Tuesday, January 12, 2016

A medical dilemma or a horror story?

Not a week goes by without Félix, with his usual uninflected delivery, tells us a shocking life-in-Mexico story that strikes Stew and me with the force of a blow to the side of the head.

"How can that happen?" we ask, while Félix's response to such day-to-day tragedies and outrages—a reaction I find quite common among poor Mexicans—goes far beyond sangfroid or steely determination. It's closer to profound impotence and fatalism: Life is shit and then you die. 

Félix' most recent story arrived yesterday and involved his twenty-three-year-old niece, Veronica. She had gone into premature labor and was rushed to the local hospital where she delivered a tiny, but very much live-and-breathing baby about five-and-a-half months old.

Rather than place the baby in an incubator to keep it alive, possibly to be transferred later to a more sophisticated facility, the attending physician told the father that the newborn, apparently normal except for its size, could not be saved. It was left lying on the crib while the father watched. The baby gradually turned blue, Félix said, and two or three hours later died without any further medical intervention.
I don't know the full medical details but when we heard that Stew and I felt a similar sadness and outrage gripping our hearts and guts: How could that happen? 

The hospital is but two or three years old and in my exposure to the facilities, when we've taken friends to the emergency room, including Félix' dad, who suffers from diabetes, alcoholism and generally a very hard life, it seemed to be well equipped and staffed. Félix said that his last two babies spent their first few hours with an oxygen mask around their tiny faces, and that there are incubators available.

Yet given the baby's chances of survival, and the medical and financial limitations of the hospital and the government-financed healthcare system on which people as poor as Félix and his family rely, perhaps the doctor had no other options.

Stew promptly said such a thing wouldn't happen in the U.S., that the baby probably would have been kept alive in a neonatology unit even if the medical bills reached hundreds of thousands or even millions of dollars. I'm not sure.
Stew may be only partly right. If this drama had unfolded at a private American hospital and the parents carried full private insurance, that baby likely would have survived. America's private health care system is justifiably renowned worldwide for all manner of medical heroics—as long as there's plenty of cash to pay for them.

A private Mexican hospital in a larger city also might have saved the baby, assuming the parents had the means to pay for the treatment. Indeed, private Mexican hospitals have a particularly draconian reimbursement system: You have to leave a substantial deposit, in cash or with a credit card, before you're treated at the emergency room or admitted.

If Veronica had shown up at a private hospital in Chicago with premature labor pains and no insurance, she would have been efficiently bounced to Cook County Hospital, a public facility dedicated to treating indigent patients. And at taxpayer's expense, she would have received first-class attention at this multi-billion-dollar version of government health care, precisely the big-government monster conservative politicians love to loath in the U.S.
But what if Veronica, indigent and thus with no health insurance—just like millions of Americans—lived in some Podunkville, U.S.A., where there's no public hospital? What would have been her and the baby's chances? I prefer to think somehow the baby would have had better chances of survival, but I wouldn't guarantee it. Maybe Medicaid? Some "charity fund" at the hospital for patients who can't pay?

And in the U.S.—this is Stew talking again—just the fear of a multi-million negligence or malpractice lawsuit against the doctor, the hospital and anyone involved in such tragedy, if nothing else, might have prevented it. I'm not sure of that scenario either. You'd have to have sufficient reserves of rage and money to hire a competent attorney to do battle with the law firm representing the hospital.

For my part, I would not have waited for the lawyers to do their work. Whether in the U.S. or Mexico I would have throttled the doctor right then and there, or worse.

But Félix and his family don't seem capable of such anger.

"Sí, me sentí molesto," was his response when I asked him this morning how he felt. "Yes, I was upset."

"Pero la vida aquí en México es muy canija," he muttered after a few seconds, looking at the ground. "But life here in Mexico is a real bitch." 

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14 comments:

  1. That's a very sad story and reminds me of the story of our housekeeper who went back and forth many times to the doctor, and ultimately died of cervical cancer left untreated for too long. Her whole story was made worse by her great fear of leaving her kids motherless so she went to curanderos rather than to her doctor appointments. Such a shame.

    But regarding your story I was curious about a baby's survival at 27 weeks and it looks like it should have been able to survive.

    http://www.spensershope.org/chances_for_survival.htm

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  2. Of course you do not know the medical circumstances of the child. It is very possible that the Doctor simply did not have the necessary means or ability to help the child.
    It is my experience that Doctors (US and MX) are not the best communicators.

