical school. He is doing a urology residency in Florida. Therese Zink, a professor in the department of family and community medicine at the University of Minnesota, assisted in the writing of this piece.