Early one Friday morning in the spring of 2022, I get in my car while the sky is still gray. The directions I received the night before take me forty minutes south as I follow the turn-by-turn steps on my phone. I take an exit somewhere in the middle of the Orange County, then park in front of a nondescript strip mall and walk through the doors of a hair salon.
My instructions tell me to say a password to the receptionist. Then I am guided to a door that looks like a storage closet. I open it, and like in a children’s story, I walk through the closet and into a larger room on the other side. Then I find myself facing the impossible: in this utility closet that’s not a utility closet is a standard dental chair.
For the next three hours, I sit in this chair while a stranger—who may or may not have formal dental training—examines my mouth. He administers anesthesia, extracts a tooth, and performs several root canals.
Through it all, a television plays telenovela reruns to distract me from the pain and to drown out the sound of the dental work for the unsuspecting salon patrons on the other side of the wall. I pay nearly $2,000 in cash for the services I’ve received.
By the end of the procedure, I have missed a day of work, endured far more pain than this maybe dentist had told me to expect, and nearly drained my savings. As my swollen mouth and I make our way back home, I think about the absurdity of my situation. In an era where the world’s accumulation of knowledge is instantly accessible on a device that fits in your pocket, I am forced to seek illicit medical triage in the back of a beauty salon.
This isn’t the first time the U.S. healthcare system has tried to kill me. Today was but an additional line item in my debts of survival.
*
When you are undocumented, you learn that even your own body cannot be trusted. Internal signals of illness may leave you waylaid and bedridden. Your body takes you out of your regular work and social responsibilities, and now you are hurting doubly or triply.
(Over time, you will lose count of all the ways you’ve been sabotaged by yourself.) Your finances, mental stability, personal relationships: everything falters when your body lets you down.
My hearing was one of the first things this country took from me. My left ear no longer works. Back in my early months of living in America—while I working at the hellish Mexican restaurant, raising AC, and learning English—I got sick.
At the time, we were usually able to address our dentistry needs during our visa runs to Mexico. However, because I wasn’t able to see a dentist regularly in the U.S., I ignored my teeth until they started to hurt.
One of my molars became infected. The infection took over my mouth and swelled in my cheek. I would sometimes have fevers, and blisters would pock my mouth for weeks. The cheapest dentist I could find in our area needed $1,500 to fix one of my molars.
I did not have that kind of money, nor the support system you might normally rely on in these kinds of situations: family who could help financially, dental insurance, the ability to take out a loan or run up a credit card. Without a Social Security number, you can’t even get a credit score.
The dentist warned me that without care, I would likely lose several of my teeth and the infection could move to other parts of my body, including my brain. With no other options, I started taking homemade remedies, like garlic, tinctures, and rubs.
But nothing worked. And then it got really bad. For eight months, my mouth alternated between states of numbness and throbbing agony. Sometimes I couldn’t sleep because of the pain.
My entire face swelled up. It became a bloated badge of my inability to get the medical care my body demanded. One night, I woke up to blood pooling down my neck. My ear was bleeding—the infection in my mouth had spread to my ear.
I perceived sounds in distorted echoes, as if I was underwater. To this day, my hearing has not recovered. I often find myself apologizing at work and in semi-crowded restaurants with friends: “I’m sorry, what did you say?” It is an apology for having tried to survive in America.
The people who imagine that undocumented immigrants come here to leech off American resources do not realize the compounded costs of living that we endure. Bipartisan legislation has been enacted based on the false premise that immigrants want illicit access to luxurious medical treatment. About thirty years ago, California’s Proposition 187 denied undocumented individuals in the state the right to access to public benefits, though it was later overturned by the courts.
In 2019, President Trump issued an executive order to suspend US entry of immigrants who cannot demonstrate proof of healthcare coverage. He railed: “Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs.”
Despite all this, I’ve tried my best to maintain my health. I’ve found local programs that offset the costs of routine checkups, physicals, and dental cleanings, and I’ve saved up for minor surgeries. Recent California legislation provides health insurance for all undocumented individuals to receive primary care, though in my experience follow-ups for specialized care has been lacking.
