AS I DISCOVERED when diagnosed with cancer in 1993, one of the unexpected challenges of survivorship is negotiating complicated relationships with family members and friends who are suddenly thrown alongside us into unfamiliar territory. Let’s face it: The burden these loved ones carry into the unknown is pretty steep. They, too, must master the language and unpredictability of cancer and adjust to changes in our bodies and spirits, all while striving to ease our path through diagnosis and treatment.
Most patients readily acknowledge that the people in their support networks play crucial roles in helping them through their cancer journeys. But the story of A. Garcia, a 32-year-old woman living with stage IV inflammatory breast cancer in my adopted state of Alabama, has made me think twice about what it means for others to have your back when you most need it.
An undocumented immigrant from Guanajuato, Mexico, Garcia is undergoing treatment for advanced cancer at a time when many people argue that she has no right to help of any kind. Garcia was diagnosed in October 2011, four months after Alabama passed HB 56, the state’s strict new immigration law. Institutions that used to turn a blind eye to undocumented employees or drivers are now demanding compliance with the law. Surveillance on roadways and in schools and workplaces is pervasive.
Garcia and her husband are facing those consequences of the new law—Garcia lost her job in a chicken processing plant, and her husband lost his landscaping job—but they are also confronting a less-well-publicized penalty: A social security number is now necessary to verify a patient’s legal status and eligibility for health care. Local health centers told Garcia they couldn’t treat her.
Eventually, the persistence of individuals from Sembrando las Semillas de la Salud (Sowing the Seeds of Health), a cancer awareness program for Latina women, paid off: They located a health care facility an hour away that would accept Garcia as a patient. Garcia and her husband began to make their way once every two weeks for her chemotherapy, and if her cancer responds to that treatment, she will have a mastectomy in March 2012. The travel is risky, because the couple faces deportation if police stop them en route. But at least Garcia stands a chance of extending the time she has with her family. Her doctors have told her that she could live three and a half years with treatment.
For Garcia, returning to Mexico would mean giving up more than the treatment that offers hope for extending her life. She is not just a patient but also a caregiver. In August 2011, just weeks before her cancer diagnosis, she gave birth prematurely to her second child, who relies on a multitude of medical technologies to breathe and digest food. “Someone must be with my baby at all times,” Garcia told me through a translator during a recent visit to her small trailer home. The hospital staff instructed Garcia and her husband in how to care for the baby’s trachea, use her feeding tube and take care of her other basic needs. “But it is hard for me to remember all of this,” Garcia said.
Tending to her sick infant while fighting for her own life would be impossible without Garcia’s faith in God, the compassion of strangers at Sowing the Seeds of Health, and the strength of her family, including her husband, mother, sisters, nieces and nephews. As Garcia and I talked, a steady stream of family members filed into the next room to check on the baby and to offer reassurance by grasping her hands and cooing softly.
“It is hard with my wife and baby, a lot to think about,” Garcia’s husband told me, as his wife stepped away from the kitchen table to attend to their daughter.
While I was watching Garcia’s family, it was hard not to think about the support system that enveloped me when I was diagnosed with breast cancer. In 1993, I was single and in graduate school, living near my parents and engaged to the man whose support saw me through months of pain and uncertainty. And in 2004, when a second diagnosis collided with my busy life as a wife and mother of two young children, I relied on the help of coworkers, neighbors and members of my church to pitch in with child care and meals.
But the differences between Garcia’s story and my own are stark. My diagnosis in both instances was stage I breast cancer, and many of the challenges I faced were temporary. I feel overwhelmingly blessed that I had unquestioned access to the best health care, and that my caregivers—my family and friends—were, in turn, supported by others in our community. An atmosphere of risk surrounds Garcia’s family. Trips to the pharmacy or grocery store require contingency plans, should a loved one be stopped or fined, or worse.
I asked Garcia how she was managing her disease and her daughter’s serious health needs under these circumstances. She was calm and thoughtful. “I am scared, but I have no choice,” she said. “I have to do this to be with my babies and give them a better life.”
Garcia is clearly at peace when surrounded by her family and symbols of her Catholic faith. Fear and an uncertain future dwell outside her front door, but inside, Garcia’s extended family gathers on the sofa after a trying day. Garcia’s 2-year-old runs around the room with his cousins and rushes to his mother’s lap in a fit of giggles. Dinner is started, and the family will circle the table to pray and share a meal.
As I thanked Garcia and her family for opening their home to me, I thought about how crucial the embrace of the familiar is to surviving cancer—for both the individual who is diagnosed and our caregivers who help us navigate the cancer journey. Stepping into foreign territory, we hold tightly to one another. Never letting go.
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