Consented, p.18
Consented, page 18
I looked up at him, stunned: “Patients are sharing this?”
He nodded: “There’s more.”
I flipped to the next page. Taiwan experts provide a simple self-check that we can do every morning: Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully . . . it proves there is no fibrosis in the lungs . . . .Self-check every morning!
I turned to the third page: SERIOUS EXCELENT ADVICE by Japanese. Everyone should ensure your mouth & throat is moist, never DRY . . . .Drinking water or other liquids will WASH them down into the stomach. If you don’t . . . the virus can enter your windpipes and into the LUNG!!
I fought to maintain a neutral expression as I turned back to my boss, but the moment our eyes met, I saw my own conflict reflected in his. It was a look I would come to recognize all too well in the months ahead: a mix of barely contained amusement (Who’s actually going to believe these posts riddled with grammatical errors and randomly capitalized words over the carefully researched pandemic updates we broadcast to our local communities every week?), a flicker of doubt (What if these aren’t entirely baseless? What if I’m the one behind on the latest data?), and a surge of professional panic (We need to shut this nonsense down now, before it works its way into people’s “windpipes” and straight into their BRAINS!!).
At the time, I didn’t realize that battling misinformation would become one of the hardest parts of my job. Despite my efforts to counter false claims with accurate data, and our staff’s diligent translations, I wasn’t Hispanic/Latine and spoke English in the video updates. Evidence shows that difficulty accessing COVID-19 information in their native languages turned migrant and ethnic minority communities to social media.57 These platforms became highways of misinformation, fueled by deep distrust of the government and medical establishment (“I have heard that people don’t want to go to the hospital because they let you die.”), fear of deportation (“There is fear that you can lose your job if you test positive for the virus.”), and, of course, medical myths (“People say that by getting tested you will get the virus.”).58
Though they do not face concerns about deportation or language barriers, other historically marginalized groups such as Black, Indigenous, American-born Hispanic/Latine, and multiracial people share the medical mistrust felt by my immigrant patients, especially amid the surge in racially charged police brutality.59 Racial injustice, having long infiltrated every aspect of our society including education, housing, employment, and access to high-quality healthcare, directly and indirectly led to lower vaccination rates and higher transmission, hospitalization, and death rates during the pandemic.60
Almost a year later, I would finally learn the full story behind my phone call with Guadalupe’s wife. As it turned out, Guadalupe had been painfully aware of how sick he was, but even more determined never to set foot in a hospital. Convinced he was dying, he had his son install a plastic barrier around his bed, allowing family and friends to say their goodbyes without risking infection.
Two years later, just before I left my first job, Guadalupe and his wife invited me to their ranch for dinner.
Guadalupe’s ranch sat on the outskirts of town, sprawling and full of life. Dozens of cows, goats, chickens, rabbits, and two loyal herding dogs roamed the property. In the late afternoon sun of August 2022, the light fell perfectly across the vines in his lush vegetable garden. But what struck me most wasn’t the land or the animals—it was the love. The moment anyone entered the property, they made a beeline for Guadalupe to offer a hug or a kiss on the cheek. A steady stream of “Hi, Grandpa!” and “I love you, Dad!” filled the yard. Conversation was nearly impossible without these joyful interruptions.
“Doctora,” Guadalupe said, handing me a fresh tortilla straight from the stove to go with my favorite goat meat—a special meal he and his wife had prepared for me. He looked at me with his signature quiet certainty. “Now you understand why I would rather die here than in a hospital.”
I did. In a world where so much felt uncertain, where illness, fear, and injustice turned us against each other more than ever before, love was the one thing worth holding onto.
The “Hispanic Paradox”
Against all odds, both José and Guadalupe recovered fully. They had one crucial advantage: prior good health. Before falling ill, as a young migrant worker, José was strong and accustomed to physical labor. Guadalupe, though three decades older, lived a vigorous life. He grew his own food, ate home-cooked meals, climbed trees, and chased after animals. Their resilience gave them a fighting chance.
