Twelve Patients: Life and Death at Bellevue Hospital (15 page)

It was five thirty in the morning. Diana and I pulled into the south parking lot before the night shift started pulling out. It was a short walk into the hospital and a quick ride to the tenth floor. The corner room across from the central nursing station was filled with activity, and everyone was glad to see us. The physicians went over the supplies that I would be taking on the trip—first on an Aeromexico flight from JFK to Mexico City and then in the ambulance to the hospital in Cuautla. I had sedatives, morphine, bandages. Everything had been carefully packed and labeled in a small suitcase. I greeted Liliana, who stood before seventeen pieces of motley thirdhand luggage and nylon gym bags, holding everything they owned in life, accumulated over the past six years. Octavio was alert and awake and living off bursts of adrenaline. He wore his Yankees cap and T-shirt. The ambulance crew arrived a few minutes later, and we made our final round of hugs and good-byes. The ambulance EMTs (emergency medical technicians) and I got Octavio safely in the ambulance while Diana and Liliana made sure the luggage made it into the hospital van that was taking them to the airport. The lot was deserted except for a lone agent in the check-in booth. As the medics closed the doors to the ambulance, Octavio waved good-bye, his dark blue cap pulled down low, hiding his eyes.

Alvaro Jimenez from the
protección
office of the Mexican consulate flagged us down as we pulled in front of the Aeromexico departure area at Kennedy. He would accompany us until Octavio was safely in the hands of the physicians at a
seguro popular
, public hospital, in Cuautla. Alvaro had all the papers and permits to ensure that the handoffs from immigration to customs all went smoothly and there would be no unnecessary delays. Time was everything on this trip.

Three rows of seats had been removed in the rear of the plane so that Octavio’s stretcher could be secured adjacent to the windows. After he was carefully patted down by a security detail and his pillows
and blankets checked for contraband, we rolled down the catwalk to the plane entrance and got ourselves securely ensconced in the rear of the plane before anyone else boarded. A bolus of morphine took the edge off the long haul down the plane for the two-hundred-pound deadweight passenger. Octavio dozed through most of the flight, and Liliana and I took turns sitting next to him. Diana and Alvaro were deep in conversation. Passengers needing to use the restroom tried not to stare, but there was no curtain to shield Octavio from their curious glances. It wasn’t too many hours before the plane made a left turn over the Hotel de Mexico on Insurgentes in downtown Distrito Federal with the volcanoes of Mexico City dominating the skyline to the right. The gray smog cloud smothered the plane as we touched down.

The airport
bomberos
, fire department, managed to carry Octavio from the plane down the steep steps from the rear of the Boeing 727 to a waiting ambulance while a team of immigration officials stamped our passports and waved us through, bypassing the usual paperwork and inspections. Octavio’s parents, Brigido and Elena, were waiting next to the boxy Cuautla ambulance that had pulled up beside the plane. We secured Octavio in the back as his mother stroked his sweaty matted hair, tears streaming down her face. His father, skinny and leathery, stood stiffly outside, not moving and hardly breathing, staring into the distance after a handshake and brief introductions.

A young woman in a white uniform and white physician’s lab coat approached me from the airport entrance carrying a cardboard container with coffee and sandwiches. She introduced herself as Dr. Laura Lazaro-Perez, the physician in charge of Cuautla General Hospital. She had made the trip in the ambulance to greet Octavio and his family and to formally accept the patient from my care. She offered me a coffee and a sandwich as we chatted for a few minutes about Octavio’s case. Arriving travelers and families pushing trolleys laden with luggage streamed out of the electronic doors. They glanced over their shoulders in our direction, not missing a step.

“Laura, Seguro Popular has a new hospital in Cuautla?” I heard from the consul.

“The Morelos government is rebuilding an old city hospital on the
main street. The Mexican government developed Seguro Popular, like your Medicaid program, ten years ago, to make sure everyone had access to a basic package of health care. Nearly fifty million people, half of the country, had nothing.” And she added quickly, “So what is happening in the States, Eric? Tell me, how come you are fighting over insuring the citizens of the United States as more are losing insurance? And the costs are astronomical. We are getting medical tourists in Mexico and not just for cosmetic surgery and dental work anymore or to buy a year’s supply of medication. We simply don’t get it here. It just doesn’t make any sense. We have no money and are doing the opposite.”

