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Emilio Gonzalez is sitting in the passenger seat of a car, dazed.
In truth, he’s not going anywhere fast. It’s a simulated car with just two seats, a steering wheel, and a barebones brown exterior –and it’s not even outside.
Gonzalez is stuck inside the rehabilitation gym at Hennepin County Medical Center, in downtown Minneapolis. He’s wearing a white long sleeve shirt, pale red sweatpants, and sneakers; a feeding tube (temporarily disconnected from its pump) runs up his body to his right nostril.
Gonzalez, 65, has lost 50 pounds since he came to the hospital during what seems like a lifetime ago. Early on, he lost his sense of taste from a severe bout of COVID-19 and he stopped eating. It’s the first day of February, more than two months since the day his daughter, Emilia Gonzalez Avalos, found him collapsed in his home and rushed him here herself.
If all things go well, today should be Gonzalez’s discharge day—the day he goes back home.
But so far all is not going well. Gonzalez is weak and tired; he isn’t speaking much. Gonzalez’s eyes are piercing, but they stare off into space.
Having brought him here, Emilia is still standing right beside him, and so is his brother, Roman, three physical therapists, and a medical interpreter. The therapists lift Gonzalez to transfer him to his walker, which he’d been using earlier today to practice walking around the gym.
Gonzalez, now standing and supported by his walker, begins to step. His left knee buckles and he drops. The hospital staffers catch him as he falls backwards and slowly lower him to the ground.
“You got dizzy,” one of the physical therapists tells her patient. She instructs Gonzalez to bend his elbow and takes his blood pressure. A quick check confirms Gonzalez’s oxygen levels are fine. His blood pressure is OK.
“I think the knee gave out on you,” the therapist says.
Several months before contracting COVID-19, Gonzalez injured his leg while falling on the job. His workplace took him to the hospital for it, but Emilia says Gonzalez didn’t get the full rehab he needed for his leg to properly heal.
Gonzalez now lies on his back. The hospital staffers roll him to his left side and explain that they are placing a hammock underneath him. They attach the hammock to a Golvo lift machine and slowly raise his six-foot frame into the air. Then, they carefully plop him into a wheelchair and cart him to a bed a few feet away.
Roman lets out a big sigh. The physical therapist explains that Gonzalez fell because he’s tired, dizzy, and suffering from vertigo. This probably comes from spending much of the day here in preparation for leaving the hospital.
Dusk is approaching outside. Gonzalez’s family is hoping to get him home by nightfall. The physical therapists and nurses recommend he stay in the hospital for one more night.
“I’m worried if something like that were to happen at home,” explains one of them.
Emilia, who holds power of attorney to act for her father, says no. Her father has been miserable in this hospital, and she worries he is losing the will to rehabilitate.
The hospital has drained Emilia over these last several weeks of visiting her father. Some days, she’d get so exhausted she would nap in her car in the parking lot before driving back home for the night.
“He wants to go home,” she tells the therapist. “We have been telling him he is going to go home, and we want him to trust us.”
Gonzalez stays resting on the bed for the next 45 minutes. Soon, it’s time to discharge him and bring him home. This time, just Emilia and Roman help him up. Using a gait belt, they transfer Gonzalez to his wheelchair with relative ease.
Standing behind Gonzalez, Roman pats him on his left shoulder. Gonzalez stares at the floor.
* * *
What do you do when you have a job and a house—but no health insurance and no citizenship?
Latinos in Minnesota account for 9 percent of all positive COVID-19 cases, according to the state Department of Health. That’s nearly twice their share of the overall state population, which is around 5 percent. Nationwide, Latinos are hospitalized with COVID-19 at more than three times the rate of whites, according to the Centers for Disease Control and Prevention.
In other words, Gonzalez’s ethnicity made him more susceptible to contracting the virus and being hospitalized. So did his role as an “essential worker”: a broad category for laborers in fields like food, transportation, and health care. Practically speaking, it often means people who can’t work from the safety of home. These workplaces often bring exposure to coronavirus. One recent federal government study, for instance, places nearly three-quarters of all workers in jobs deemed “essential” at high risk for infection.
