by Nick Farriella

Esme was a charity care worker or “charity care officer” as she’d like to call it when discussing her job with relatives at family functions. She’d been doing it for twenty-two years, approving or denying thousands, if not millions of people Medicaid or health care assistance. At first, she felt like her job was a public service that she, an immigrant herself, was helping her people get the medical attention they needed. But now, a seasoned American citizen, Esme felt more like a gatekeeper, a guard of America’s wealth. How things change.

Esme has been suffering from panic attacks lately. Call it menopause, or hot flashes, or low level anxiety since her twenties, but whatever you call it, Esme has had to rise from her desk chair, stagger across her office gasping for her breath, and turn over the deadbolt on her door. The simple click was a quick relief. Next came crouching behind her desk and hyperventilating into a brown paper bag until her breathing settled, her heart rate lowered, and the world aligned with itself again. She remembered thinking, briefly during her first panic attack, it was as if the uncertain state of her home country of Colombia had found its way into her mind and took a small bite. Slowly, this anxiety ate at her, until she felt it had consumed her thoughts entirely. Even her office—a small, broom closet-like office in the basement level of St. Katharine Drexel’s hospital—had felt as if it were shrinking, closing in on her to the point where it felt her ear was steadily against the door and with each knock of a new patient, came a dreadful thud of panic.

Her husband, Paul, a gringo always comfortable with the ground he stands on, had told her to relax, to chill out. But honestly, Esme thought, Callate la fucking boca, because she hasn’t been able to chill out since she left Colombia in 1978.

When Esme decided to tell her son Jorge about the panic attacks, on the phone while attempting to eat her lunch at her desk in between patient visits, spooning the refried bean casserole into her mouth while tears hardened in streams on her cheeks, she expected that he would offer her some type of console. Instead, his voice cracked and quivered. Panic attacks, Mija? His worry had made Esme worry; anxiety over anxiety, the loop continued.

It was usually after lunch when Esme would find herself feeling sluggish. It was easy to blame the greasy cafeteria food or the three to four hours of attempted sleep where she was half conscious, hearing her heartbeat in the canals of her ears as she tried to drift off, but the thing that depleted her energy entirely was the fact that she was tired. She was tired of seeing patient after patient, always wanting something from her. Whether it was a pregnant Muslim woman, dressed in a burka, who traveled from Saudi Arabia to New Jersey to have her child be born an American citizen; with only eyes looking back at Esme that said, “You better make this happen, white woman, or it will be your life,” or the slender man from Nigeria with gorgeous facial features, dazzling jewelry, and a royal complexion, that refused to look at her because she was a woman. She imagined him lifting her off the ground by her throat and sliding an elephant’s tusk through her chest if she denied him Medicaid. People assumed, because she was on one side of the desk wearing a suit with an ID badge around her neck, that she wasn’t one of them, that she was simply some white bitch.

“It’s mentally exhausting,” she had admitted to Jorge over the phone one night, pouring herself a glass of wine.

The job wasn’t like this at first. In the late nineties, when Esme had just graduated from college at thirty-eight, she would proudly say, even before a drink, with all seriousness, “I love my new job.” That, she did. She loved all the different kinds of people who would come to her with their illnesses, their flaws, and she was the one to fix them. Well, not actually do the procedure, but she at least got them through to the next round, as if she was an interviewer or a talent scout. The patients would knock on her door, enter with sunken eyes of helplessness, and she would be sitting behind her desk, back straight and sincere smile, and think something like, “No need to frown, dear human, there is hope. This is America and you are in good hands. Now let’s see what you’ve got.”

What a wonderful time that was. A time when patients would offer her gifts, bracelets, fruit baskets, even cash; which she always denied. The smiles she accepted, the gracious stamp that another good deed was done, another person saved. Gratitude was always enough.

What had changed?

It wasn’t her drinking. She always kept that in moderation with the help from a doctor’s opinion that one to two glasses of red wine per day helps keep the blood pressure down and the overall health up. So, what was one more extra glass going to do? She still went to work every day, she kept her son and her husband fed, the house clean, the laundry done. It was definitely not the wine.

She wondered if it was her that had changed. At times she would stare at herself in the mirror and think, “Has my skin always been this white?” Her hair, chemically straightened and blonde, opposed to the voluminous dark curls of her youth. She sometimes would cry and think of her home country. It tore her up to realize that she had been in the United States for almost thirty years longer than she was in Colombia. “That seems like another life,” she once admitted to Jorge, before any wine was had at all.

