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An Immigrant's Heart 

To survive the ordeal of escaping Guatemala, Julia needed a big Heart. But not this big.

Wednesday, Jun 30 2010

Page 3 of 4

Julia is trying to get her name on the list. She and her husband—a legal resident in the U.S.—are working with a social services lawyer at Bellevue to get the necessary paperwork processed. But it has already been nine months since they began the effort.

Eric Manheimer, Bellevue's Director of Medicine, learned about Julia's case a year ago. He's assisted her with financial issues and has expedited her paperwork so she can get Medicaid.

"Look, what isn't rare is that, as an immigrant, all your organs can be harvested. But you can't receive any? We don't have the statistics, but a lot of our patients end up being donors," he says. "I think there's controversy: Why should undocumented patients give an organ, when they can't they get an organ?"

Her doctors are not certain that she'll live out another year without a transplant.

Danielle Ofri's weekly schedule frightens some of the physicians in her department.

She rarely has a moment to spare, between delivering lectures on the changing demographics of patients and seeing the patients in her clinic, raising three young children, touring recently for a book (Medicine in Translation: Journeys With My Patients), and serving as the editor and co-founder of the Bellevue Literary Review. It's probably fortunate that only a couple blocks from the hospital is her home, where she relaxes each night with cello practice.

Born a New Yorker, Ofri graduated from NYU, completing a seven-year PhD and MD program while still finding time to travel. In her book, she writes about the challenge of serving patients from around the world who speak many different languages. Bellevue is known for its ability to handle New York's immigrant population and has an interpretation services department that takes up half of the hospital's fifth floor. The in-house staff can handle eight different languages, and telephone interpreters allow them to handle 73, at last count.

And that's the way Ofri likes it. In a lecture she gave to the emergency room staff recently, she said, "I hate it when patients are like me"—white, educated, and neurotic.

And she's not all talk. In 2005, she and her husband, a computer programmer, uprooted their family to live in Costa Rica for a year. But when she realized she was pregnant with their third child, "that threw a wrench in the works," she says, "but we decided to soldier on."

Ofri says she had always found Costa Rica to be friendly—"The culture is so warm and inviting," she says—but when she went into labor, she realized there was no one to leave her other kids with. "We literally had no one. [We had] neighbors, but we really didn't know them." The experience, she says, made her think about her patients' journeys to America.

"All the time I was not feeling confident that I could explain myself. I had to rely a lot on nonverbal assistance. I thought about my patients and how they are so sick and they are just trying to make themselves known."

An emergency Medicaid plan allows Julia to pay only about $22 a month for the 15 different medications she must take to lessen the symptoms of her enlarged heart. She picks them up at Bellevue, but since she's too weak to climb the stairs at the subway station, the hospital provides transportation.

Her weekly routine at Bellevue includes blood tests, questions from doctors, and meetings with social service workers and a heart failure group. She describes the group as an awkward meeting where her doctors gather and speak only in English about her heart. "I never understand what they say," she says. The hospital also provides her weekly with a psychiatrist in addition to her regular medical appointments.

Julia is always tired. Her older sister says she is "tranquil" from the pills she takes every day, but there is also in her a kind of resigned defeat. She is at risk of being deported, but only if she doesn't die first. But she speaks about her decaying heart as if it were another bruise on her frail arms—a result of some recent blood tests. The only time her face scrunches with worry is when she thinks about her children losing their mother. Then she breathes out a long puff of air as if to deflate her whole body.

Julia's long, flat hair is jet-black, without a fleck of silver. Her skin is golden and smooth, but she has dark circles under her piercing brown eyes. Her fingernails are polished and maintained, but her hands look aged and worn down. Her voice is high-pitched and slow, and her shortness of breath makes her sound a little choked up.

When she leaves Bellevue each week, she carries a brown paper bag full of medication refills. She's used to the routine: one pill to thin the blood, one to control the thyroid, another to control the water levels in the heart, two to maintain her blood pressure, another to help get to sleep, and a pill to control depression.

She also comes back with sheets of printed paper that describe her blood test results, her next appointment, the names of nurses who have poked her with needles. It's all in English. She and a social worker go over each one and she writes down translations where she can: Marzo instead of March, cinco instead of five.

"My daughter asks me, 'Why don't the other parents have to go to the hospital when they are sick?' " she says with tears in her eyes. "I have to tell her that someday, hija, I will have to go to the hospital and not come back."

About The Author

Shefali Kulkarni


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