One of the steps in my application process included showing proof of income and sharing my U.S. tax records. Like with many immigration policies, the contexts of healthcare access are constantly changing.
In the times when I’ve been in most dire need of medical support, however, the available resources have been insufficient. And each time I’ve moved, I’ve had to search for local resources, clinics, and health advocates all over again. In my first year in Los Angeles, I found nothing.
The Kaiser Family Foundation has reported on how undocumented immigrants are more likely to confront barriers to healthcare than citizens or legal residents. Legal and financial barriers delay needed care, leading to substantially worse health outcomes for our community.
It’s funny how quickly healthcare options vanish when you are asked to provide a Social Security number. Establishing resources through the Affordable Care Act, for instance, requires tracking people via Social Security numbers. And with constant changes to statewide policies, it often feels nearly impossible to keep track of which programs and policies currently exist.
In the months leading up to that underground dentist visit, I refused to listen to my body’s warning signs—the feeling that something was off in my mouth, stomach, and lungs. I wasn’t oblivious; I was responding to how I’d seen my labor and my body interpreted as dehumanized labor in this country.
*
The knowledge that my life only matters as a body for labor feeds on my heart like a parasite. It chews at my feelings of self-worth, self-esteem, and hope. It feasts on my financial insecurity. It whispers that it’s not okay to miss work. It reminds me that I can’t afford the healthcare I need. Instead, I carefully watch my diet and brush my teeth after every meal. I do regular maintenance in hopes of forestalling a major tune-up.
The domestic, agricultural, and industrial labor that my undocumented community provides comes at the cost of our wellness.The domestic, agricultural, and industrial labor that my undocumented community provides comes at the cost of our wellness. We are on the front lines of the U.S.’s most dangerous and unhealthy workplaces. After 9/11, undocumented immigrants were tasked with cleaning up the debris of the World Trade Center, as Karla Cornejo Villavicencio showed in her book The Undocumented Americans.
Undocumented labor has also been used to restore cities in the wake of climate disasters, as reported by Sarah Stillman. And every year, pesticide poisoning and excessive heat afflict the agricultural workers in this country.
The COVID-19 pandemic pulled this reality into sharp relief. Undocumented individuals were among some of the first casualties of the pandemic back in 2020, and we continue to experience some of the highest rates of COVID infection and death. If we are also members of other vulnerable groups, such as individuals experiencing homelessness or chronic health conditions, our risk increases.
For me, an undocumented individual with chronic breathing issues, the pandemic was particularly terrifying. Not knowing when I would be able to get my inhaler refilled (I could not afford the out-of-pocket expenses to see a doctor who could write the prescription) only added to my unease. I needed to constantly monitor the health risks around me while also continuing to assess my environment for deportation risks. The double bind of healthcare and legal danger made my life in this country suffocating.
Even before the pandemic, undocumented immigrants faced unhealthy living conditions in this country. We avoid hospitals as sites of state surveillance, and we can’t access most forms of subsidized healthcare offered through legislation like the Affordable Care Act. Even in sanctuary cities, where we may be legally able to get medical treatment, we often cannot not afford the medical bills or the time away from contingent work.
Christopher Moriates, chief of hospital medicine for the VA Greater Los Angeles Healthcare System and a professor of clinical medicine at UCLA, describes how, in states like Texas, uninsured and undocumented individuals may only be granted care when their condition has become critical. Emergency dialysis is one such example. “It’s called compassionate dialysis, but there is nothing compassionate about it,” Moriates explains.
When individuals get critically sick, hospitals will provide them with emergency dialysis and then send them home with instructions to only return when their condition is once again critical. At that point, treatment is “more costly and…way more dangerous.”
Infuriatingly, these barriers to healthcare do not even cut costs for hospitals or the healthcare system. Patients are not charged for this limited care, so the costs are footed by the hospital and by the broader national healthcare system. Continually placing financial stress on our hospitals and denying consistent, desperately needed care to undocumented individuals is financially imprudent—and morally bankrupt.