On top of this, Gonzalez’s age and high blood pressure put him in a higher risk category for suffering serious illness from the virus. Chronic health conditions like these are more prevalent in the country’s Latino population, and they’re less likely to be properly controlled.
Still, medical experts don’t have all the answers for why COVID-19 patients like Gonzalez suffer serious hospitalizations and long-term effects while others don’t. Nick Lehnertz, a medical specialist in the infectious disease and epidemiology division of the Minnesota Department of Health, says much is still unknown about the way the virus works, even one year into a deadly, global pandemic.
“We’re still gathering data and we’re still looking at this thing,” Lehnertz says. “Our understanding of medical conditions that are associated with severe disease—we keep expanding it as we learn more.”
One thing that is known: If a COVID-19 patient ends up hospitalized, he or she has a much higher chance of experiencing long-term effects from the virus. One study from last summer in the Journal of the American Medical Association concluded that 87 percent of hospitalized COVID-19 patients in Italy were still suffering persistent symptoms 60 days after infection.
In Minnesota, around 5 percent of all people with confirmed COVID-19 cases have been hospitalized. Nationwide, COVID-19 hospital stays last a median of eight days, according to the Centers for Disease Control and Prevention. Gonzalez’s hospital stay lasted 76 days, threatening his potential for a full recovery.
Gonzalez faces other challenges. Looking at his current condition, it’s difficult to imagine him returning to work—especially the type of taxing labor he’s done until now. And for his whole life, Gonzalez has worked.
Like his father, Gonzalez labored in construction. “Ever since he was able to carry a brick, he joined his dad working,” Emilia says.
With no guaranteed way to bring in income, Gonzalez also faces financial difficulties. He came to the U.S. undocumented in 1992. In 2001, Roman petitioned the U.S. government for Gonzalez to gain permanent residency. The petition was approved in 2006, according to Emilia, but his green card has been delayed ever since. Immigrants who apply for residency through a brother or sister often find themselves at the bottom of the immigration preference list. Their wait time for green cards can be as long as 25 years.
Emilia, a permanent resident herself, can’t petition for her father for another four years. If Gonzalez’s permanent residency isn’t resolved by then, that’s what she plans to do.
All this means Gonzalez must navigate this crisis as an undocumented immigrant with no health insurance. It’s unclear how Gonzalez will pay for many of his medical bills. As an undocumented adult, most government aid programs like Supplemental Security Income are closed to him. When he contracted the virus, Gonzalez and his family encountered the crisis with no advance warning and limited resources.
But they did have strong family bonds. Gonzalez grew up in a working class neighborhood in Gustavo A. Madero, a municipality in the north part of Mexico City. Many of his family members still live in the same family home today, and they often check in on him via Zoom. Physically, Gonzalez is surrounded by his brother, son-in-law, grandkids, and a daughter who is actively engaged in the community.
In her day job, Emilia is executive director of Unidos-MN, an advocacy group staffed by a dozen Latinos, most of whom are immigrants like her. Ever the social activist, Emilia took her father’s story—a microcosm of larger inequities around race and class during the COVID-19 pandemic—to the public through Twitter, local media, and even national outlets like Newsweek and MSNBC. Not knowing how the family would pay for unresolved medical bills, Emilia is relying on a GoFundMe account to help pay for much of her father’s recovery. To date, the family has raised nearly $30,000.
* * *
From a warehouse job to a ventilator
Gonzalez fell sick with COVID-19 sometime in November. Emilia, 39, isn’t sure exactly when.
She had just spent the last several months leading the biggest Latino voter turnout project in the state, through Unidos-MN. Outside of elections, Unidos pushes for causes like supporting ethnic studies to school curriculums, stronger renewable energy quotas from utility companies, and pro-immigration policies locally and nationally. After a long election season, Emilia took a few weeks to decompress and focus on finishing her long-delayed undergraduate degree at the University of St. Thomas.
At the time, her father kept his distance. “I had midterm exams, so I didn’t see him that often,” Emilia says. “He doesn’t like bugging me when I’m studying.”
Occasionally, Gonzalez brought homemade meals to her house to help her study.
When she got the call from Roman on November 17, Emilia realized she hadn’t heard from her father in a few days. He wasn’t well and needed help, Roman told her. Emilia and her father both live in Richfield and she made the quick drive from her house to his.
