Celeste squeezed a drop of blood from the lancet prick on her thumb onto the glucometer strip. The machine counted down: three, two, one, beep. The clinic nurse and I looked at each other. The monitor showed 538 mg/dL. Five hundred and thirty-eight mg/dL. I squinted at the little screen, hoping I had misread the number. I had not.
Celeste was approaching a diabetic coma.
The clinic nurse looked Celeste up and down, a frown forming on her face. She probed her about whether she had been taking her insulin. Celeste kept nodding vigorously. She had taken her insulin. The nurse flipped over the device so that Celeste could see the number on the screen. Celeste gasped, bringing a hand to her mouth.
We had to get her insulin now. We piled into Celeste’s golf cart and quietly zipped through the stables to find her home.
When we reached her home, Celeste pushed open her door to reveal four windowless walls with bare, concrete floors. Her bed was made of a Walmart mattress resting on three large, black plastic storage bins with yellow lids. I knew this scene all too well. It was one in which my parents were raised, one they worked so hard to shelter me from — poverty.
Celeste pried open her miniature refrigerator door and retrieved her insulin, injecting it into her belly. She winced. Even after years of taking insulin, she was not used to the pinch.
—
I met Celeste on my first day at the clinic for the racetrack workers in Saratoga. She was a short, broad-shouldered woman with a dark complexion and kind eyes. She wore a navy-blue baseball cap with a checkered flannel tied around her waist. Instantly, she reminded me of my mother. Not physically, but in the way she let her determination carry her. Her energy filled the clinic with her strong strides, and I felt her immediate attention and love towards me.
Celeste had an intrinsic care for others and a belief that the world would care for her, too. It was the reason I felt so deeply for her. Like my mom, she left behind the world she knew in search of a better one for her children. She fought deliberately against the violence of poverty so that her children would never have to endure what she did. And though the road was not easy, it was the path she continued to walk — every dollar saved was one that could go towards her children’s education and well-being. I, like Celeste’s children, was the beneficiary of this sacrifice. It was my turn to give back.
—
At first glance, I could understand how some fell victim to the beautiful facade of the racetrack. The stables visible from the main roads were well-kept, their white paint glistening in the summer sun. The dirt roads were lined with perfectly symmetrical fencing, and the blades of grass were trim and tidy. But the true eye-catchers of the track were the black, brown, and white stallions, whose muscular legs, lush colors, and groomed manes seemed to dominate the arena with a magical aura. In awe of their presence, the ordinary passersby would never look past them at the tired, overworked Latinx men and women who broke their backs to make the horses shine as they did.
With Celeste by my side, though, the lives of those workers became clear to me.
The backstretch, the world behind the racetrack, was unlike anything I had ever seen. Passing through it on Celeste’s golf cart, I never would have imagined we were in the United States. Reguetón played from the radio propped up on the stables lining the muddy dirt roads. The smell of taquitos and arroz con carnitas rose from the open windows of a wooden hut labeled “Cocina.” The sound of whispered Spanish words resounded in my ears from the people grooming and walking the horses. In some ways, it felt more like my grandmother’s village in India than it did a suburban hometown. The people worked diligently, nothing went to waste, and the aura felt sencillo — serene.
—
After thirteen years with the horses, the backstretch had become Celeste’s home. The community was her community. They had a mutual understanding of the sacrifices they made to be there. It was for the people they loved, and in some ways, it did not feel like a choice. They neglected their own happiness, their own health, so that their children could prosper. Despite the countless hours they invested into keeping one of America’s deepest traditions alive, their brown skin, hispanohablante accents and lack of papers meant that the benefactors of their work would never dare to call them “American.” Without status, without understanding, without acceptance, they were often barred from clinics too.
That is how Celeste’s blood sugar climbed to 538 mg/dL. To other clinicians, it may just be high blood sugar, but to me, it was a punch in the gut. That 538 stood for the agony that my father felt cycling in and out of hospitals as a kid awaiting treatment. It stood for the COVID-19 vaccine that my grandmother would never receive, stranded on her second-floor apartment in her remote Indian village. It stood for the dedication that my parents displayed to earn their American citizenship, only to be told they could never be “American” by my high school classmates. It stood for the times that I was asked for my identification at the voting booth, the times that I was interrogated at customs upon re-entry into the United States and the times that I had received death threats as a little girl just for existing.
Celeste worked from 3 a.m. to 8 p.m., six days a week, so that my American peers could gamble away hundreds of dollars outfitted in their pretty dresses and statement hats. She lived in a shack without a kitchen or air conditioning while my American peers relaxed in beautiful racetrack restaurants. She lugged her laundry on a bicycle to the laundromat one day a week, when there was a washer-dryer on site just for the announcers to always have a clean-pressed suit. The least she deserved was adequate health care.
—
After that day, Celeste pledged to get better. We equipped her with long-acting insulin samples and checked up on her regularly.
One day at the end of the summer, when Celeste’s blood sugar level was more consistent, she picked up a state-of-the-art, used-and-recycled rotisserie oven. She wanted to prepare something special for us, she told me.
Behind the clinic, Celeste set herself up at a wooden picnic table. She plugged the rotisserie oven into one of the trailer outlets and tied her chicken to the oven’s metal rotating rod. She sauteed onions, garlic, tomatoes, and bell peppers, using a sizzling pan on her hotplate, and let tortillas slow-cook at the bottom of the oven. She chopped jalapeños and avocado to make guacamole and pureed the extra tomatoes and onions into a salsa using an old blender.
When she was finished, Celeste had put together a magical meal. Roasted chicken, marinated in spices and garnished with salsa, salad, tortillas, and guacamole. She arranged each of her creations carefully onto paper plates with finesse. She invited everyone from the clinic to join us, and we sat together in the summer sun, talking, laughing, and enjoying the beautiful meal that Celeste had prepared with so much love.
Image credit: Photography, taken on January 26, 2024, provided by the author for this Mosaic in Medicine piece.
Medical Student Contributing Writer
Albany Medical College
Medha has a deep-rooted passion for aiding the underserved, especially the migrant and refugee community. As a future physician, she hopes to use her skills to provide equitable healthcare to those in need.
