UPDATE, November 30, 8:00 a.m.: Immigration and Customs Enforcement deported Samuel Oliver-Bruno from the United States to Mexico on Thursday evening.

Julia Perez Pacheco and Samuel Oliver-Bruno have been together for more than 20 years and for the entirety of that time, Oliver-Bruno has been Perez Pacheco’s rock. He has supported her financially and emotionally, paying her medical expenses, driving her to doctor’s appointments, and caring for her during hospital stays.

He is her husband, her caregiver, her “everything,” she told Rewire.News through a translator, and soon they may be separated permanently.

As has been reported widely, Immigration and Customs Enforcement (ICE) agents in plainclothes violently took Oliver-Bruno into custody on Friday. Since then, the federal agency has transferred the husband and father to the Stewart Detention Center in Lumpkin, Georgia, and according to advocates, his deportation may be imminent.

The effect his deportation will have on his life is clear, after having spent over two decades in the United States. Less acknowledged has been the effect his deportation will have on the health of his family members, who have already been shaken to their core by his detainment.

For his wife, his deportation could have potentially “life-ending” and “life-changing” effects, according to her cardiology physician assistant, who wrote a letter of support for the family as Oliver-Bruno pursued deferred action.

Perez Pacheco has pulmonary arterial hypertension, an “aggressive and progressive” condition caused by lupus, a diagnosis she received at 15. Lupus affects most of the tissues in the body, causing them to become inflamed and scarred. For Perez Pacheco, this primarily has meant that lupus is affecting the blood vessels in her lungs and her heart. Pulmonary arterial hypertension is not curable, the physician assistant explained in the letter, and ultimately Perez Pacheco’s condition will “deteriorate.”

Presently, she is devastated. She told Rewire.News the past several days have been hellish. She is tired and has “no willingness to do anything.”

“I have horrible headaches and mentally, I don’t know how much longer I can keep carrying all of this pain,” Perez Pacheco said late Monday afternoon. “I don’t know how much longer I can do this.”

Although her particular situation is unique, the negative health impacts of detainment and deportation on families is an underreported, yet increasingly common, issue. Fear, trauma, and stress are having very real and damaging effects on immigrant communities that researchers are still working to understand. Adults who are subjected to immigration enforcement are experiencing severe and wide-ranging health implications. And these outcomes, medical professionals say, should be viewed as a public health crisis.

“Please Pray for My Family”

The week has felt endless for Perez Pacheco. She is a person who doesn’t like the spotlight, but Monday she had no option but to be “on display,” first at a press conference in front of the Wake County Detention Center, which until a few hours prior, had detained her husband. Then it was off to Republican Sen. Thom Tillis’ office, who told her he wouldn’t make any statement of support for her family. (In an email to a local outlet, a spokesperson for Tillis said the senator’s office has “inquired on the case and will continue to monitor the situation.”)

She sighed into the phone on her interview with Rewire.News before considering the worst case scenario, that her husband may be deported, and then she burst into sobs.

She couldn’t allow her mind to go to “such a dark place,” she said in tears. She could not conceive of a life without her husband. She had already spent nearly a year separated from him, while he’s been in sanctuary, and she has been sick with worry. Literally.

While Perez Pacheco’s health conditions existed long before the U.S. government began targeting Oliver-Bruno for deportation, there is no denying the stress and trauma of his potential deportation has endangered her health. Because lupus can directly affect the nervous system, stress can bring on flare ups, according to a recent study linking post-traumatic stress disorder to lupus. Ninety percent of people diagnosed with lupus are women and there is a direct link between stress, trauma, and flare ups.

In the “fight or flight” state associated with extreme stress, the heart rate goes up and cortisol release is less controlled, which leads to inflammation. “This stress response is exactly why lupus flare ups—which is marked by inflammation—are connected to, and sometimes indistinguishable from stress,” according to one of the Harvard researchers, the Daily Mail reported.

Beyond Perez Pacheco’s specific condition, new evidence suggests Trump’s immigration policies and anti-immigrant rhetoric have been dangerous for health, particularly for maternal health. It’s been well-documented how stress and trauma are risk factors for premature labor, and researchers have seen birth outcomes worsen after immigration raids. A study published last month in the Journal of Epidemiology and Community Health and led by a researcher at the Harvard T.H. Chan School of Public Health examined the premature birth rate in New York City before and after the 2016 presidential election. Foreign-born Latina women saw the sharpest rise in their preterm birth rate, with the most dramatic increase happening among Latina women born in Mexico and Central America.