Before contracting COVID-19, Gonzalez worked, through a temp agency, in a warehouse, packing dry goods like granola bars and cereal. Emilia had been worried that Gonzalez would contract the virus on the job. She ultimately isn’t sure where he contracted COVID-19, but suspects it was at work.
Emilia arrived to find her father on the floor, struggling to breathe and burning up from fever. When he saw her, he tried to quickly get up and act like he wasn’t very sick. It didn’t work: Gonzalez still couldn’t stand on his own. And Emilia struggled hauling her father to the hospital.
Gonzalez’s symptoms and the condition of his lungs convinced doctors it was the coronavirus, though they didn’t confirm it with a positive test until a few days later. Doctors quickly placed him in intensive care and put him on supplemental oxygen.
For Emilia and the rest of the family, the next several weeks would prove to be an emotionally draining experience.
A grueling stay followed, as Gonzalez would veer between getting better and suffering new setbacks. At his best, he would become alert and communicate with his family over Zoom. At his worst, he spent one week knocked out on a ventilator. In January, his recovery was looking up. Then he suffered kidney failure, though he recovered from it quickly enough to avoid dialysis.
Some days, when it looked like Gonzalez might not survive, Emilia and her husband Daniel Del Toro would start cleaning out her father’s home in case they needed to sell it.
* * *
‘All the blankets are mine’
Dusk gives way to night as Emilia pulls her Toyota Sienna in the driveway, near her home’s back entrance. The house is a two-story, mid-century colonial in a quiet, darkly lit suburban neighborhood. Her two kids—11-year-old Miranda and four-year-old Joaquin Del Toro—wait anxiously inside, near the back entrance. They haven’t seen their grandfather in person since before he disappeared to the hospital nearly 11 weeks ago.
Daniel, Emilia’s husband, is also with them. As Emilia centered much of her time on her father’s care, Daniel focused on caring for their kids. They exit the back door and greet Emilia and Roman in the driveway. Gonzalez naps in the passenger seat and slowly awakens.
“He made it, he made it,” Roman says as he greets the family.
While much of the day has been a struggle, Gonzalez’s old self shines through for a few brief moments. As Roman, Emilia, and Daniel prepare his wheelchair, Gonzalez orders his brother to climb into the car and sit in the driver’s seat. Soon, he starts to lecture his little brother on the proper way to cart him from the car to the house.
Emilia, Roman, Daniel, and the kids all share a laugh. “My dad is a little bossy,” Emilia says.
After transferring Gonzalez into his wheelchair, Roman has a minor struggle getting him up the stoop at the home’s back entrance. Once inside, they quickly bring him to the bed they’ve placed in the middle of the finished basement.
The family has set up the basement for his recovery. Two beds lie near each other, including a special medical bed that the family purchased for him. The floor has been cleared for Gonzalez to practice walking from one bed to the other—a therapy regimen for the days and weeks ahead.
On the south end lies a full-size bathroom, with a shower big enough to fit the wheelchair inside—although he’s not mobile enough to use it yet. Until then, Emilia plans on giving him towels soaked with Dr. Bronner’s soap to clean himself from the bed.
Roman places a commode chair next to his bed, and explains to Daniel how he might help Gonzalez use it.
An electric heat blanket awaits Gonzalez in the bed. But after he lies down, he still complains of being too cold. Eleven-year-old Miranda asks Gonzalez which blankets in the house belong to him.
“All the blankets in the house are mine,” he tells her.
Different family members leave the room looking for any extra blankets they can find, and one by one, they come back and cover him up. Before he contracted COVID-19, Gonzalez didn’t get cold this quickly, Emilia says. Both Roman and Daniel blame his chills on how little he has eaten since losing his sense of taste.
“Once he starts eating better, I think he’ll get warmer,” Roman says.
One of the blankets they bring down has the logo of Las Águilas, the Mexican soccer team. Emilia and Daniel cover the logo with another blanket. Gonzalez is a lifelong fan of Chivas, a rival soccer team.
“That is not his team, so we are hiding it,” Emilia says.
