An Immigrant's Heart

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

"Que te vaya con Dios," Ofri said to her, and then moved on to another patient.

"She was scared to tell me the truth, I could tell," Julia says now. But she was probably better than most at girding herself for bad news. Three months before she was admitted to Bellevue, her brother had died of cancer. Nine of Julia's 13 siblings had died of either cancer or heart failure. Her sister Carmen has endured two brain surgeries for cancer over her 11 years in the U.S.

And for seven years now, Julia has been waiting to die.

Baja Verapaz, a southern state in Guatemala, was riddled with violence in the mid-1990s. Salamá is the state's destitute capital and focal point for massacres of the Mayan people. Julia was born and raised on a chicken farm in Baja Verapaz, the eighth of 14 children. Her small kitchen in Greenpoint is a reminder of the past: It's decorated with pictures, pot holders, a clock, and salt and pepper shakers with images of roosters on them. She says they remind her of where she came from, creating a more pleasant version of Salamá. After completing sixth grade, she worked in a clothing factory. By the time she was first married, she had inherited her sister's bodega and worked as its clerk, hauling crates from trucks into the store. But the pay was lousy.

By the time she gave birth to Wilmar, she knew she couldn't stay in the war-torn country any longer, but she had to wait until he was older and save up money in the meantime.Several of her brothers and sisters were already in the United States.

In the spring of 1998, Julia walked for a month and 22 days to get from Salamá to Houston. She crossed the Mexico-U.S. border with 17 others, including two coyotes, or smugglers, whom she paid $5,000. "It was so terrible. There was always this feeling that I was going to die," she says. She packed three black shirts and a pair of black pants, and wore black Nike sneakers. "We walked at night, and we wore black to hide from Immigration helicopters," she explains. She survived off rancid chicken legs and drank whatever rainwater collected in holes in the desert. Three people were left behind during the trek.

"The coyotes told us that if you can't stand walking, we'll just leave you there." One woman was very large, and too heavy to carry. They moved on. Another man wore cowboy boots, and his feet were shredded. He was unable to stand up. They moved on. Another man drank saltwater. He began vomiting, and they moved on. "I don't know what happened to them," she says.

"After we crossed the Rio Grande, the homework started, they would tell us. We would walk day and night and we would hide from Immigration in trucks. It was very sad." At one point during the walk, Julia's knee swelled to twice its normal size and turned purple. She figured it was either a snakebite or a rat bite. "Eventually, you can't feel your legs," she says. Two smugglers carried her, but she begged them to take her back to Guatemala. "They said it would be more expensive to send me back than get me to the U.S." At another point, she was vomiting. Someone stole her fresh water at a rest stop, and she went without for days. When she arrived in Houston, she had head lice, she had tick bites, and her knee was useless. By the time she got to Brooklyn, she had no clothes except for the dusty ones on her back. She was bedridden for two months, eating pears and drinking coconut juice, she recalls with a slight smile.

Wilmar, her ill son, followed her three years ago. He was 12 by the time she had saved up enough to pay for him to come to the U.S. He was picked up and incarcerated in Texas, but her brother contacted a church that managed to negotiate his release. A deportation case is still hanging over her son, but Julia admits that she doesn't understand the legal details.

After her own arrival, Julia found a part-time job at a cleaning company contracted by Con Ed. In 2002, she gave birth to a daughter, Jasmin, the only American citizen in the family.

Today, Wilmar takes special education courses at school and says he wants to be a nurse. Jasmin, eight, prefers to read books and tells her mother she wants to become a writer.

"She's very, very smart," Julia says. She tries not to rely on her young daughter, who speaks fluent English, to translate for her when it comes to her medical case.

"Back in the 1980s, we basically used kids [for speaking to patients]," says Ofri. "Because the kids were the ones who were bilingual. Which is completely inappropriate."

Surprisingly, it wouldn't be impossible for Julia to end up with a new heart, even as an illegal immigrant. But it wouldn't be easy, either.

"Being undocumented, by itself, does not make a person ineligible for transplant," says Stuart Katz at NYU's Division of Cardiology. In a telephone interview, he explains that, in a case like Julia's, insurance coverage is crucial. He says that even if a heart transplant were performed, there are costs associated with post-transplant care that can overwhelm patients without insurance. "More than anything, we have to access how sick a person is," and base a transplant on blood type, body size, and urgency. Katz has advised a number of undocumented patients who can't afford the costs of a heart transplant. "I tell them, when they aren't too sick, 'You have to get documentation.' Sometimes, I tell them to hire a lawyer. I mean, unfortunately, a medical plea to the State Department falls on deaf ears."

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