The Assembly Line

By Ashley Osuna / Spring 2025

The smell is what lingers long after everything else fades. Not the artificial lemon of cleaning products or the comforting musk of home, but the sharp sting of antiseptic mixed with adult diapers. It clings to my skin, my hair, my clothes—a permanent reminder that my life at twenty-three looks nothing like it should. While my peers worry about exams and weekend plans, I measure time in medication schedules and wound dressings. The plastic gallbladder drainage tube protruding from my grandmother's abdomen needs emptying three times daily, its contents a fluorescent yellow-green that looks unnatural against the clear collection bag. When I change the dressing around her surgical wound each morning, I've learned to hold my breath. The skin there never healed properly, stretched tight and shiny like plastic wrap over raw meat. The home health nurse showed me the procedure once before deeming us "stable enough" to manage alone. Now it's just me, my shaking hands, and YouTube tutorials playing quietly on my phone as I peel back soiled gauze, trying not to wince at my grandmother's sharp inhale of pain.

Mornings begin not with alarms but with sounds that have become my personal wake-up call: the wet rattle of my grandmother's cough, the persistent beep of the oxygen concentrator when its tubing kinks. By 4:30 AM, I've already cleaned and redressed her wound, crushed my brother's antipsychotics into applesauce, and suctioned thick mucus from her tracheostomy tube—the gurgling sound it makes still turns my stomach after all this time. There's an unnatural rhythm to our days, a cadence of survival that leaves no room for spontaneity or mistakes. At 3:00 PM, while my classmates are in lectures, I'm on hold with Medicaid, appealing denied claims for wound care supplies for the eighteenth time. By 8:30 PM, when most young adults are out with friends or studying, I'm checking my brother's arms for track marks again, counting pills, and listening for the telltale alarm that means Grandma's oxygen levels are dropping, or the sudden silence that means my brother has slipped out again—sometimes to run barefoot in traffic or chase voices he thinks are spying on him.. This isn't living—it's medical shift work without pay or breaks, where the patients share my last name and calling in sick isn't an option.

My mother crossed the border in 1997 with my brother kicking beneath her rain-soaked blouse, her shoes filling with water as she carried them both toward a country that would demand everything and give little in return. Now her hands tell the story of two decades in America: nails permanently stained with bleach from cleaning jobs, knuckles swollen with arthritis she can't afford to treat. She asked me once, if I was ashamed to tell people she cleans houses. What I couldn't explain was how the question didn't hurt because of shame, but because it revealed how thoroughly this country convinces people like us that our labor should be hidden. I would never be embarrassed to express pride in my mother’s work ethic. Her exhaustion built the foundation of my life, and now I can't tell where her sacrifice ends and my survival begins. When I see "Now Hiring" signs at air-conditioned offices offering wages that still wouldn't cover our rent, I want to scream at the injustice that her backbreaking work earns less than those jobs pay teenagers.

The social worker calls our situation "multigenerational caregiving" as if it were some cultural choice rather than financial necessity. She doesn't see how we've turned our home into a makeshift hospital—the living room dominated by Grandma's hospital bed, the kitchen counters lined with prescription bottles, the bathroom shelves overflowing with wound care supplies. IHSS grants us twenty-four care hours per week, as if human need can be neatly portioned into increments. Those hours disappear like water through fingers: three lost when the caregiver no-shows, five spent appealing denied claims, seven compensating for my brother's latest psychiatric crisis. The system operates on paperwork and waiting periods designed to wear people down until they give up. We haven't given up yet, but some days I wonder if anyone would notice if we did.

There are things no one tells you about caregiving—how adult diapers cost more than your cell phone bill, how "family medical leave" doesn't apply when you're the unpaid caregiver, how the human body can produce so many different kinds of pain. No one warns you how to respond when someone you love says they want to rot in their bed because living hurts too much—or how to find words of hope for a woman who once raised six daughters and now depends entirely on a granddaughter. Love in our household takes forms that would seem unnatural elsewhere: checking my brother's arms for needle marks, calculating which prescription to refill this month, pretending not to see my mother crying over the electric bill. Family shouldn't smell like the cloying vanilla air freshener my aunts spray to mask the scent of illness, or the zinc oxide cream I spread on Grandma's bedsores, or the metallic tang of blood when my brother jumps from the roof. I’m twenty-three and fighting for conservatorship over a brother who doesn't believe he needs help, navigating legal paperwork in between lectures and medical appointments. Yet this has become our normal, a series of unnatural acts performed in spaces meant for love and living.

I am a pre-med student who knows more about Medicaid appeals than cellular biology, who can recite Grandma's fourteen medications but forgets lunch dates with friends, who jerks awake at 2 AM thinking I hear the oxygen alarm. The system calls this resilience. But it's not resilience—it's the slow erosion of a person into something purely functional, a caregiver-shaped machine running on exhaustion and guilt. Sometimes, in rare quiet moments, I catch glimpses of the person I might have been: when a classmate laughs about their weekend adventures, when I pass a coffee shop and see students studying without medical alarms buzzing in their bags, when I realize I've forgotten what it feels like to be touched by someone who doesn't need something from me.

But the machine doesn't stop for grief or longing. Grandma needs her dressing changed. Brother's due for his meds. Mom's feet are swollen again. The assembly line of caregiving doesn't care about your dreams—it only cares that you keep showing up. I don't know who I'll be when this is over, if it ever ends. I only know that for now, my hands are the ones keeping everything running, and no matter how tired they get, they can't afford to stop shaking.