While media attention focuses on racial divisions between white and black, another prejudice -- against the alien -- is taking its toll among California's undocumented population. A year after Californians passed Proposition 187 to ban public services from illegal aliens, a health care worker counts the human toll. PNS commentator Tara Moss is a physician's assistant working in a community health clinic in rural northern California.

NORTHERN CALIFORNIA -- Had I known the full story I would have known what to do. But the patient was undocumented and I assume that he was afraid I would report him, as Californians intended when they passed the anti-immigrant Proposition 187 last year. So he withheld vital information. Eleven hours after he left our clinic, he died.

He was 24, handsome, and appeared healthy when I saw him, except that his feet and ankles were swollen. He told me that he had "hiked" a lot in the heat, and that in the past his feet had swollen when he hiked a lot, only this time it was "a little worse." I did not think to ask where he had been hiking. He had an air of casualness underplaying his symptoms. He denied any history of other problems or risk factors, like fever, shortness of breath, surgery or drug use.

What I later learned was that he had indeed walked a long way, more than a hundred miles, from Tijuana to Riverside. Shortly before, he had undergone minor surgery for a boil on his buttocks. As he crossed the polluted river along the border, the wound had allowed an unusual bacterium (Aeromonas sp.) to enter his bloodstream. By the time he came into the clinic, he had bacterial sepsis (a systemic blood infection) so advanced that his body could no longer produce the symptoms normally associated with severe infection: high fever and white blood count. He looked basically well except for his edema (swelling). He did not tell me that several days earlier he had been very sick.

In a young healthy person swollen feet are unusual and could signal problems in one of the major organ systems. I suggested that he go to the emergency room for further evaluation, but he adamantly declined. He asked that I keep costs to a minimum. I ordered an EKG, urine and blood tests, and had them sent out to a lab for evaluation. To rush the results would have added to the expense.

After he left, a woman who knew him came in to tell me that he was not a U.S. citizen and had recently been deported back to Mexico. She also told me a bit of the story of his "hike" -- over the border, back into the U.S. I then wished I had told him that I never report a patient's immigration status. I tried to call, but the phone number he had given us was wrong, as was the address and, I learned later, also the name.

The next day I was notified that he had died that night, eleven hours after I saw him. More experienced colleagues tried to console me by reminding me that one is bound to lose some patients. I was prepared for that. But what is important is that I could have made a real difference for this person. He did not have to die. Had he felt free to tell me his real history, I would have had an idea of how to treat him. He also might have come to the clinic earlier had he not been afraid.

That evening I took a long walk with my young son. This young man's parents, in a small village in Mexico, had not yet been notified. I had no way of contacting them, but still I thought of what I would say. I grieved and I was angry that my clinic has to struggle with funding cuts, that we have lost our funding for indigent care, that our country is full of prejudice that Californians could pass a law banning all public services, including health care, to illegal aliens. Since Proposition 187 passed those without U.S. citizenship fear detection and deportation, so many won't tell their whole story, even in the face of grave illness.

Later I went out to my garden. I had bought a weeping plum but had not yet planted it. As I dug a hole I cried for the injustice and the loss. I grieved for this young man, his family, and for all the other people who are too afraid to seek needed care because I know that he was not the only one.