paradox

Tomas came from Nicaragua. He has three children, the oldest of which is sixteen. He and his wife need more money to pay for her school, and it is not to be found anywhere around. So, he rode north, hidden in the bottom of a truck, to the Mexico-U.S. border. Then, he paid $1500-- an unimaginable amount of money-- to a "coyote," or human smuggler, and started off into the desert.

He told me this in our ICU last Tuesday, where he landed after a March cold snap brought snowdrifts, wind and rain to the desert. The brief report was:

36 y/o male, found down in a snowdrift
walking in the desert for 8 days
Diagnosis: diabetic ketoacidosis, rhabdomyolysis


"We walked for eight days," he said.
"Did you run out of food?"
"Yes."
"How about water?"
"Yes, we were out of that, too."
I asked him his destination. "I have family in Chicago and Houston," he said. I waited for more information, but he just looked at me.
"How were you going to get to them?"
"The coyote. He told me it wasn't far, he would get me there. That was part of the $1500."

Tomas was a relatively stable patient for the ICU, breathing effectively on his own and his heart properly delivering oxygen-rich blood to his whole body. The report said he was found in a snowdrift and brought to our hospital by helicopter. He says he remembers feeling terrible, and several members of his walking group being sick. There was a man who had a bad nosebleed and was also vomiting blood. It was very cold. He shut his eyes and went to sleep, and when he woke there was no one around. He started walking and found a highway. This was lucky because there are not many out in the desert southwest.

I took the best care I could of this man. He was receiving intensive care in a state of the art hospital. This was the same man who had to risk and nearly lose his life just to try to foot the bill for his children's school. Tears appeared in his eyes when he told me about his kids.

"This is the first time I've ever left them," he said quietly, staring at the bedspread.

His diabetic ketoacidosis was quickly resolved, and he turned out to have no damage to his organs from the rhabdomyolysis. As usual in our country, we were glad to give him a helicopter ride to the hospital, perk him back up, and then kick him out all on his own, with no resources. I apologized for the bad welcome to our nation, worked all day with the social worker on our unit to contact family in Nicaragua, and tried to get good calories in him. We had some epic international dialing sessions, trying to reach the right humans.

It's all about the rescue in our culture.... we invite, practically beg people to come here as undocumented workers with our daily practices and our standard of living, then force them to risk their lives and health getting here. We treat them as outcasts, and complain about them taking jobs we wouldn't want anyway-- at least not for that pay. We save them from death in the desert, or a gunshot wound from a border drug smuggler, then we congratulate ourselves and cast them off again to be forgotten along with the homeless and impoverished who already live here.

Last weekend, four humans were found dead in the desert. Likely cause: hypothermia, exposure. They may have been part of Tomas' group. Humans, trying to survive, feed, clothe, house, and educate their families. Dreaming, hoping, risking. It is not rare for us to have someone found down in the heat of summer, kidneys toasted thanks to rhabdo, and they get shipped back to Mexico just as bad off as before, only now they're dialysis dependent. In some places, it is a three day walk through the desert, at minimum. We are forcing our brothers and sisters to take these risks.

Tomas was one of the lucky ones. I was lucky to be his nurse, and be reminded that there are thousands of other humans on this same journey every day. I hope the compassion and interest I showed him were enough to sustain him until he could reach some semblance of home.