It was another life. Life on a farm for the youngest girl of 4 sisters and 6 brothers was not easy, a life where she had to give up a childhood for work and routine. Every day felt like a life in itself; born into a task to retire by dusk. This was all she knew. She was the dirty farm girl in school with a big nose and crusty ponytails. Her friends were the animals on her father’s farm, not the kids that picked on her because of her smell or her rotten shoes. After a long day of farm chores, school, then house cleaning, she would welcome the death of sleep each night. It was there where she would dream of a foreign place; one where she felt like she belonged, one that didn’t feel like a struggle to exist in, one that looked like America in Time Magazine.

Often, usually on nights when Paul was away on business trips, she wondered if it was the distance from who she was to who she is that broke her apart, like two continents splitting and drifting away. Over time did she erase who she was to be who her new country wanted her to be? These were questions that a fourth glass of wine would bring up, which Esme never poured.

What had changed her job was the change in the country. Prior to 2008, her patients were mostly immigrants from Mexico, undocumented workers who got hurt on the job or pregnant women who had been in the country illegally for years. This was no problem, they needed help. She would file the proper paperwork along with her stamp of approval, to ensure these people got the best health care that was available to them. They were survivors just as she was; hardworking, kind people, who one day will seize the opportunity to become legal citizens, just as she had. But for them, there was always a nasty tooth, a broken femur, or an unexpected baby in the way of that goal. It was Esme’s job to keep them on that path, a path to freedom. This is what she loved about America, its dutiful responsibility to immigrants; that you can come here and belong, that after bubbling in George Washington as the first president on a Scantron test, you will be accepted.

After 9/11, this ideology would change in a devastating way. It seemed foreigners were not to be trusted, but vetted with a nationalistic scope of judgment. This seemed to be a global sized problem, an issue to be worked out over time by future presidents and world leaders. How was it possible for Esme, in the charity care department of a Catholic hospital, to end up with a small scope of judgment herself? It started with a change in her patients, then a change in Paul to cause her scope to grow in size.

It was in early 2009 when Esme started to get an increase in volatile patients. The outbursts were nothing new; this part of the job was expected when someone’s health was on the line. It was the knife that was new, pulled on her behind a closed door. Luckily she had a panic button beneath her desk. After the knife, it was spitting. She had been spat on by all races. People denied healthcare because of expired visas, criminal records, or because they already received a certain amount of money for their last child, their last surgery, their last visit to the ER. After spitting came death threats, not just to her personally but to the country of America. “No wonder why they bombed the towers. They ought to do it again,” a woman had said. Esme froze and felt offended. She had lost a friend in 9/11. It was hard to hide her smile as she stamped DECLINED on the woman’s application, as security dragged her out.

At times she didn’t know who to blame, so she blamed Paul. After all this time he still didn’t understand her. It didn’t help that he naturally rejected anything Hispanic. “Turn that crap off,” he’d groan, when Esme would play Salsa music while mopping the kitchen. “This is disgusting, I’m ordering pizza,” he said, pushing away the plate of Bandeja Paisa, a famous Colombian dish of red beans cooked with pork, white rice, ground meat, chicharron, fried egg, plantain, chorizo, arepa, hogao sauce, black pudding, avocado, and lemon. One may ask, who would tolerate this? Well, Esme saw in Paul what she saw in America. She saw his dark history, one of liberation, misguidedness, racism, triumph and glory, but what she saw most was great potential.

At first, her marriage with Paul marriage was good. Paul was a good man, a man full of life. He was always laughing. They met when they were both nineteen. Paul would play his records, they would smoke some pot.  Esme would sit in silence, admiring his grandiosity. He was big, he was strong, and he was American. He was a hard worker like she was and had great taste in music. Esme would attest to learning English from Paul’s Led Zeppelin collection. They were married by twenty-two. That was thirty years ago, now. And much like the state of race in America, Paul hadn’t made the changes necessary to accept Esme as an equal. Paul could never really grasp the idea that Esme was from a different world. To him, it was as if she was from a small suburban town similar to his, just one that was too far to drive to. When Esme brought him to Colombia, the first thing he said of Bogota was, “Oh, it’s like a shitty New Brunswick.”