After I sent my email to Dr. Rodney demanding justice for José, we received more resources from his office, connecting us with clinicians and organizations offering charity care. My team fought to renew José’s medical coupon and ramped up support in every way possible. As for Guadalupe, he eventually agreed to visit the clinic—on the condition that he wouldn’t be sent to the hospital. After confirming he was stable enough to stay home, we gave him steroids and put him on oxygen (at the time, antiviral treatments and monoclonal antibodies weren’t yet available).
Beyond baseline health and medical intervention, something just as instrumental made their survival possible: community. Guadalupe had a devoted family who met his every need. José, lacking family in the US, built his own. His coworkers fed him and drove him around when he was too weak to care for himself. Our staff called to check on him constantly, worried about him like family—even covering the cost of his medications when he couldn’t afford them.
These factors reflect what researchers call the “Hispanic mortality paradox.” In 1986, after analyzing two decades’ worth of data, two researchers found that the health measures of Hispanic/Latine populations in the southwestern United States were much more similar to those of white people than to those of Black people, even though “socioeconomically, the status of Hispanics is closer to that of [B]lacks.”61 Over the years, scientists debated the existence of this paradox, which generated “significant logistical confusion.”62 Finally, in 2013, a meta-analysis of fifty-eight studies involving 4.6 million participants confirmed that Hispanic/Latine populations in the United States were indeed 18% less likely to die over time than their white counterparts.63
As someone who has cared for hundreds, if not thousands, of patients like José and Guadalupe—and as an immigrant myself—I am not logistically or otherwise confused about this phenomenon at all. Like José, migrant workers are often young, able-bodied individuals—a phenomenon known as selective migration. And since health data often combines foreign-born and US-born individuals under the same racial category, this skews outcomes, making the group as a whole appear healthier. Additionally, many migrants return to their home countries for retirement, where their earnings stretch further, distorting survival data even more. Beyond these statistical factors, there are cultural ones: As José and Guadalupe demonstrated, physically active lifestyles and tight-knit social and family networks contribute to longevity.64
Yet this advantage is not permanent. As generations pass, born-and-raised Americans replace immigrants within a racial or cultural group, assimilation erodes traditional health-protective behaviors, and these benefits fade.65 Researchers once predicted this process would take generations. But COVID-19 accelerated it in a single year. The pandemic slashed the Hispanic/Latine life expectancy advantage from 3.3 years longer than white Americans to just eleven months, undoing 70% of the longevity gap in record time.66
The paradox was finally reduced. From the perspective of power, the world made sense again! Rich people could go back to reaping the full benefits of being rich. The novel coronavirus’s equalizing force was finally at work.
Meanwhile, the Black-white life expectancy gap, which had been slowly closing since 2006, was violently ripped open, widening by 40% during the pandemic.67 Did the enslaved people have “paradoxically” longer lives when they were taken across the Atlantic Ocean in 1619? It’s not hard to imagine that if a force as indifferent as a virus could wipe out survival advantages so starkly, then the brutality of those who consciously denied people’s dignity would never have allowed such a paradox to exist for long.
The mortality advantage of Hispanic/Latine families is no paradox. It is resilience, an ancestral gift, a blessing from lands that have nurtured generations for thousands of years. But even this blessing was no match for the unequalizing force of racial injustice, deeply embedded in how we treat each other. The ongoing struggles of the Black community prove that once unleashed, oppression takes centuries to undo, yet mere moments to take hold. One crisis or one oversight can tear open the wounds. And the blood of our ancestors spills in vain all over again.
No virus has ever had the power to equalize or divide. That power has always belonged to people.
The Asian Dilemma
Have you noticed that I haven’t yet mentioned another racialized group: Asian immigrants, Asian Americans, and Pacific Islanders (AAPI)—the racialized box I’m in? If you have, thank you for noticing. If you have not, then I’ve proven my point. By leaving out their stories, I’ve mirrored what has long happened in conversations about racial inequity: AAPI voices are ignored so often that many assume they have somehow “risen above” racism. Perhaps even many AAPI individuals thought so too—until the Great Unequalizer placed us at the heart of the storm.