This model is all too prevalent in undocumented medical care. After learning about the hearing damage I’d suffered due to my tooth infection, Moriates said my experience was common: “We admit people to the hospital with serious tooth infections who did not have dental care. These patients now require serious treatment—IVs and antibiotics—because they couldn’t see a dentist to begin with.”
Moriates is also the executive director of Costs of Care, a nonprofit organization focused on creating pathways for more affordable and equitable access to healthcare in the U.S. Moriates points to ways doctors can support our physical needs, despite a political system of willful bureaucracy.
Moriates helps demonstrate a value-based approach to healthcare that guides individuals “who care for patients [to] optimize healthcare outcomes while also taking direct and specific responsibility for costs and patient experiences.”
*
In the weeks before I ended up in the back of the salon, I felt a familiar pain and ignored it. It was a dull ache underneath my tooth, accompanied by my numbing denial that it would get worse. I couldn’t afford for it to get worse, and so I ignored it.
On Monday, I took some Tylenol and hoped the pain would stop. On Tuesday, I popped a few more Tylenol and powered through. On Wednesday the pain got worse, but I took some more Tylenol and told myself: “Maybe it will just go away.” On Thursday, I was eating lunch with the twins I was nannying when I bit into my sandwich and pain seared across my nerves. It bloomed into life, rooted deep into my gums, petaling across my mouth.
I found a dentist that was only a few blocks from where I was working. Somehow, I got an appointment within an hour. I took this as a hopeful sign.
I left work early for the first time in months and happily filled out a new patient form. The bright pain in my mouth blinded me to the questions I was filling out, I ignored the spaces where I was asked to provide a Social Security number. I knew I didn’t have dental insurance, and I definitely knew I didn’t have $5,000 or $6,000 to pay in cash. But I kept telling myself that I was a human being and they’d give me the care I needed.
They took X-rays, and the dentist pulled them up on a computer screen. He said, “I’m pretty sure that you’re in a lot of pain right now.”
That was for sure—I was dizzy and seeing stars. He continued, “Right now, you need to get an extraction. And then, you need two root canals, and crowns.” He paused, then said, “I usually don’t do two root canals at the same time, because it’s a lot, and that’s on top of the extraction.”
What he didn’t know is that I’m a tough cookie. I wanted to get this operation over with and I knew my opportunities to do it—given the cost, the time off from work, and finding a dentist who would see me—were limited. I said, “You know what, let’s get it all done now. I don’t care.”
The dentist looked at me in surprise. He said, “You’re going to be in a lot of pain for the next couple of days.” But I’d been in a lot of pain for weeks, and during the hour I’d been at this office, it had been steadily increasing.
The dentist left to create a financial estimate for the treatment. It felt like he took forever to come back. When he finally returned, he showed me an impossibly high number. It would be around $8,000 for the extraction, root canals, three crowns, anesthesia, and a list of medications and follow-ups that went on for pages. There was an option to pay the bill in monthly installments.
I could see at a glance that I wouldn’t be able to afford the down payment and interest rates, but all I could think was: “Let’s do it. This pain is unbelievable.” I was willing to take on the years of debt if it meant relief. But before I could sign off on the equivalent of a second car payment, I had to fill out one more form.
I remember exactly where it asked me for my Social Security number. I entered my tax ID number and, sure enough, the application was rejected. The receptionist couldn’t tell me why, but I already knew the reason. I was a fraud in the eyes of the U.S healthcare system.
The office gave me a second application with many of the same questions replicated and I raced through it, bouncing my knee in pain as I again entered the information that I hoped a computer would decide made me legitimate. But that application, too, was rejected.
I was a fraud in the eyes of the U.S healthcare system.By the time they gave me the third application—again asking the same questions about insurance and Social Security numbers in a slightly altered order—I’d texted my friend Vanessa. She’d once said that if I ever needed a cosigner for an expense, I could go to her. She has a great job and a stellar credit score.
