Author’s note: This is a fictional account based on true facts.
Ten years ago D. came to New York from war-torn Congo. I know nothing about how she navigated the international bureaucracy to get asylum and how she then moved here, alone and sick and not knowing much English. I know that in her past she was “a businesswoman” and traveled all over Africa buying and selling things. She even went to South Africa, she said. I know that her husband died at some point and that when she came — leaving her children behind — she already knew she had the virus.
I was still trying to piece her story together when I unwittingly became a holder of her family’s secrets.
I met D. in the spring of 2010, when I was a case worker in New York. She shuffled into the office, limping, cane in hand, out of breath. “Ah! Two hours it took me. The train stop at Burnside Avenue is closed so I have to walk all the way to 166th Street! But whatever it takes to get help. You have to help me.” She screamed in accented but solid Congolese French. I motioned her to sit down and she slowly did. She is only 55 but has the slow, labored movements of an elderly woman. Then she pulled a handful of pictures out of her bag and handed them to me.
They were pictures of enormous, subway-sized rats that had invaded her ground floor apartment in the Bronx. One image was of a bloody, dead rat on her kitchen floor — she killed it with her cane, she said — shown to scale next to a canola oil bottle. One was of D. sitting in bed holding up two bandaged fingers — because she fell and injured herself while chasing one of the rats.
That was enough: she had my undivided attention and dedication. How could I let a woman as sick as her — live like that? I had to find her a new apartment. Much later, I realized that the pictures were a few years old, that the subway rats were long gone, and that she brought them for show, to put herself first on my list of priorities. But it didn’t matter to me — if the rats were gone the cockroaches were still there, and the show she put on for me came from years of desperation and frustration, from hours spent with people saying they would help then didn’t.
As I worked tirelessly towards this seemingly simple goal I started to learn more about D. When she first came to New York she worked at an African restaurant as a waitress. One day she collapsed and was brought to Harlem Hospital. She was there for a month with CNS toxoplasmosis. She was tested for HIV and was told she had it. She pretended not to know, even though she had been tested in Kinshasa after her husband’s death. But back then she had chosen to ignore the result because there was nothing she could do about it. Plus, it could compromise her asylum application. In any case after this hospital stay she was sick enough for “the welfare system.” She was now eligible for Medicaid, cash and rental assistance through the city. From what I know she was really sick. I read letters written by her doctors telling Immigration that if she were to return to Africa, she would die. I never understood why she needed them — why would an asylee be deported? Under what circumstances did she really come here? But D. was full of mystery. Friendly and talkative as she was, it was impossible to get her to answer simple, factual questions about her past.
Just a few weeks after I started working with her, D. announced that her daughters were coming from Africa. M. was 16 and A. 20, she said. She anxiously awaited their arrival. And, almost by magic, as if this hadn’t been years in the making — paperwork and bureaucracy and all — they arrived.
I first met them one afternoon in the bare, third floor waiting room of a Bronx welfare office. We were appealing the city’s HIV/AIDS Administration for additional cash and food stamps benefits to cover the girls, who were unaware of their mother’s HIV status. The office was unmarked (as they all are), but the room was full of posters and pamphlets related to HIV prevention and HIV-related social services. “Don’t you think they will realize, if they read the signs on the wall?” I had asked D. when we were debating where to meet that day — “Pff. That building is just like Africa — signs about HIV are everywhere. Not to worry.” While we sat in the rickety chairs, staring at the HIV prevention posters hanging crookedly on the walls — too late for those who saw them — I couldn’t help but think that this room could indeed be 5000 thousand miles from New York, in a public building in war-torn Kinshasa.
The other thing I noticed that day was that the two girls I was expecting to see were instead grown women with sophisticated hairstyles, dressed impeccably in tight jeans and boots. M. was thin and had an honest, delicate expression on her face — but looked 18 at the very least. She was smart, as her mother had told me, and was already reading a French-English dictionary to learn her first English words. “I took English in school, even Spanish” she said “but with the war we could never go to school so I know nothing.” She was excited to go back to school. A. was plumper, more serious, and much older. Just like her mother, she had worked as a “businesswoman” in Kinshasa. Now, she just wanted to find a job. I figured they both looked older because of the tough lives they had back home, growing up on their own.
We got what we needed from “the system” and left. In the next weeks I referred “the girls” to countless resources for new asylees and helped M. enroll in summer camp and then school. Meanwhile A. found a job filling shopping bags at a Chelsea supermarket, a world away from her mother’s cockroach-infested one-bedroom in the Bronx.
Congolese immigrants in New York have a tight community that operates by similar rules as it would back in Africa. For HIV-positive people, stigma is a huge issue; they are terrified of people in their community knowing their status, and chose their clinics and community-based organizations wisely, usually as far as possible from the neighborhoods they live in. But some people still find themselves accessing HIV related services from the same places and become friends, confidants. So it was for D. and my other client, F.