The head of behavioral health services at Esperanza Health Centers, a Chicago-based federally qualified health center serving the largest population of Latino immigrants in the Midwest, explained that in terms of health implications for undocumented adults, there are “a lot of unknowns.” Immigrants arrive with “complex and nuanced mental health histories of war, torture, and strenuous migration journeys,” a recent study in the Public Health Reviews journal noted, and experts are struggling to understand and properly address the health care needs of this population. Even the individual stages of migration outlined by a 2011 report—including pre-migration, migration, and post-migration resettlement—come with their own “specific risks and exposures.”

An emerging trend in immigrant communities, according to the head of behavioral health services at Esperanza, is anxiety manifesting as “somatic complaints”: insomnia, gastrointestinal issues, and panic attacks. “Mental health affects physical health,” said Jessica Boland, Esperanza’s director of behavioral health services, in a July interview. Immigrant communities are increasingly reporting that they are experiencing chronic headaches, chronic gastrointestinal distress, and high blood pressure.

Boland said she is talking to patients about anxiety symptoms, “an exaggerated response to a fear,” but in the case of immigrant communities, “their fears are real. The response is not necessarily exaggerated. Patients need help coping with a very real threat while continuing to function day to day.”

No one knows this better than Perez Pacheco and her son, Daniel. Perez Pacheco said Daniel considered going to the hospital Monday. The 19-year-old’s blood pressure was high, he was feeling dizzy and anxious, and his mother said he couldn’t sleep.

Daniel was one of the 27 people arrested on the day ICE took his father into custody after protesters surrounded ICE’s vehicle for nearly three hours, temporarily hindering federal agents from driving off with Oliver-Bruno. Witnesses said Daniel was “taunted” by an ICE agent, who repeatedly blocked him from saying goodbye to his father. This same ICE agent accused Daniel of “assault.” Daniel alleges he was choked.

It was a traumatic day that seemed to “never end,” Perez Pacheco told Rewire.News.

On Monday morning, Perez Pacheco received a call from the wife of another detained person. It turned out that Oliver-Bruno had quickly made a friend in the Wake County Detention Center and gave him Perez Pacheco’s phone number. The man agreed that if Oliver-Bruno was transferred to another detention center, he would somehow contact Perez Pacheco and let her know where ICE had taken him. Oliver-Bruno suspected he wouldn’t have the chance to call his wife, and that ICE wouldn’t tell his family where he was.

ICE ultimately transferred Oliver-Bruno to the Stewart Detention Center in Lumpkin, Georgia, “the black hole of America’s immigration system.” Most men detained in North Carolina eventually get funneled to Stewart, a detention center notorious for having the highest deportation rate in the country. In 2015, less than 2 percent of men detained at Stewart won their immigration cases. While ICE assured U.S. Reps. David Price and G.K. Butterfield that they would “allow Mr. Oliver-Bruno to remain in the U.S. in detention while his case is adjudicated,” the sheer fact of his detainment made him less likely to win his case.

Late Monday night, more bad news came.

Around 10 p.m., Reps. Price and Butterfield announced that USCIS denied Oliver-Bruno’s appeal for deferred action, and that ICE “intends to immediately move forward with [his] deportation to Mexico.” In a last-ditch effort, the reps called on Department of Homeland Security (DHS) Secretary Kirstjen Nielsen to reverse Oliver-Bruno’s order of removal. As of right now, it is unknown if the sanctuary leader has been deported.

According to Price’s office, the Congressman has been in contact with senior ICE and DHS officials and has asked that they release Oliver-Bruno. Advocates are asking the public to call DHS and demand Oliver-Bruno’s “order for removal be reversed immediately.” Tuesday night, outside of the Cary, North Carolina, ICE office, his supporters gathered for a peaceful protest and prayed for Oliver-Bruno.

In many ways, this week’s events have broken Perez Pacheco’s spirit. News reports have mentioned in passing her health problems, but Perez Pacheco told Rewire.News that she is actually “very sick” and that while of course she loves her husband and wants to be with him, she also needs him.

“I am so scared that I will get so sick that I will need to go back into the hospital and Samuel won’t be there,” she said. “I can’t think about what will happen. It makes me too sad, too scared. I don’t know what we will do. Please pray for my family. We are suffering.”

No Mercy

In 2014, after arriving at her sister’s house, Perez Pacheco had extreme heart palpitations. It wasn’t just that her heart was beating oddly, she said, but you could see her shirt rise as her heart thumped away. She knew her condition was dire. Her sister took her to the hospital and the doctors immediately prepared her for open heart surgery.

“They told me if I didn’t have surgery, I would die. They said my heart would burst,” Perez Pacheco said. 

Shortly after her surgery, Oliver-Bruno returned to the United States after a brief trip to Mexico. When Oliver-Bruno, an undocumented immigrant who had previously resided in the United States for years, tried to re-enter the United States, Customs and Border Protection apprehended him. Immigration officials released him after he presented Perez Pacheco’s medical records during court proceedings showing he had re-entered the country because his wife had just had open heart surgery.