In December 2019, the first known cases of COVID-19 emerged in Wuhan, China. From across the ocean, I watched in horror as a great city fell, while my parents, blissfully unaware, packed their bags for their trip to visit me for the 2020 Lunar New Year. On January 23, the very day they boarded their flight from Beijing, Wuhan was placed under lockdown. Days after they arrived at my home in Washington state, China slammed its borders shut. When I opened the door to the guest bedroom, I thought I had welcomed a pair of relieved elders who had escaped a national disaster. Little did I know that I was unsealing the chasm that would fracture my world for months and years to come.
January 2020. My medical school friends in Beijing mobilized selflessly to Wuhan to assist the overwhelmed healthcare system in the city. They documented and broadcasted the horrendous disaster to sound the alarm for the rest of the world. Meanwhile, people around me jokingly commented, “Oh no, is it the ’rona?” whenever they heard anyone cough.
February 2020. COVID-19 infections led to multiple deaths in a long-term care facility in the Puget Sound region of Washington state, making it the epicenter of the earliest outbreak in the US. I nervously devoured all the research articles and data my friends at the front lines in China sent me. An insensitive acquaintance asked me if my parents were going to become the “patient zeros.”
March 2020. The WHO declared a global pandemic. My CEO appointed me the COVID-19 physician lead after I sent out an email summarizing what I knew about the novel coronavirus. I put off clinical medicine just four months after graduating residency and stepped up to assist public health efforts full-time. Meanwhile, President Donald Trump called SARS-CoV-2 “the Chinese virus” and “kung flu.” Within one week, over 392,000 tweets with the hashtag “#chinesevirus” contained overt anti-Asian sentiment.68
April 2020. At work, I split my time between the newly built viral clinic in full PPE and the administrative efforts to protect staff, patients, and the community. At home, I socially distanced myself from my parents, whose return flights to Beijing kept being postponed by the Chinese government. Every day, I went straight from the garage to the shower when I came home, moved into my study, and ate by myself. Meanwhile, anti-Asian hate crimes surged by 145% while overall hate crime in America dropped by 6%.69
2021. After thirteen flight cancellations and two failed attempts to travel home, my parents’ visa status ran out, and we started the immigration process. Embodying the “Beijing hospitality” wherever they went, my parents made dumplings and buns for my friends, colleagues, and neighbors whenever there was a chance. Even with zero foundation, they set out to learn two hundred English phrases in a year and waved “Have a nice day” or “You look amazing” to everyone who passed them by. Meanwhile, anti-Asian hate crime increased by 339% in 2021 compared to the first year of the pandemic.70
On a summer day in 2021, I drove my parents to their immigration physical exam, loaded with folders of paperwork. The rising tide of anti-Asian hate heightened my protective instincts. As they stepped out of the car, cheerful as ever, I couldn’t share their optimism.
“Good afternoon! You look amazing!” My mother greeted the physician assistant, who came in first, with one of her favorite English phrases.
“Oh, thanks.” Her flat tone worried me.
“Hi, my name is Zed, and I’m a physician. These are my parents. They are just learning English.” Normally, I wouldn’t make my occupation known outside of work so quickly. But desperate times called for desperate strategies.
“Emma,” she said, extending her hand. Her eyes met mine, and I gave her my firm handshake, a silent warning mixed with a glimmer of hope.
Emma went through the motions of paperwork quickly, hardly looking at my parents as she scribbled on the forms. Her physical examination was brief, almost mechanical, as if she didn’t care to listen to their hearts or lungs. I clenched my jaw, frustration boiling.
“All we need now is blood work for TB, syphilis, and HIV,” she said flatly, circling a few items on the paperwork.
“Why?” my mom asked after I explained to her what the blood work was for. It was the first time someone had ever mentioned testing for any sexually transmitted disease to her without asking if she was at risk for them.
Without a hint of hesitation, Emma responded, “To make sure you guys don’t start spreading any other diseases in our country.” My heart skipped a beat. She continued, “You know, like what happened with COVID.”