Over time it was these micro-assaults on Esme’s ethnicity that built a wall between them. Esme felt like a foreigner in her own house. As the news became more intense, more polarizing, Paul grew angry and cold. He no longer laughed with her. He no longer reached across the table for her hand at dinner to look at Esme with his wide green eyes to say things like, “We’ll make it happen together.” She no longer saw potential in him nor sought comfort in his words. She only heard his outbursts, as if every single person who comes into the country to use America’s services for their benefit was a personal attack on his character. She became an attack on his character. It showed in his flushed face, in his salivating mouth.

“Es, are you kidding with that shit? Do you really believe that America could be just this open door mat? Get a grip.”

Esme would sink into herself like a turtle and mutter to herself that he just didn’t understand.

Maybe it was her too that didn’t understand. Maybe this is how it was. She understood that getting older brought opportunities to become someone new, but she could never adopt new things like going to baseball games, using credit cards, and celebrating the Fourth of July with tequila shots and a stars and stripes bathing suit. She struggled to learn that a good patriot is loyal to her country. Even though no matter where she was from, America was her country now, her home and she was incredibly lucky to have that. She’d relinquished her past and wanted to believe that made her strong. She just could never see, not even in the cards of her fate, that she would eventually tolerate knitting besides an American husband, as he drank beer and watched Fox News. It was impossible. And as Esme struggled to accept this, the further away she felt from it all. It was as if America was some bus that she had missed, and Paul was the driver.

Slowly over time, Esme began to hide her ethnicity from her husband, as if it was a secret lover or a private smoking habit. She would play the Salsa or the Cumbia while in the car or in her headphones at the gym. She would enjoy the foods of her country only on Sundays with her son. But eventually, she would go to the gym less and less, her headphones would lay dormant in her nightstand drawer, and Jorge would go off to college.


“This is the new world,” Paul was saying. They were on the couch, watching TV together. Esme had just finished making hamburgers. Fox News was running a segment on immigration about how illegal immigrants “drain” the healthcare system. “It’s time to close the borders,” Paul declared.

Was this true? Esme thought, sipping her wine in distress. The more she sipped, eventually finishing her glass, and then the bottle, it started to make sense to her. It gave reason to the influx of volatile patients, patients who seemed ungrateful.

“It wasn’t like this for me,” she blurted out, sort of snobbishly, the way older generations speak of younger ones.

“That’s right,” Paul agreed.

“I struggled,” she said.


“I never took advantage of the system like this.”

The next day at work, Esme had her first panic attack.


That was six months ago. She tried therapy, but was put off when having to talk about her childhood. Some scars just run too deep. The death of her father at age six. Being raped at age thirteen in Medellín. The loss of her mother at sixteen. She couldn’t understand how things that happened fifty years ago could ever impact her now, especially in her new country. Paul said that she had a point. Her primary care physician agreed and went the scientific route, the biology behind it all.

“It’s clear that your hormones are at play here; menopause, along with your history of anxiety. Is your job very stressful?”

Esme contained her laughter.

“Doctors are quacks,” Paul said later that night, flicking on the TV, “Have another glass of wine.”

By this point, her and Paul were like two passing ships. The idea of sitting with him as he consumed his media repulsed her, so she retreated to her bedroom to text her sister in Colombia using an app that doesn’t charge long distance through Wi-Fi.

Hola, it’s been awhile, what’s up?

It was strange to her that even now, after all these years, she and Rodika spoke to each other through text in English when Spanish came out naturally over the phone and in person. It was as if Spanish was strictly reserved for intimacy.

Hi!!! Que Paso…

-Not much. It’s just me and Paul. Jorge is back at school. How’s everything?

-Wonderful! We have new chickens :^)

For some reason, Rodika always correlated the wellness of her life with the stock of her farm. This made Esme miss home and jealous of the simplicity.

-Question… have you ever had a panic attack before?

Esme felt foolish for having asked this through text and wished she never did. She wanted to delete it, but Rodika started typing.



Rodika would start typing then stop, building the suspense. Esme hoped that a break in connection caused her last text to fail before sending.

-How are the kids? Esme sent quickly.

-Of course I’ve had panic attacks Mija. We all have. Have you tried meditation?

Meditation to Esme was for hippies and Buddhists. She didn’t understand how sitting in silence, legs crossed like a pretzel, could relax the mind. What does that even mean? Relax the mind. Anytime Esme closed her eyes, it was as if she could feel her thoughts whooshing by in her head. She could never sit still listening to all of that chatter.

