1. Davis, Cortney MA, NP

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Milagros is an undocumented immigrant, one of many who come to the women's clinic where I'm a nurse practitioner. She has a Social Security card, but four other patients claim the same number. Last month, she called herself Milagros Lopez. This month, she signed in as Milagros Hernandez. One of the nurses recognized her. "Hola, mi amor," the nurse said in rapid-fire Spanish. "Pick one name and stick to it. You know we won't report you."


Five years ago, we saw few undocumented immigrant patients. Then, every month, the census increased. Now our appointment book overflows with the names of longhaired women who've fled Ecuador, Colombia, or Mexico, leaving everything behind to follow men who are convinced life will be better in the United States. Here, a man can earn enough to send money home. Here, a pregnant woman can get prenatal care.


Milagros was just hospitalized, now in her seventh month of pregnancy. Her blood pressure is out of control. Although she's stable, we can't discharge her: she has no permanent home.


Shortly after Milagros arrived in the United States, she discovered she was pregnant, and then her husband abandoned her. She sleeps on the floors of friends' apartments, moving every few days. She doesn't speak English, and she can't read or write Spanish. Her blood pressure might be stabilized with bed rest, but she can't quit her job-her friends can't afford to let her stay for free. She can't return to Ecuador either, nor does she want to. She hopes to give this baby what the three children she left behind don't always have: food, shelter, and medical care. Milagros has been on the maternity ward for three weeks.


If we release Milagros and her blood pressure becomes critical, we'll have to deliver her baby prematurely, then provide prolonged neonatal intensive care. If she doesn't have a legitimate address when the baby is born and ready for discharge, he or she will be placed in a foster home. We meet to decide what to do.


"We'd send any other patient home," the attending physician says. "Hospitalization is unnecessary and expensive."


"But if we discharge her," the chief resident says, "she goes back to work and her pressure hits the roof. She has to work in order to eat. Morally, how can we let her go?"


"Can't the visiting nurses help?" the medical student asks.


"Sure," the visiting nurse replies. "But she keeps moving. If we call, no one answers. She thinks we're the authorities."


At this meeting, I see Steve, a physician, whose family may have lived in the Irish slums of New York at the turn of the last century. I see Elena, a resident, who chatters on the phone to her family in Greek. I see Miriam, a nurse, whose ancestors were Caribbean slaves. And when my coworkers look at me, they see a woman with the pale complexion of Scottish, Welsh, and English ancestors.


And so Milagros lingers. If her pressure cooperates, she'll probably deliver around her due date. If she finds a friend to volunteer an address and telephone number, Milagros might take her baby home. But "home" will remain a series of stopovers in already crowded apartments. Her only alternative would be to find a new boyfriend to provide housing and food, at least temporarily.


After a while, she may know enough English to take the bus or read directions without help. Because her baby will be an American citizen and will receive welfare, Milagros will have some money for rent and food. Some day, she may send for her other children, if she has saved enough for their expensive, dangerous transport.


I've heard the complaints from others: that soon the only language we'll hear in this country is Spanish, that "illegals" like Milagros get services for free while citizens pay. But I don't know anyone who'd want to be in Milagros's shoes.


"It's like what my grandmother went through," my husband says. When she arrived from a Russian shtetl, his grandmother spoke no English and, along with Irish and Italian immigrants, she was marginalized by more established Americans. She raised five children; two became physicians.


I don't think Milagros should be discharged. I can't support the idea that she should be deported. I know that she's part of the latest wave of Americans, but I don't know how to negotiate the years between now and the future. Women of Milagros's generation will be the mothers of nurses and physicians whose skills will improve our country and who, in turn, will care for the next arrivals, whoever they may be. For now, I see Milagros, lying in her hospital bed, unable to communicate without a translator, and with no place to go. I can only imagine her walking out of the hospital with her baby, and I don't know how to help her.