The third application didn’t have a cosigner option, so the office looked for a fourth. The dentist found one with a cosigner option, but it required communicating medical needs to an individual with a Social Security number in order to proceed.
I started questioning why I was wasting the time of the people at this office, patiently trying to work with me. Through my blistering pain, I heard my undocumented identity asking: “Why are you doing this? You know why you are getting rejected. Vanessa’s credit is obviously good. But you know that you don’t have a number that proves that you are a human. You don’t have a number that says you deserve treatment.” I don’t often cry, but in that moment I just melted down.
The dentist came back to see me bawling. I didn’t even care. Screw this shit. You want me to act like everything is fine when I am in intolerable pain and all your rules and policies and numbers are okay with that?
The dentist awkwardly told me he found a fifth application: “And this one has to be a good one,” though I’m not sure who he was trying to reassure at that point. I filled it out and convinced myself that the fifth time would be the charm. But twenty minutes later, I was rejected again. When the dentist came back, his demeanor had changed.
He told me, “I think you need to stop trying because I have another client and I’m wasting time. I wish I could help you.” He gave me a prescription for antibiotics and painkillers. I went to the pharmacy and waited an additional two hours to get them filled.
By this time, it was dark out, and my mouth was starting to swell. I called every dentist in the area. Most were closed. I called clinics connected to local medical and dental schools, but they only offered routine care and had lengthy waiting lists. I asked friends if they might know anyone who might know anyone who could help me. I called friends in the medical field, friends who were migrant farmworkers, searching desperately for a lifeline.
Finally, a friend got back to me with a tentative lead. They’d heard about a place some distance away that might be willing to treat me. They said a friend of theirs had gone there, and did not actually recommend it. There would be no way for me to know if the people running this business were actually dentists. “But,” my friend said, “If you think you are tough enough to go to this room and see somebody whose qualifications you don’t know, then go for it.”
There were no other choices. Of course I was going.
My friend gave me an address and a phone number.
I called this maybe dentist and described my situation. He spoke Spanish. He said he was too busy to see me the next day.
In a shaky voice, I asked him when was the earliest I could come in. He must have heard the pain in my voice, because then he said that if I came early the next day, he could try to fit me in before his other appointments. He described his business as very under-the-table.
I felt like I was buying drugs. But I graciously accepted the appointment. I felt oddly comforted by the fact that he spoke Spanish. If I was going to do something this shady, at least it would be with a Latino!
I remember thinking, unrhetorically, “What’s the worst that could happen to me?” If this place had a dentist room in the back of a store, what else could they be selling there? I couldn’t let my mind focus on anything other than a plan of action.
The maybe dentist warned me not to give out his address or phone number to anyone else. So when I walked into the hair salon, I reminded myself that the receptionist who greeted me was not really a receptionist. She was a nice lady who just happened to be sitting in the salon.
She, too, reminded me to keep their secret: “Acuérdate que nada de lo que viste aquí lo puedes compartir con nadie. Al menos que sea alguien como tú que necesite ayuda.” You were not here, you didn’t see anything Remember to not share this place with anyone unless it’s a person like you, who needs dental care. Then I was ushered through the closet. When I went into the room, I giggled nervously at the sight of the huge TV blaring telenovelas.
A man came in wearing a surgical coat, face mask, hair net, and gloves. I barely could make out his dark brown eyes, and I knew that I wouldn’t be able to identify him in public. He had a deep, serious voice, and as we conversed in Spanish, I noticed that his accent didn’t sound Mexican.
I was terrified, shaking and giggling as I was subjected to another set of dental X-rays. He confirmed what the dentist from the previous day had said—I would need multiple sets of extractions and crowns. He said, “I can do the extraction today, and you can come back. I’ll do a root canal tomorrow, and in two more weeks, I’ll do the other one.”
That wasn’t going to happen. I was here now, and I didn’t want to come back again. I said, “No, we need to get it all done today.”
We had a “you don’t understand” battle.
“You don’t understand how much pain this process will take on your body.”
“No, you don’t understand the set of responsibilities I have ahead of me,” I responded. “Let’s get this over with.”