“The politics of health care are all about money,” I said, “very big money. Almost three trillion dollars and counting. The key players in the health industry, from the hospitals to the insurers to Big Pharma and the physician groups, have gotten so powerful that they can distort and deform what happens in Washington.”

“Harry and Louise?” she said as she sipped a macchiato and looked at me through her wire-rimmed glasses.

“Exactly, Laura. Exactly.” She was referring to the ad campaign financed by the Small Business Council that undid the Clintons’ efforts at comprehensive health care reform in the early 1990s.

“But seriously, health care?” she picked up. “We were an embarrassment on this continent. We still have a long way to go. Some people complain that our program is ‘
Ni Seguro, Ni Popular
’—neither safe nor popular. But embarrassment is a huge motivator. When we compared ourselves with other Latin American countries, we had to start doing something. Long live national humiliation.” She smiled.

“Embarrassment evidently doesn’t work in the States,” I came back. “Imagine a tide of economic refugees from the north in their silver campers driving to Morelos and Cuautla?”

“We are already seeing them coming. Look at the growth of gated communities here.” She was matter-of-fact. “This is the new normal, Eric.” I thought of our house in Tepoztlán, the high stone walls, the giant twisted black
ciruela
trees, the electrical storms and pounding rains from June to October, the walks to the shops and the market. I kept silent.

An ancient large brown van cruised to a stop in front of us, the doors opened with Liliana and Diana inside surrounded by six years of baggage. Brigido reached inside the ambulance to touch his son and to say good-bye to his wife before he hopped up into a passenger seat in the van. We agreed upon the route to Cuautla and pulled into the never-ending rivers of traffic on the
periférico
heading south to the toll road. This would take us out of the Valley of Mexico and over the ten-thousand-foot pass between volcanoes into the state of Morelos. I sat in the back of the ambulance and looked out the windows at the taco stands, colored plastic awnings and chairs, flat-tire shops, hotels, restaurants, football stadiums, and endless miles of houses, cars, and people. Where incoming roads brought traffic to a near crawl, dozens of Mexicans in Nextel orange jumpsuits sold cell phone cards, candies, custards, windshield wipers, and plastic toys. There were no sword swallowers or jugglers with flaming batons today.

Looking at the smog and the traffic, I thought of the sheer improbability of twenty million souls fashioning a life on a dried-up lakebed. This entire area had once been Lake Texcoco; the island city Te-nochtitlán was ruled by the Aztec emperor Moctezuma until his fatal welcome of Hernán Cortés. We drove past a turnoff for Coyoacan, once the lakefront suburb for Cortés and now a center of bohemian life, bookstores, and restaurants. It was a paradoxical token of life and peace and quiet in the throbbing city.

As we snaked our way south, I checked on Octavio and gave him morphine and another bag of saline solution since his catheter bag had only a small amount of urine. I talked to his mother about her grandchildren and to Laura about Cuautla, balancing her career and family, plus the inevitable dose of Mexican politics.

Elena wept silent tears as she smiled at her son. She tried to keep him steady as we drove over the speed bumps and took the tight curves from access road to the highway to the local streets, avoiding the dense congestion. I looked at Octavio’s mother hunched over her son and looked away.

The Mexican idea of death had traditionally been framed around the festival of the Day of the Dead or Día de los Muertos. The annual
holiday starts at the end of October and goes on until the fifth or so of November, overlapping with All Souls’ Day on November 2. Mexicans go to the cemeteries where they’ve buried their dead. They tend and scrub the grave sites and then carefully arrange flowers and food plus sweets to share with the dead. It is a time of communion with relatives, parents, grandparents, and children in a spirit of caring, loving, and sharing. It is not filled with grief and sadness. The dead are very present and alive in this national holiday, which can be traced back many centuries before the Spanish Conquest and has merged into the Catholic calendar.

I could finally see the new Walmart in the outskirts of Cuautla with its acres of empty parking lots. The upraised, rifle-wielding arm of Emiliano Zapata, the revolutionary leader of the early twentieth century, indicated the main turnoff to the city’s center a few kilometers ahead.