“He was desperate to be with me because he knew I needed him; I needed his help after such a serious surgery,” Perez Pacheco said. “All he has ever done is work, go to church, and take care of his family. He is an exemplary man. He is not a ‘criminal.’”  

“Criminal” is how ICE describes Oliver-Bruno. The federal agency told Rewire.News in a statement that he is a “convicted criminal” with “no legal basis to remain in the U.S.” Oliver-Bruno’s only criminal history stems from a 2014 guilty plea for trying to use false documents to try to re-enter the United States, the Associated Press reported.

ICE also asserted that his detainment was part of a “targeted enforcement action,” though he was detained while attending a biometrics appointment at U.S. Citizenship and Immigration Services (USCIS), the next step in processing his request for deferred action. 

Oliver-Bruno had taken sanctuary at CityWell United Methodist Church in December 2017 after receiving a deportation order under a Trump administration enforcement strategy that made longtime undocumented residents like him a target for enforcement. Once Oliver-Bruno had taken sanctuary, Perez Pacheco and her doctor noticed a change in her health. Before Oliver-Bruno entered the church, Perez Pacheco visited her doctor once every three months. In the eleven months since they have been separated, her visits increased in frequency, she said. Perez Pacheco said she now has doctor’s appointments “around seven times a month.”

“She is struggling to keep things together,” the physician assistant wrote in the letter. “Stress levels and tincture of time are causing her lupus to flare and this in turn makes her pulmonary arterial hypertension worsen. Our only saving grace is that she can see her husband from time to time, but the stress and angst of him facing deportation is taking its mental and physical toll on Julia. Julia’s medical conditions [require] frequent doctors’ appointments, blood testing, procedures (like echocardiograms, heart catheterizations), and she cannot do this alone. Her very life is at risk by not having any caregiver support from her husband.”

Love in the Time of Sanctuary

Before his detainment at the USCIS office Friday, Oliver-Bruno had only left sanctuary one other time: to attend a convening in Durham, North Carolina, for members of Colectivo Santuario, a new, nationwide coalition of people in sanctuary fighting for their liberation. At the convening, he and other “sanctuary leaders,” as they came to be known, learned strategies for developing their own deportation defense campaigns.

During a group meeting the last day, where organizers and attorneys gathered around a large conference table as sanctuary leaders shared their personal stories, the women in the room erupted in cheers when Oliver-Bruno described how he loved to take care of his wife and bring her breakfast in bed on days when she felt too ill to get up. The men in the room joked that he was making them look bad, but Oliver-Bruno was sincere. He grew emotional telling the room it was these small things he missed the most while stuck in sanctuary. He expressed his pain knowing his wife had to battle a debilitating chronic illness alone.

At 47, Perez Pacheco has spent 23 years with Oliver-Bruno, almost half her life. At the Durham convening, Colectivo Santuario members poked fun at the couple because of their affection for one another. They held hands throughout the convening and Oliver-Bruno’s arm stayed wrapped around Perez Pacheco’s shoulder or around the small of her back.

“It’s always how we’ve been,” Perez Pacheco said. “We’ve always been like that, always together, always touching.”

Theirs is a true love story, but in this moment, the couple has more pressing concerns. Perez Pacheco has only spoken to her husband once since their family’s worst fears were realized. Oliver-Bruno called from the Wake County Detention Center Sunday night to tell her that he loved her and that she shouldn’t worry about him. “Don’t get too anxious,” he said. “Focus on your health.”

In turn, she “can’t stop thinking about” whether or not Oliver-Bruno will receive the care he requires in Stewart. He is diabetic, she said, and requires daily medication, including insulin. Medical personnel working with ICE are notorious for denying people basic medical care, which has resulted in completely preventable in-custody deaths. Perez Pacheco says she knows all of this, she has heard the stories.

There is no question that Oliver-Bruno wants to stay in the United States, but the reason he requested deferred action, Perez Pacheco said, is because he needs to stay in the United States. According to advocates working with Oliver-Bruno during his 11 months at CityWell, he left his sanctuary church Friday with the understanding that he could be detained, and he did it anyway because he believed deferred action was his only hope of being able to take care of his wife. He may now be deported, and where that leaves Perez Pacheco is unknown. Her physician assistant did not mince words when it came to the implications of Oliver-Bruno’s deportation.

“The bottom line is this—if Julia’s husband is unable to remain in the U.S. to provide the support she needs as a husband, a friend, and a caregiver … Julia’s prognosis is even poorer,” the cardiology physician assistant wrote. “[A]s a medical professional, I have obligated myself to do as much as I can to improve quality of life for my patients, and ensuring Julia’s husband is not deported is part of this objective.”