However, with help from a few Facebooks posts, shared by Rodika, Esme found herself using an iPhone app to assist her with guided meditation. The first session was for ten minutes. Esme put on stretchy pants to signify that some type of exercise was about to be done. She shouted out to Paul, “I’ll be in the basement for ten minutes doing some yoga.”

“Whatever,” he said.

She wondered why she felt like she had to lie and thought that that wasn’t a very good start.

Esme sat on the faded beige carpet next to the broken treadmill that had old winter coats thrown across it. She sat as legs crossed as she could, feeling completely ridiculous, feeling like a child in time out. She followed the instructions from the soothing voice in her earphones; focused on her breath, let thoughts come and go. She was surprised that for about fifteen seconds out of the entire session, her mind seemed to be thoughtless. She decided to meditate again the following day.

The next morning at work, Esme was twisting her hair behind her desk, trying to focus on her breath. She was waiting for the next knock on her door. The previous patient was a pregnant woman from Dubai. She had brought along her husband; they were expecting twins. They were approved for Medicaid and when they received the amount due, $14,676, the husband said, “I cannot pay this. This is absurd.”

“I do apologize, Mr. Antar,” she said.

He seemed stunned.

She apologized once more.

“I’m sorry, Mr. Antar. It shows here that this is your fourth Medicaid request and that you have been approved twice before. It seems that you were able to pay your last amount due with no problem, in cash. There’s nothing else I can do.”

“Fucking bitch,” he said, then spat across her desk.

As soon as the door slammed, Esme felt her breath escaping her. She could feel her heart hammering inside of her chest, feeling it pulse in her neck and her arms. She began to sweat and lose focus visually. Her office felt like it was melting away.

Despite her racing thoughts, Esme tried to follow the meditation guide: focus on your weight in the chair, feel your feet against the floor, concentrate on your breath. How does one focus on what they cannot catch? Inhale on one, exhale on two. It’s like trying to chase the wind. Her eyes gaped with fear, her ears felt nearly closed, until a knock on the door brought her back.

Knock knock.

A couple entered, slouching over to the chairs at Esme’s desk. They had a skittish demeanor, the way one can scrunch in the presence of someone of a higher class. They were Hispanic. The woman was small, slightly wounded looking with a youthful face. The man was rugged looking, dirty with sunken eyes. He was missing his left hand. Esme, coming down from her panic attack, was unimpressed. She had seen it all and by now she was numb to it.

“How may I help you?” she said.

“We would like to apply for charity care,” the woman said.

“The two of you?”

“For our daughter. She is sick.”

Usually she doesn’t like to hear patient’s stories. It puts an unnecessary context to the entire process and the last thing Esme needed was to feel guilty for denying someone their coverage. An application was enough. Medical history, immigration status, financial status; these were concrete things attached to no emotion, but the woman went on.

“We are from Nicaragua,” she said, in clear English.

“I see,” Esme said, “undocumented?”

The couple’s eyes found the floor.

“Yes,” the woman said.

“Have you filed for a green card?” A Diversity Visa?”


“Unfortunately, I cannot assist you until the proper paperwork has been filed.”

This is when Esme expected the spit, the knife, or the cursing. Instead, the woman leaned in close and spoke in a direct manner.

“It took us twelve days to travel here by train. You see, our daughter was awoken in the middle of the night with a fever and a deep cough. We figured she had caught a cold from school. It is winter in Nicaragua, the temperature sometimes drops suddenly. It affects our farm, we farm sugarcane.” 

Esme began to focus on her breath, listening with half an ear, more so concerned with how much longer until the end of her shift.

“The fever no passed even after a full day. I spent all night at her side, patting a soaked towel on her forehead and rubbing menthol cream on her chest. This went on for two more days. We went to the village doctor. After a day of tests, he was sure she had cancer. He referred us to the shaman for prayer and a dose of pills.”

By this point, Esme was studying the woman’s face. She was looking into her eyes thinking, “Okay, what else? My first three patients this morning were children, all under the age of two, all with terminal cancer.”

“We did not want our daughter to suffer anymore. We knew that she needed the best health care. Cruz, my husband,” she said, “had heard that America was advanced. There were surgeries, better tests, more certainty.”

