Two little girls, two similar paths to medicine, but one difference: immigration

I’ve been thinking a lot lately about two little girls, one 6 and the other 8.

Both girls came to America with their parents, who were looking for better opportunities in health care. Both girls watched their parents navigate the American health care system — in one case, as a patient in need of advanced medicine, and in the other, as providers in a profession uneasily reliant on immigrant doctors. Both girls took those experiences to Harvard, and then medical school, and finally, residency, serving patients from disadvantaged backgrounds.

We’re basically the same, Raquel and I. We’re both American. We really don’t know any other country as our home. The only difference is that my family had visas, and then I became an American citizen. Raquel’s family didn’t.

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Earlier this week, President Trump moved to end DACA, Deferred Action for Childhood Arrivals, an Obama-era policy that allows undocumented children who came to the U.S. with their parents a deferral on deportation and the ability to work. On Thursday, he tweeted that DACA recipients have “nothing to worry about” — for now.

For all of those (DACA) that are concerned about your status during the 6 month period, you have nothing to worry about – No action!

— Donald J. Trump (@realDonaldTrump) September 7, 2017

But Raquel is a DACA recipient, and she told me on Wednesday that she is worried. How could she not be? If Congress or the president doesn’t act, her career is at stake, and our profession could lose the work of yet another primary care doctor.

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“Though it is concerning, it sucks more for the communities rather than the actual applicants,” Raquel told me, referring to the financial and emotional stability that children like her provide for their communities.

True to her childhood experience, Raquel chose family practice for her residency, partly because she wanted to do it, but also because the residency can be completed in just three years, so the likelihood that she might not finish because of immigration issues was lessened.

The president’s decision threatens to derail even this safety plan. DACA gives her a renewable work permit, and it expires just before her residency ends.

Raquel and I matched into residency the same year. I’m asked multiple times a week about my plans for my career. Raquel’s dilemma has made me realize that my ability to freely design my own destiny is a luxury, one she said the ticking clock of her immigration status doesn’t afford her.

Without DACA, or something akin to it, she may lose her right to work. If she doesn’t finish her residency, her options in the U.S. are limited. If she has to leave the country, she said she worries more about who she’ll leave behind.

Raquel is frustrated. Her immigration status is always in the back of her mind, she said. She has little faith in the government she reluctantly trusted when DACA was put in place, when she handed over all her personal information for that work permit, for that residency, and for the ability to become a doctor in the only country she’s ever known.

“I want to devote as much time as I can to the patients, and the work that I’m doing, and this is always happening on the side,” she told me at the end of a long evening in a mobile clinic in California, where she is based. We talked about the DREAM Act, legislation that would lessen immigration uncertainty for her and so many other medical students. It’s been bouncing around Congress in one way or another since we were in junior high. “Congress has had 16 years to work something out. I would be shocked if something were done in the next six months.”

Becoming a doctor is one of the hardest things I’ve ever done. The demands of education and training have dominated my near 30 years of life and I can’t imagine being so close to the finish line and then being disqualified at the last second. It makes no sense on both an emotional and practical level.

DACA recipients, also called “dreamers,” and undocumented people in the American health care system contribute to our nation in immeasurable ways, not the least of which is community health, Raquel’s calling. When it comes to people like her, I can’t help but wonder why America is trying to bite the hand that heals it.

Raquel is unsure what comes next. Should nothing be in place for her to renew her work permit, she’s hoping the hospital she’s working for, and her residency director, will help her. She told me, “I would be willing to work for free to finish.”

I really admire her. Raquel was one of the first undocumented medical students to match into residency under DACA. She has really pioneered uncharted waters. And she recognizes that it’s a bit of luck and timing that she happened to qualify for DACA in the first place — other children of undocumented adults, she said, for whatever reason, aren’t protected, and they should be.

To that end, she’s started a nonprofit called fundscholar.org to help other students caught in immigration crosshairs get to where they want to go, or, she said, “just to have someone be supportive … that is important.”

She’s so right.

Two little girls came to the U.S. with their parents. Both saw the role of community medicine in building health. Both lived in a country that expected more from them as women of color than other people, and both rose to that challenge. Both have struggled to find support in a medical system still trying to be more integrated, diverse, and inclusive. And, both have made it their life’s work to give back to the people in this country who need help the most.

Yet, I get to pursue my dreams without fear of having to leave suddenly. I get to go to work each day, focused on my patients, focused on their health and well-being, and focused on becoming the best doctor I can be. I get to be an American, all the time, without question. Because of security I get from holding a U.S. passport.

Something here just isn’t healthy.