By Jared Chausow
By Katie Toth
By Elizabeth Flock
By Albert Samaha
By Anna Merlan
By Jon Campbell
By Jon Campbell
By Albert Samaha
Her business was a family affair. Mercado had two paid employees: Myra, the clinic manager, and Myra's husband, Edward Capistrano, the billing supervisor. The Capistranos' children handled the patients.
Paul, a 23-year-old political science grad student with a degree in math, and Bernard, a 21-year-old graphic design major, measured heights, weights, and blood pressure. Twelve-year-old William sat at the front desk, answering phones and filling out appointment cards.
Irma handed William a referral card from Claudialee's pediatrician, Dr. Cabatic.
She'd taken Claudialee to see Cabatic five days earlier for the first in a series of flu vaccinations. Claudialee had the sniffles, so Cabatic ran her through a full examination. Four days later, the doctor called to say that Claudialee's urine and red blood cells showed abnormal glucose levels. Her blood sugar was above normal, suggesting the girl might become diabetic. In her notes, Cabatic wrote, "probable diabetes mellitus."
The disease stems directly from high blood sugar. In type 1 diabetes, the immune system kills off cells that produce insulin, the hormone that brings the body's glucose supply to muscle and fat. If the body doesn't get more insulin, the person will die.
In type 2, a person has a lot of insulin, but the stuff just doesn't work. Insulin resistance, doctors call it. Obesity is the usual cause. The damage is slower and can be treated through diet, exercise, and medication.
Cabatic knew Claudialee was at high risk for diabetes. The girl's maternal grandmother, paternal grandfather, and three of her uncles had it. She recommended that the girl see a specialist and gave Irma the name of a pediatric endocrinologist who spoke Spanish and would accept her Metroplus Medicaid card. (Metroplus, a nonprofit healthcare organization that provides Medicaid in New York, did not respond to interview requests for this story.)
Irma called Mercado's office to set up an appointment for the next morning.
After asking about the family history, Mercado took a blood sample from Claudialee. The doctor was a short, round woman who peered over thin spectacles and disarmed with a cheerful smile. She told Irma she would send the blood to a lab and they'd discuss the results in two weeks.
The test would duplicate Cabatic's results: Claudialee's blood sugar level was higher than normal, but not high enough to be considered diabetes. She was "prediabetic." During the next visit, Mercado explained to Irma that the results were nothing to be too concerned about. The girl just needed to lose weight. Diet and exercise. She handed Irma a sheet of paper with a food pyramid on it.
In her notes, Mercado wrote that if the patient didn't lose weight by her next checkup in mid-December, she would prescribe Metformin, a drug used to treat type 2 diabetes.
Though type 2 used to be called "adult-onset" diabetes, Mercado knew recent studies had shown that a growing number of kids were getting it. At 3-foot-9 and 67 pounds, Claudialee was clinically obese. Mercado noticed a dark spot on her neck, often a sign of insulin resistance.
By her next appointment on December 12, things were looking up. Claudialee was thinner. Mercado didn't conduct any tests or ask many questions. It was a brief but reassuring meeting, full of grins and calming words. Claudialee is fine, the doctor told Irma. She just needs to drop another pound or two. Diet and exercise.
In her notes, Mercado wrote that she'd administer another blood glucose test on the next visit. As Irma left, William handed her an appointment card telling them to come back on February 23.
Cabatic echoed Mercado's optimism when the mother and daughter returned on January 9 for the girl's final flu shot. It happened that Claudialee had come home early from school the day before. During snack time, she complained that her heart was beating faster than normal. The nurse sent Irma a note saying a doctor had to sign off before Claudialee could return to class. Cabatic assessed her vital signs. Normal heart rate and blood pressure. No cough. No chest pain. No difficulty breathing. All was stable.
Cabatic had more good news: In the 10 weeks since the October 26 checkup, Claudialee had lost five pounds and grown two inches.
As far as the doctors could tell, Claudialee was getting healthier by the week.
On January 21, Marta Nicanor, Irma's sister, picked up her six-year-old son, Gustavo, and Claudialee from school. Irma worked as a housekeeper for a family in Port Washington, Long Island. Most days she left her apartment at 8:30 a.m. and didn't get home until nearly 8 p.m, so Claudialee spent most of her evenings at her aunt's place. She'd play with Gustavo, her best friend.
Claudialee told Marta she was tired and that her stomach had been bothering her. She wanted to lie down. Marta called Irma, who called Dr. Cabatic to schedule an appointment for first thing the following morning. She left work early and arrived at her sister's apartment about 4:30 p.m.
When Claudialee heard her mother come in, she hopped out of bed, ran over to her, and threw up. Irma took her to their apartment, one floor up in the same building.