Miranda starts adorning the basement with photographs and keepsakes, including a caricature of her and her grandfather that a mall artist drew several years ago. One of the photographs she hangs next to the bed shows an upright Gonzalez proudly holding two children, his grandson and grandniece, one in each arm.
Four-year-old Joaquin hoists himself on the bed next to Gonzalez and quickly embraces him. He leaves the bed and then, muted and expressionless, walks up the stairs and leaves the room.
Miranda is now sitting near her mother. Emilia tells her not to get too excited tonight and reminds her that her grandpa has a long road ahead. “You need to rest,” Emilia tells her, “because this is a marathon, not a sprint.”
* * *
Looking for the motivation to eat again
Five days after returning home, Gonzalez is progressing, albeit slowly.
In the past week, Emilia has become his caregiver. She’s seen a lot since then. The worst part is helping her father cough up fluid from his lungs each day. Sometimes she reaches into his mouth and pulls it out with her hands.
She recalls what her father was like before he contracted COVID-19: a gruff man, a proud immigrant, a child of the 1960s. To this day, he still prefers listening to the music of that time—artists like Eric Clapton, Joe Cocker, and Led Zeppelin.
His own father was a son of the Mexican Revolution, valuing land and freedom as his core values. And this tradition was passed down to Gonzalez. One of his greatest fulfillments in life was buying his own home, which he did 15 years ago.
“I might not have fancy clothes and I might not have fancy things in my home, but it’s mine, and I don’t have to be bugged by a landlord,” Emilio would tell his daughter.
During his sickness, Emilia sometimes struggled to recognize the man her father once was. Until he got sick with COVID-19, Gonzalez was a strong man. When she was 10, Emilia says, he used to hold her with one arm and let her swing all the way around—like a jungle gym. Now, he needs a walker to move, and he can only do so for short periods of time in the basement.
Emilia also remembers her father as a man with a love for cooking and eating. Now, with his taste buds distorted from the COVID-19 infection, his motivation to eat is largely gone.
Gonzalez’s doctors have advised him to wean himself off the feeding tube and start eating on his own. If he doesn’t, his doctor told him he’ll have to come back to the hospital.
For the first week back home, eating proved to be a struggle. A few days after Gonzalez left the hospital, Emilia tried to feed him a serving of baby applesauce with cinnamon and oatmeal.
“It tastes like shit,” Gonzalez told her. “It tastes rotten.”
When she tried to give him more, she says he almost cried. “Please don’t do that to me,” he told her.
In the following days, Gonzalez’s appetite grew to accept smoothies and chicken wild rice soup. But he still uses the feeding tube at night.
Mentally, he’s in a better place than he was. In the hospital, Gonzalez developed ICU delirium, a common symptom for severely ill patients during extended hospital stays. He was often confused and unable to distinguish the hours and days from each other.
Some of the trauma of his hospital stay still lingers. At night, Gonzalez has nightmares that he’s in the hospital. He calls for his uncle. And Emilia, who now sleeps on the couch across from him, wakes her father and reorients him.
He’s less confused now, but often tires quickly from talking, even for short periods. Following the advice of his doctors, Emilia makes him sit up and talk to his family for parts of the day. This can anger him.
“He called me a betrayer,” she says. “He said, ‘I don’t want to be sitting up talking to nobody.’ I told him, ‘You have to do it for cognitive therapy.’”
For Emilia, the days are wearing. She worries about his mental health as the reality of his new life continues to sink in. She hopes he can find peace and joy in life as he ages; she fears he’ll feel useless if he can’t work anymore.
Leaning into her activism, Emilia adds that she wants the immigration reform discussion to include people like her father—the aging undocumented parents who got left out of initiatives like the DREAM Act and Deferred Action for Childhood Arrivals.
“It was easier for the mainstream to accept me and not accept our parents, and we’re running out of time,” she says.
One thing is for certain: Providing full-time care while running a nonprofit is not sustainable for Emilia. She’a started to look for a full-time personal care assistant to do this job, hoping the money her family has raised through GoFundMe will help. Even if that arrangement works out, she’s worried her father will not trust a stranger to care for him.
Over the weeks that Emilia shared her family’s story, she repeatedly expressed her hope for another development: that her father would regain enough strength to recount his COVID-19 experience for himself. The next time someone calls her, Emilia says, he might be ready.