Deportation

Since he was incontinent and needed a good cleaning-up we undid his wrist restraints so we could turn him from side to side. Of course the first thing he went for was the tracheostomy tube. He'd rip it right out of his throat in an instant if he had the chance. Then he'd go for the PEG tube.

A while back he was jumped at a bus stop and got clobbered in the head. He had a nasty blowout fracture of his left orbital and a subdural hematoma that had severely impaired his cognition. He was alert and would track us with his eyes, but he didn't follow simple commands such as "please do not pull out your tubes." He couldn't effectively swallow anymore.

I think maybe he wanted to die, and perhaps he thought his situation was rather hopelessly miserable and he didn't want to spend decades in an extended care center... maybe he thought that if only he could get those awful tubes out he would quietly fade away.

He was a young guy, in his late twenties, and he didn't have much else to look forward to.

Today I am excited. I will roast a turkey and share it with my family. I don't think this guy is feeling anything at all like that. Who gets excited about a can of Jevity running through a stomache tube?

He was not a U.S. citizen. He was not insured, and we couldn't get him covered due to his status as a Mexican national. So we deported him. It was a nightmare for the case managers who arranged his trip to Juarez, and it is an ongoing nightmare for the patient himself. Hopefully he will have family members there who can advocate for him and help him deal with the very difficult circumstances of his ruined life.