He tried to tell me that “for girls, this pain is too much.” I just gave him the stare. There have been too many times in my life when I hadn’t felt brave in the moment but had been forced to move forward anyway.
There was the time the man in a red truck had followed me home from school, or the time I’d landed in Georgia with AC, pretending our time in the U.S was temporary. There was the time I’d slept with scissors in my pocket in the house of the man who’d bullied my brother. There was the other time I’d slept with scissors in my pocket next to the man who’d attacked me. And there was the time I had said goodbye to my dad.
Besides, it was a Friday, and I couldn’t face a whole weekend of excruciating pain. My goal was to be back on my feet by Sunday morning.
He relented, and I was rewarded with the extractions and root canals I desired. Aside from the surreal location and Mi amor!’s blaring from the TV, it felt as routine as it could. It took two and a half hours.
After the surgery, the dentist apologized for being unable to prescribe any pain medication. Through my numbed mouth and thick tongue, I mumbled that the dentist I’d seen yesterday had taken pity on me and loaded me up with drugs.
I saw the kind squint of the dentist’s eyes as he smiled, like this was a blessing. “I’m so glad that that happened.” He talked to me for a few more minutes to make sure the anesthesia was wearing off and that I was good to drive home. I felt relieved and grateful. My body was coming down from an adrenaline high that I hadn’t realized had been pumping through me.
“Hey,” I said, “I really appreciate you taking me in today. I know that you had a very busy schedule and that you squeezed me in. I really appreciate that you are here for people like me.”
When I said “people like me,” he gave me a questioning look. Sometimes I share too much. I said, “I came here because this was an emergency, and I really appreciated finding somebody like you.” In that moment, it didn’t matter to me if this person was a real dentist or not. He had given me the care I had been begging for.
He said, “‘People like you?’ Todo lo que tenemos es a nosotros mismos.” All we have is each other. “Sometimes we have to do these things to help our own people. At the end of the day, all we have is each other.”
I keep thinking about that “we.” The U.S has certainly made it clear that I am not a part of its collective “we.” I am a survivor, and we survivors find each other in the places where the world doesn’t see us.
This dentist was a total stranger to me, and he still spent hours pulling and digging at the horrors of my mouth. The world sees him as a criminal, as a fraud or a con man. That’s how I’d first saw him.
But we had both been making poor assumptions about each other. When I first came in, he’d thought I couldn’t handle two root canals and an extraction. When I’d said “people like me,” I could see that he’d assumed that I wasn’t a person in need. Maybe he’d thought I’d just been hunting for a bargain when it came to dental surgery.
I paid him in cash: $700 for each root canal and $280 for the extraction. I would go on to get three crowns from him in the coming months, which would total $1,300 each.
Today, I still think about how this man had had to squeeze me in to his schedule, his time fully booked with similar appointments from people like me who have no other choice. All tough cookies. We are sick undocumented kids, undocumented people in ERs, hooked up to compassionate dialysis. We are undocumented people who have cancer.
It blows my mind how much a set of nine numbers (or lack thereof) can transform one’s experience of the world. Nobody should have to go through this.
*
This country frames certain immigrants as nonhuman and “illegal.” Policies and media depict immigrant communities as a threat to American health. These ideas make it acceptable to neglect our bodies. They convince people that we do not deserve human treatment. It’s a tradition that goes to the core of America’s settler-colonial foundation.
In Fit to be Citizens?: Public Health and Race in Los Angeles, 1879-1939, Natalia Molina systematically breaks down how, more than a century ago, the Chinese, Japanese, and Mexican communities of Los Angeles were portrayed as health threats to the white gentry. Health officials created designated regions for the city’s Mexican neighborhoods, Chinatown, and Little Tokyo.
Racist assumptions of immigrants as “dirty” and “disheveled” meant they received “inadequate medical care, exposure to raw sewage, and malnutrition.” In other words, they faced pollutants, food deserts, and barricaded healthcare—all of which continue to threaten undocumented communities today.
