“I Stayed on the Line”: How One Care Team Helped a Family Navigate Life Beyond the Exam Room
From the perspective of Rocsana E. De Leon Cifuentes, Associate Case Manager, Marin Community Clinics
To protect patient privacy, names and identifying details have been changed
On the morning of her five-year-old daughter’s spinal surgery, Ana called me from somewhere inside UCSF. She was lost.
Her five-year-old daughter, Sofia, has spastic diplegic cerebral palsy, and the surgery could help her move more freely. But Ana speaks Spanish and couldn’t find the surgical suite.
She called me again and again. I stayed on the line, listening as she spoke with hospital staff and helping translate until, finally, we found where Sofia needed to be.
I remember thinking: This is only the beginning for her.
When a child has complex medical needs, the whole family feels the impact. That’s why our Complex Care team looks beyond the medical appointment to understand what a family needs to make care possible.
Because health is more than a visit—and no family should have to navigate the challenges surrounding care alone.
Ana is a single mother of three. She works to keep food on the table, the bills paid, and a roof over her children’s heads.
So when Sofia’s surgery was scheduled, Ana faced an impossible choice: How could she be at her daughter’s
bedside and still earn enough to support her family?
She also had no car. Sofia would be recovering at a hospital across the bridge, miles from home.
And through all of this, Ana worried that she wasn’t doing enough.
I wish she could see what I see: a mother carrying an extraordinary amount and still showing up, every day, for all three of her children.
We kept looking for a way forward.
Long before surgery day, I began reaching out to organizations that might be able to help. Some possibilities didn’t work out. But we kept trying.
Working with the hospital’s social worker, we found assistance with transportation expenses, including gas, bridge tolls, and taxis. A relative could now help Ana visit Sofia several days a week while she continued caring for her other two children at home.
But one problem remained: Ana still couldn’t afford to miss work.
So I kept calling.
I contacted St. Vincent de Paul and left a message. They called back that same day and connected Ana with a Spanish-speaking outreach worker. Through that connection, Ana received temporary financial assistance that gave her something she desperately needed: time to be a mother at her daughter’s bedside without constantly wondering how she would feed her other children.
For families like Ana’s, healthcare doesn’t stop when they leave the clinic.
A successful surgery matters. But so does being able to reach the hospital. Understanding what the medical team is saying. Keeping food on the table. Paying rent. And having someone to call when you don’t know where else to turn.
That is what Whole Family Care means at Marin Community Clinics.
It means seeing the person behind the diagnosis—and the family surrounding that person. It means helping navigate the barriers that can stand between a patient and the care they need.
And sometimes, it means simply staying on the line.
Your support helps Marin Community Clinics be there for families through the moments that happen beyond the exam room—connecting them with care, resources, and people who will keep looking for a way forward.
Because healing a child also means caring for the family helping that child heal.