My parents smiled, nodded, and looked at me for a translation. But inside, I was seething. I felt the sting of her xenophobic, accusatory words reverberate in my chest. A minute ago, I had just been a physician on the front lines of the pandemic, giving everything to fight for my patients. But now, I was the daughter of two foreigners, people whose lack of English comprehension made them unworthy of respect. And worse, I was, along with my parents who had devoted all their money and efforts to support my pursuit of the American Dream, a possible spreader of the “Chinese virus.” The world felt unfamiliar, unfriendly, and cold. Was this how José had felt when he was turned away from the CT surgeon’s waiting room? Was this what drove Guadalupe away from the lifeline of an emergency room?
I looked at my parents’ hopeful faces and at the immigration paperwork in Emma’s hands. Do I speak up and risk her withholding the necessary forms, or do I protect my parents from the harsh realities of racism and xenophobia by pretending nothing was wrong?
“Zed?” My mom nudged me, still smiling but looking slightly worried. “Is everything okay?”
I swallowed hard, then answered in Chinese: “Mom, Dad, don’t worry. This is just part of the process. Everything is fine.” In the end, I chose to let them keep their rosy-colored glasses, just as they had done for me when I was a child.
“Great!” My mother exclaimed, extending her hand to Emma.
“You are so nice!” my father searched for the best English phrase to use and settled on the one furthest from the truth.
While I was there to protect my parents, many other AAPI people weren’t so lucky. Even before the pandemic, one in four Asian Americans faced job discrimination, one in three endured it in daily interactions, and 13% experienced it in medical care, forcing many to avoid doctors altogether.71 Then came COVID-19. Hate crimes surged, and nearly 30% of AAPI individuals reported increased discrimination, while over 40% suffered more anxiety, depression, and sleep issues.72
Like racism in the larger society, medical racism is detrimental to mental health, resulting in significant levels of long-lasting psychological distress.73 And like societal racism, medical racism kills. AAPI individuals who faced COVID-related discrimination were twice as likely to delay or forgo care,74 often arriving at hospitals already gravely ill. And when they did, they were 48% less likely than white patients to receive certain life-saving treatments, such as monoclonal antibodies.75 A national survey of 5,500 adults found that AAPI adults were the most likely to experience COVID-19-related discrimination among all racialized groups.76 At the peak of the crisis, they were up to 180% more likely to die from COVID-19 than their white counterparts.77
AAPI individuals are just 7% of the US population but make up 22% of physicians and 10% of nurses.78 But these numbers shouldn’t be twisted to uphold the “model minority” myth—a tool historically wielded to maintain the artificial racial hierarchy and pit us against other racialized groups. Instead, they should serve as a reminder that countless like me have been, and will continue to be, on the front lines of every medical crisis, risking everything to save lives. Yet when the “model minority” became the “kung flu,” the same shields that once protected us shattered overnight, just as the “Hispanic paradox” vanished in the face of systemic neglect. And as the oppression of Black communities deepens and the genocide of Indigenous peoples continues, history and reality have made one thing clear: It’s only a matter of time before the fangs of racism cinch into all of us. Because the only color it sees is blood.
Will AAPI people remain collateral in a system that dictates who receives care and who is left to suffer? Or can we break the cycle by standing together to fight for one another, so that no one has to ask: Am I safe? So that I can tell my patients, my mother, my neighbors, and my siblings in solidarity: Yes. You are safe here.
A Whole-Story Future
As a forty-six-year-old multiracial first-generation American with roots in Guatemala and Taiwan, you’ve seen the struggles faced by past generations. But today is different. When your seventy-year-old father, a Taiwanese immigrant, mentions chest pain, you feel concern. But you don’t panic. Thanks to affordable healthcare and a vast network of urban and rural clinics, cost and access barriers have diminished. More importantly, the #FairAndJust movement has transformed the system, ensuring culturally competent care. Healthcare staff now reflect the communities they serve, with translators and resources readily available.
