One crisp January afternoon one of us (Sarah) sat in the living room of Guadalupe, an immigrant farmworker in California’s Central Valley, as she explained why she had refused to accept Emergency Medicaid to cover her children’s delivery. Quietly and calmly, as though she were describing an ordinary event, Guadalupe shared how she and her husband scraped together the funds each month—on a farmworking salary averaging about $18,000 a year—to pay off the more than $20,000 debt they owed hospitals for the births of their children.
Blood tests, echocardiograms, waist measurements, and body weigh-ins comprise a cyclic apparatus of health checks at clozapine clinics. Most patients have a diagnosis of “treatment-resistant schizophrenia,” but their clinical records are mostly filled with cardio-metabolic concerns. Having a “clozapine belly”—as one patient described their weight gain to me—becomes normalized in the clinic waiting room.