“That was when I made a deal with the Devil,” Cruz said in Spanish, lifting his left arm in the air, showing a curve of skin and stitches where his hand used to be.

This had struck a nerve with Esme; it had broken the rhythm of her breath and allowed a flood of thoughts to enter her mind. She was always quick to assume that missing limbs, like scars, had stories behind them. When her uncle had lost his foot from gout, he said it was because he danced with the devil for too long. Did the Devil always take limbs?, she wondered, then started to listen to Cruz with intent.

“My cousin knew a route to America, a freight train that went from Nicaragua to Mexico City, then Mexico City straight through to Texas. It was called The Beast.”

Esme has heard of such trains, they were almost mythicized, where hundreds of immigrants would board the train, sometimes tucking themselves underneath the beams below the freight cars, but usually laying on the roofs like excess baggage thrown above for convenience. She had heard that a lot of people had died before getting into America, some struck with illness or starvation, some were sucked under the train in motion, and some were even murdered. She compared this to her migration to the states, a coach flight from Bogota to Miami.

“We met a man in the Mexican desert who went by the name of El Diablo. He said for one-hundred thousand pesos he could get us a spot on the train to get us to the U.S. border. From there, it was up to us. At the border, the train running at full speed, a man with a bandana tied around his face like half of a mask, blew an air horn. That meant it was time to jump. I held tight around my wife with our daughter between us and leapt into the darkness, directly into the hands of God. Aminta and Lana landed in some shrubs; they were scratched up, but no serious injuries. I smacked the desert ground so hard, my teeth rattled, my hand was badly broken.”

By this point, Esme was one with her breath. She was a vessel being filled with her surroundings. When Cruz explained the eighteen mile hike out of the desert, the infection, the amputation, the train ride from Texas to Chicago then to New Jersey, Esme was full, bursting with emotion. She heard this story and saw herself alongside Cruz, Aminta, and Lana on their journey. It’s the sacrifices we make that mark us for eternity, Rodika posted to Facebook after their text conversation. Esme understood it, and even hit “like.” It was the result of these sacrifices that was left unknown. Had Cruz sold his soul, exchanging his hand for his daughter’s health? Unfortunately, she still had to deny them coverage. They had none of the right paperwork, and their only U.S. residency was Cruz’s cousin, who had a criminal background of theft and arson. So, what was it all for? All of that sacrifice just for an opportunity?

When Esme saw what she had given up for her life of freedom, it doesn’t seem like much in comparison to Cruz and Aminta, who smiled and thanked her for her time as they left her office. Such gratitude. Perhaps what she found here in the land of the free wasn’t freedom at all, but different ways by which she was imprisoned. Perhaps she will never understand what else she has left to give, just as her husband may never understand her, and maybe her panic attacks will never go away. This is uncertainty that she would have to learn to live with, like a scar or an amputated hand. “Dios que da la llaga, de la medicina,” Aminta had said. God, who gives the wound, gives the salve.

She left work that day feeling what she had felt in the airport leaving Colombia all of those years ago. Her body trembling. Her mind racing. It was these physical symptoms that always reminded Esme it was time for action, like an alarm clock waking her up. But this time it wasn’t begging her to leave her country, but to leave herself; whatever idea of herself as an American. She had called Jorge on her way home and let out everything that has been troubling her. It felt as if she had split open an artery. His voice sounded encouraging through the speakers of her car, filling up the space around her almost god-like, embodying the words she needed to hear. “It’s okay if you divorce,” he said. “I can’t say I didn’t see this coming. I’m old enough now to take it. I just want you to be happy.”

At home she had went straight to her room, ignoring Paul’s request for dinner and his demanding poison tipped arrows trying to infiltrate her, trying to pierce her skin with his negativity. She locked the door then found a place in the center of the room to assume the lotus position. She closed her eyes and focused on her breath. She felt her weight on the floor, observed the tension of her shoulders, her neck; she felt the weight of her entire being. It seemed like so much, too much to bear. But she stayed focused on her breath. Soon, breath after breath, the floor beneath her feet fell away, along with Paul’s high-pitched yelling and thunderous knocks against the door. She felt weightless.

About the Author:

Nick Farriella

Nick Farriella’s fiction has appeared in Barrelhouse, X-R-A-Y, Maudlin House, and elsewhere. He lives in New Jersey and works as a copywriter and a flash fiction reader for Split Lip Magazine.