We swung around to the front of a makeshift entrance to a non-descript building ten minutes later. Dozens of people were sitting outside on colored plastic chairs; there was a small, open-faced pharmacy with a metal grille covering the space next door. The hospital was undergoing renovations and was at half capacity. Everything was catwalks, plastic tarps, stacks of adobe-colored bricks, and roped-off areas. A middle-aged guy in a white guayabera shirt sat in front of a small wooden school desk at the entrance with an official-looking cap. He called patients to the clinics and limited access for everyone else. Food vendors hovered everywhere, their stands close by, catering to the visitors who sat for hours waiting to be allowed in to see relatives. They cleared the area to let us in.

Octavio was settled into a three-bedded room on a medical surgical unit with post-op patients recovering from C-sections, angina, lobar pneumonias, and a pneumothorax from a knife wound. Plain vanilla, concrete, whitewash, linoleum, no AC, barely room to get from one place to another sideways. Trays of soup were handed out by the candy stripers amid the strong smell of disinfectant and bug spray, the hum of a distant generator, and mariachi music filtering in the wide-open breezeless windows. There were patients in the two other beds; patients
in beds lined the corridors. Student nurses in scrubbed and pressed uniforms bobbed between the beds and the rooms. Guards stood at the entryways while families, doctors, and visitors all wove their way through the hospital. As an American doctor bringing a dying young Mexican patient by jet plane to his hometown in the sweltering heat of the plains of Morelos, I felt like a Martian from outer space. This was the entry point for Octavio into the Mexican health system.

Octavio’s receiving doctor and I went through the case in detail at the nursing station in front of a bank of computers. He made it clear that they were not a hospice and had neither the familiarity with taking care of dying patients nor the narcotics and other medications to keep Octavio comfortable for more than twenty-four hours. A pain specialist was available once a week. This was a bread-and-butter community hospital. The young man on one side had a leg fracture from an automobile accident and had been waiting several days for OR time and a metal pin to realign his tibia. On the other side, an old man with a deeply crevassed face with emphysema and bronchitis was sitting bolt-upright, wheezing with an intermittent deep phlegmatic tubercular cough as intravenous medications dripped slowly into his arm. I offered to get narcotics from a private pharmacy if the doctor wrote me a prescription. We negotiated his medication regimen and went over what they had in stock and what I had remaining in my box from Bellevue. Enough for another twenty-four hours, we were in business.

When I got back to his room, Octavio was sitting up in bed smiling and appeared comfortable. He and his two hospital mates were propped up, eating ice cream from cups with small red plastic spoons. Diana, on the way to Cuautla, had bought and smuggled in a liter of ice cream from Tepoznieves, our favorite Morelos ice cream store.
Beso de Angel
was dribbling from everyone’s chin as nods and slurping noises greeted me. For the first time, I relaxed and smiled and joked with the Salcedos, his mother, and the other patients in the room. We had made it back to Mexico intact, and with Octavio in one piece. Exhaustion hit Diana and me at the same time. We said our good-byes and took a cab to our house in Tepoztlán nestled in the Tepozteco thirty minutes
away. Unbelievably, after the day’s ordeal, Liliana left the hospital to go look for a job. Ever since I’d met her on the ICU floor, she had been obsessed with work and their vaporized savings. She had nothing to bring back to the family compound.

The drive back down the sinuous road into the valley of Morelos through a break in the vertiginous cliffs that guarded the entrance to Tepoztlán was always breathtaking. We passed the ruins of old sugar haciendas from two centuries earlier when Morelos had been one of the largest cane-sugar-producing areas in the world. Its underground water supplies in volcanic earth had managed to support this vast labor-consuming industry, bringing extraordinary wealth to a feudal planter class. The inequalities fueled the anger and rage that led to Zapata’s uprising in 1910.

We had planned on one more day, one more visit with Octavio before flying back to New York City. The entire Salcedo clan materialized, hanging out at the bedside and spilling into an empty ophthalmology waiting room. Kat sat next to her father, holding his hand. She had his same large, luminous eyes. They had reconnected. The young boys played in the hall, finding alternatives to the reality playing itself out in the hospital room. Octavio’s mother had slept on the floor at his side in her clothes. Octavio’s sister and niece sat outside, available to run errands. They were unhappy with his care in a public setting, the lack of privacy, the 250-peso-a-day cost plus medications (another 750 pesos), the commotion and noise. It was clear they needed to have him at home. It was something I could not suggest; they needed to get to that point themselves.