By Deborah Bickel
Over the last several days, I have been trying to manage or at least CONTAIN a nightmare of a case unfolding in another part of Mexico, also known as a haven for expatriates. This is unfortunately a very true story, and it has not yet been resolved. It began for me five days ago when I received a call from the family of “Alan” (names and any other identifying information have been changed) an 80-year-old expatriate on advanced life support in a small private hospital where he has been the only patient.
Six days ago, Alan was walking with his wife when she saw a look of disorientation cloud his face followed by the sound of a crack as his head connected full force with unforgiving cement.
A fall, head trauma, and any unanticipated or “early” death are sad and troubling events but not really the stuff of nightmares. No, this nightmare began when decisions and actions of the “care team” overrode all efforts to broker the peaceful dignified death Alan and his wife imagined. Indeed, those wishes are a part of a medical directive on file in the United States.
The nightmare continues unabated even now as the “treatment plan” unfolds. Over the course of far too many hours to sustain any credible sense of urgency, the “team” managing his care in this small hospital decided to perform what can only be described as exploratory brain surgery “to assess the extent of any bleeding or injury.” The team also put in a PICC line or “feeding tube” to deliver nutrients and insisted on replacing the first smaller line for a longer lasting and more durable one.
Meanwhile, I helped the family find a bed at a palliative care facility nearby, but just before the ambulance arrived, Alan made a few hand movements and opened his eyes. His gaze was vacant, and the twitching movements he made are best described as involuntary. Thus began the nightmare.
Alan’s eyes closed once more, and his hand motions ceased. Despite a chart note indicating Alan’s life expectancy was less than two weeks, the “care team” advised the family that any attempt to move the patient “might kill him.” They also hinted at legal problems that could ensue for his family should they discharge him against medical advice. Similar objections were raised concerning the patient’s dependency on oxygen; the team said they didn’t trust the hospice facility to reliably deliver oxygen via simple nasal cannula. More astonishing still was a recommendation to keep the dying man over the weekend in order to get a “cardiac evaluation” at a “more convenient hour.”
It is now five days since Alan fell, and he is still in the hospital. The family enlisted a lawyer who confirmed what I suspected—any planning carried out in the United States such as the creation of a medical advanced directive is useless in Mexico. She also told them something I did not know and have not yet confirmed: any hospital in Mexico must provide, upon request, a written record of diagnosis and a treatment plan, including all associated costs in the patient’s native language.
Sharing essential information and then helping create plans of action in the event of a health crisis such as this one should be the bedrock of advocacy work. However, far too often my work over these seven years most resembles that of a fire fighter. While astonishing levels of misinformation and greed characterize these ugly events, simple, albeit understandable, ignorance and a failure to plan left this family painfully vulnerable, financially as well as emotionally.
Next week, look for Part 2 of this column for simple measures and practical tips on how to best prepare for the least-expected.
