Mr. M is an 84 year-old patient who lives alone. Mr. M was born in Colombia but immigrated to the United States 50 years ago. He has worked as a custodian of a large building in the city for a long time. He does not speak fluent English. He has a past medical history of diabetes, alcohol abuse and hypertension.
Mr. M is separated from his Colombian wife, but she lives in the same apartment building with their two daughters and several grandchildren. Mr. M fell while going to the bathroom one morning and could not get up. He was brought to the hospital via ambulance after someone heard him moaning. On exam, Mr. M was confused, and oriented only to his name. Further testing reveals a left hip fracture. He is “cleared for surgery” the same day. Multiple unsuccessful attempts are made to reach the family.
After surgery, Mr. M is in respiratory distress. You perform his intubation and respiratory therapy helps you with the mechanical ventilation parameters. Further testing indicates massive pulmonary embolism. Several days later, Mr. M remains unresponsive and dependent on life support. The ICU physicians believe his prognosis is very poor. Mr. M’s family arrives after multiple attempted phone calls and phone messages by the ICU team. Mrs. Miguel states that she was away visiting her family in Colombia and she returned today.
You set up a meeting in an hour, and when you arrive, there are numerous people waiting for you. Mrs. M just saw her husband and is crying loudly “Esto es terrible, no puedo creer que me pase a mi!” (This is terrible; I cannot believe this is happening to me!). At introduction time, you realize that there are 4 children, 1 of them from a different mother, several grandchildren, and patient’s relatives. All of them have questions for you.
This situation is very surprising for all of them. No one seems to know if Mr. M had advance directives, and by the look on their faces, it is clear they might not understand the definition of an advance directive.