Health perspectives of the nineteenth and twentieth centuries regularly portrayed Mexican women, in particular, as fertile beings who relied “on free birthing and medical services and reliant on charity to support their newly expanded families.” As goes the nineteenth century, so goes the current day, when arguments against immigration are driven by fears of their growing families.
In 2020, the world was horrified by images of refugee children separated from their families and caged at the southern border. At the very same time, the COVID-19 pandemic was revealing the true costs of immigrant health.
We were placed most at risk while dutifully taking on the labor necessary to keep this country operating. While more affluent citizens sheltered in place, essential workers—many of them undocumented immigrants—continued to procure your food, care for your children, deliver your toilet paper, and keep this country afloat.
We did this with little additional compensation for the risks we faced. While stimulus and rental-support checks were mailed across the country, undocumented individuals were barred from support.
In September 2020, wildfire smoke rolling in from Northern California turned my sky a dystopian orange. The outside air was unhealthy to breathe. I saw eerie pictures of farmworkers, just an hour south of where I lived, continuing to work in the fields as they breathed in that shit. What are the long-term effects of breathing in air that an app on my phone says is “very unhealthy?”
I was reminded of the way immigrant health is exploited by the foundations of U.S supply chains. In the years since the pandemic began, epidemiologists have tried to determine the impact of COVID-19 on excess mortality. That is, how many more people died “from all causes during a crisis above and beyond what we would have expected to see under ‘normal’ conditions.”
Excess mortality is hard to quantify. Some research suggests that the federal government’s efforts to return the US to a “new normal” amount to attempts to “accustom the population to mass death in perpetuity.”
My life is on the cusp of excess mortality. Undocumented immigrants walk a tightrope of health scares while still working in the most unsafe conditions. Though some states have offered vaccination support and COVID guidance to immigrant communities, others, like Texas, have leveraged the pandemic to actively harm the undocumented.
This was first done through dismantling in-state mask and vaccine requirements. In 2021, Texas governor Greg Abbott proclaimed, “The path forward relies on personal responsibility rather than government mandates.” Simultaneously, Abbott pandered to unfounded claims that undocumented immigrants were responsible for the pandemic surge.
As Adam Serwer reported in The Atlantic, Abbott directed state troopers to surveil and stop “vehicles suspected of transporting undocumented immigrants.” Serwer wrote: “The primary step Abbott has taken to reduce the spread of the coronavirus . . . is to encourage armed agents of the state to engage in racial profiling. You know, in the name of freedom.”
*
Recently, my body has started giving up on me again. More than a decade of physical and mental toil has caught up with me. Daily, I am taken over by extreme stomach pain. It’s gone on long enough that I can no longer simply wish it away or try to adjust my diet.
Throughout this book, I’ve described the times I’ve failed to “listen to my gut.” From messages from God to the warnings about abusive relationships, my gut has been a beacon trying to guide me. And now, it’s blaring all of its Klaxons for me to heed its physical warnings. For the first time since coming to this country, I’ve missed multiple days of work, even as I hate disappointing the families depending on me.
Initial tests and antibiotics have not helped. Some days, I can’t get out of bed, or I end up going home from work a few hours after showing up. I’m a shadow of the woman people have relied on. Instead, I’m merely a belly full of cramps and pain.
As I write this, a doctor has told me that I urgently need to get an endoscopy, a colonoscopy, and a biopsy. I am bleeding internally from an unknown source. Even if I were to hand over all my savings, I would barely be able to afford one of these procedures.
The costs of health have been financially, spiritually, and physically draining. What’s more, these costs aren’t going away. They are increasing dramatically from day to day, an inflation that compounds on my life. I’m praying for a miracle—perhaps that all these symptoms turn out to be nothing more than gastritis.
It feels funny to be crossing my fingers for a severe case of gastritis, but that’s where I’m at. A more serious diagnosis could be unsurmountable.
______________________________
Excerpted from The Cost of Being Undocumented: One Woman’s Reckoning with America’s Inhumane Math by Alix Dick and Antero Garcia. Copyright 2025. Excerpted with permission by Beacon Press.