As unprofessional as it was F. and I often talked about D., and vice versa. D. had been like a mother to F., taking care of her children while she worked, and giving her relationship advice. When D.’s daughters arrived from Congo we were all so excited, we couldn’t stop talking about them. “Did you hear A. found a job? Did you know M. and my oldest daughter are hanging out?” F. would say. We would laugh – it was not often that I heard good news from my clients. But one day — I have no idea why — F. blurted out: “Do you know how old D.’s daughters really are?” 16 and 20, I said. “Pfff. No.” she answered with a smirk “A. is at least thirty years old. M., she is at least twenty. You see my daughter? She is 16 for real, not like M. You can see the difference.”
I was stunned. I felt betrayed. We were friends by now, I thought. I had worked so hard to find D. a new apartment, which I eventually did — a rat-free two-bedroom — and had been going everywhere with her and the girls — doctor’s appointments, schools, government offices … We had spent hours chatting about our lives in waiting rooms all over the city. D. had been teaching me Lingala and was so proud of my progress … How could she — how could they all — lie to me like that?
Of course I never said a word to D. or her daughters. I knew why they had been lying. Asylees can only apply for their family members to join them if the latter are below 21 and unmarried. But that didn’t solve the whole mystery — why had they waited so long to file? Why had she waited ten years to bring her kids to America and how could she have lived ten years without seeing them? Not to mention her other three sons who were still back in Congo.
D. wasn’t my first client with a mysterious past and secretive daily life. But it felt strange to find out her secret from others and go on pretending I didn’t know. It was even stranger to become an accomplice and lie — or at least omit — on the family’s behalf. But I was their advocate, and by definition I had to be always on their side, no matter what that meant. That was the moral choice I made. They needed me on their side; Immigration, doctors and the welfare office did not.
I referred A. and M. to an adolescent clinic in Washington Heights and lied to the doctors about their age. I translated as they were asked and answered questions about their social and sexual histories. I wondered how much of what they said was true. In any case, I heard things they would never say to their own mother.
At the same time that I was keeping the family’s secrets from ‘authorities’ of all sorts, I kept protecting D’s secret from the girls. When I handed my business card to them I took care to give one that did not include the agency’s name, which would have been a dead giveaway. But they called me all the time and my voicemail clearly spelled it out. They came to visit me, even without their mother, and saw signs all over the office. How could they not know? I started thinking that they, just like me, were just pretending.
In December D. had abdominal surgery. The afternoon after the surgery, we were all standing at the foot of her bed — A, M, and I. I was part of the family. We were all terrified of seeing her like that — she was in excruciating pain and looked terrible, hooked onto countless tubes and wires and beeping machines. A nurse was hovering around her, fiddling with the machinery like a mechanic fixing a broken car. I couldn’t stay long, it was too painful. My client, my friend, my teacher, my D. — I walked out of the hospital and tried to forget about her, but couldn’t.
A few days later A. came to see me in my office. “I know that my mother is really sick” she said. “Please, please tell me what is wrong with her. I am too worried.” Oh no — I thought — the moment I had been dreading had finally come — she knew there was a secret, and she knew I knew it. Now what? Of course I did not budge. I had been trained to maintain a client’s confidentiality no matter what, especially regarding their HIV status.
But A. was desperate that day, and although I wouldn’t tell her my secret she decided to tell me hers. Perhaps she was overwhelmed and emotional about her mother’s illness and felt like unburdening herself. In any case she finally said it: “I am not really 20. I am married. My son is nine. My husband is in Congo.” She paused and scanned my face for a reaction. I pretended to be surprised. I didn’t ask for details but it wasn’t difficult to imagine how she had forged her birth certificate and passport to create this lie. In a sense I felt flattered that she had decided to tell me truth; she knew that her secret was safe with me.
By the time I quit the job things were a little better. D. had recovered from the surgery and was able to climb two flights of stairs up to her new apartment — albeit slowly. M. had finished her first year of high school in America and received excellent grades, and A. was working hard earning money for her families — here, and back home. She was still wondering about her mother’s illness. I never told D. that I knew about the family’s secret but I did tell her that A. wanted to know her own secret. I wonder if she ever told her.
It’s been two years since I said goodbye to the family and have not seen them since. I spoke to D. on the phone once, but it was not the same. She asked me for help as she always did but I couldn’t give it to her because I was gone. I often go back to New York but somehow it’s a different city, now that I’m not going to Burnside Avenue and 166th Street into the modest living rooms of people struggling every day to survive.
Now that I am going to be a doctor I often think about how I got caught up in this and other families’ lives, probably much more than I should have. I was trained to set clear boundaries with my clients but we are all people, not animals in separate pens. We spend time together, start to care about each other, and end up all together in one big pen — so of course I am going to give you my cell number and answer your call on a Sunday, and listen to your secrets and your children’s secrets.
I am relieved to no longer be holding D’s family secrets but feel privileged to have been trusted by people who knew nothing about me other than my dedication to them. But I miss them, and it hurts to know they are so close yet I might never see them again, and learn the rest of their story — because most of it is still a mystery to me.
Contributing Writer Emeritus
Warren Alpert Medical School of Brown University
Bianca is a Class of 2015 medical student at the Warren Alpert Medical School of Brown University. She graduated from Harvard College in 2009 where she majored in global health and African studies. Before medical school, she was a case worker in New York.
