Sunday, March 15, 2009


She was old, in the country illegally, and dying of AIDS.

When I met Anne-Marie, she'd already been in the hospital for several weeks. Her relatives back home in Latin America had rejected her because of her illness. Her children in the United States danced around the question of whether they'd take her in. Because she was undocumented, she had no access to Medicaid or any other public programs to fund her care. There have been published reports of hospitals loading sick illegal aliens into airplanes and flying them off to their home countries -- a form of medical deportation, if you will. We weren't going to do that; it's contrary to everything we in the hospice world believe in. So we enrolled her in hospice, ate the cost, and Anne-Marie stayed in her hospital bed.

She was barely arousable and was so thin that a concentration camp survivor would have looked positively obese by comparison. I don't think I've ever had an adult patient whose width from shoulder to shoulder was so small. She never seemed to have a visitor. One morning I discovered her silently grimacing. Pain medication had been ordered as needed, but how does an obtunded patient signal her need? We quickly placed her on a morphine drip at a low dose. Her face relaxed, there was no more grimacing, and she died in apparent comfort a few days later.

One shouldn't have to die alone or in pain. Did her legal status affect the way Anne-Marie was assessed and cared for? I hope the answer is no. Life's end is hard enough already.

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