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    1. I agree with all those commenters that pointed out that I don't know the full details of what happened here, except that the baby definitely died. I've also heard of a relatively high preference by doctors in the government health care system here for C-sections rather than natural births presumably because they can be "scheduled". Also I've heard that there is a high incidence of diabetes and kidney problems (don't know if they are related) coupled with very limited accessibility to kidney dialysis.

      But what struck me about the story was Felix' unnaturally quiet anger and resignation with tragic events.

      Thanks for your comment.

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  3. Wow, how terribly sad. In this day and age you'd think stuff like this no longer happened.

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  4. I have had similar experiences here on the coast. Fatalism and tragedy that would make Clytemnestra appear like a model mother. But you are correct that similar stories exist up north. Some of the stories I heard from residents of the Salvation Army shelter in Salem could have easily kept me in tears. As you have pointed out before, though, that is what motivates us to show grace through our prayers in action. Thanks for the reminder.

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    1. What should we call it? Stoicism? Fatalism? Resignation? Octavio Paz' The Laberynth of Solitude talks about it and compares it to the more forward-looking and optimistic attitude up North.

      I once tried to circulate a petition among the folks in Sosnavar to the mayor to pave our road. Not one person signed it. They looked a me as if I had just landed from Mars. Were they afraid? Indifferent? Cynical? The road was paved later on but only because the then mayor has a set up a vineyard down the road and I guess he wanted a smoother ride in his Humvee. Yikes.

      al

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  5. I like my friend's comment on our local country hospital: " I've had lots of relatives go in there, not one has come out alive."

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    1. Actually, Cook County Hospital in Chicago is very good, particularly at treating trauma patients from its low-income "catchment area." But its burgeoning budget is also a perennial source of griping by the county taxpayers.

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  6. When my daughter was seven months pregnant and induced to give birth because she had just been diagnosed with acute myologenous leukemia, Christopher was born and in a neonatal unit at a Catholic hospital in Houston. The bills for a healthy 7 month old pregnancy were close to $200,000 USD and insurance does NOT pay all of it. He started life out with a bill of $80,000USD to be paid but is now an almost healthy, fabulous kid about to turn 18!
    I would think the baby in SMA would have had to go to Leon or DF for the care it would have needed, by life flight............imagine. Sad story.

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    1. Wow. That's a tragic story, though one with a half-happy ending in that the baby lived. Who paid the remaining 80K bill? You or did the hospital forgive it?

      Al

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  7. That's a very sad story and reminds me of the story of our housekeeper who went back and forth many times to the doctor, and ultimately died of cervical cancer left untreated for too long. Her whole story was made worse by her great fear of leaving her kids motherless so she went to curanderos rather than to her doctor appointments. Such a shame.

    But regarding your story I was curious about a baby's survival at 27 weeks and it looks like it should have been able to survive.

    Not sure why my previous comment didn't show up except that I did include a link which I deleted here...

    ReplyDelete
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    1. There are a lot of sad stories around these parts, particularly involving alcoholism and also diabetes, though I was impressed with the neonatal care Felix's wife received during her three pregnancies. As I mentioned to another commenter, I don't know exactly what happened to this baby, except it died, and the family took the tragedy with a resignation I can't understand.

      Al

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  8. You touch on some very complex issues. Though I can fully understand Mexican public insurance having some kind of fiscal cut-off for premature babies (after all, they can involve some of the most complex and expensive medical care available), it is truly surprising that the hospital did NOTHING, not even the simpler interventions like intubation, incubator or whatever. That is what seems like gross negligence.

    And of course you don't have the full story, so the facts may be different. Even if the doctor explained a medical reason as to why the baby was indeed doomed, it's likely that Felix lacks the capacity to understand and correctly relay such an explanation.

    Still, quite sad. My heart goes out to his niece.

    Saludos,

    Kim G
    DF, Mexico
    Where it's quite evident, just walking down the street, that medical care is quite unfairly distributed here.

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    1. Actually, I've heard—more hearsay reports—that IMSS hospitals in DF are quite good, far better than what we get here in the boondocks. Here in San Miguel, there seems to be an adequate level of basic medical care, such as vaccines etc., but more expensive and complex treatments, quite naturally, get a little dicier. Thanks for your comment.

      al

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