Caracas Chronicles

6:30 p.m.

“I’m sorry, we can’t treat her here, we have no beds available” says the medical employee.

Martha, María, José and Sula share nervous glances. They’re at the front door of Centro Medico Total, a private clinic. Their mother, “Mami” started having difficulty breathing in the afternoon, just after having a nasal feeding tube removed. She has been home for just over a week. Having spent the first few weeks of December hospitalized with pneumonia.

The family lives in Puerto La Cruz, near the refinery. They have no car. The public emergency ambulance service is not working. But their nephew knows a guy, who knows a guy.  They put them in contact with a paramedic named César from Asociacion Venezolana Banda Ciudadana, an institution affiliated to Proteccion Civil.

César and his wife Marisol are the paramedics on duty that night. Their shifts usually lasts more than 24 hours. The organization has one cell phone. It never stops ringing. They never stop driving.

They comfort the family. “Let’s go somewhere else. We won’t leave you alone here, you can count on us,” they say.

They go to another private clinic.

7:30pm.

The ambulance parks at the emergency entrance of  “Centro de Especialidades Anzoátegui”.

Martha runs inside, while the others wait in the ambulance. The minutes tick by and nothing. César, the paramedic, checks the oxygen in the ambulance, it’s getting low, and “Mami” needs it desperately. Her lungs are giving in, she struggles with each jaggged breath. Her Parkinson’s has stolen much of her mobility, she can’t talk anymore, she can’t tell them how it feels, but it hurts, and they can see it through her eyes.

Meanwhile, Martha is pleading and crying trying to get a room. But the answer is the same as last time.

“We have no beds, Estamos colapsados, we can’t admit her”.

Finally, the clinic agrees to at least give first aid to “Mami”, so she can make the trip to another clinic. They admit her to the trauma shock room. They give her oxygen, stabilize and treat her with a nebulizer. But they make it clear that she can’t stay there.

Outside,the paramedics inform the family that the ambulance needs to go make another round. Another patient needs them.

“We’ll be back as soon as possible”, they say and leave.

The family frantically calls doctors, relatives and friends, trying to find a spot for “Mami” somewhere, anywhere. Even Caracas may be an option, if they can find an adequately equipped ambulance. Someone responds, it’s her surgeon.

“You can bring her to Policlinica Puerto La Cruz” says the voice over the phone “we have space here”.

8:45pm.

The ambulance arrives after the patient round. Martha and María go with “Mami”, but Sula and José have to stay at the medical center and pay the bill. The insurance has been all eaten up in a previous hospitalization. Luckily everyone in the family has pitched in, so there’s money in the emergency account.

“We’ll meet up as soon as the payment clears” says José. They go their separate ways.

9:00pm

They don’t even make it inside the Policlinica Puerto La Cruz.

Her surgeon was unaware that even though the medical center had beds, it did not have intensive care physicians. He apologizes half-heartledly and offers no solace to the family.

A doctor comes outside and checks “Mami” inside the Ambulance. His face is somber.

“Su Madre esta mal, You’re mother is very ill, we have beds but no personnel. Go immediately to Las Garzas”  he says.

Las Garzas is the name for Hospital Dr. Domingo Guzman Lander, it’s located in Las Garzas sector, hence the name.They share uneasy glances, the public managed hospital is located in a zona roja, a high crime area. The last time Maria was there, visiting a sick neighbor, she left heartbroken over the ill conditions of the hospital. They argue back and forth deciding what to do.

Should we take her to Las Garzas?, Should we go somewhere else?, But where? There is nowhere else. Call her doctor, call her neurologist, call somebody.

It quickly becomes clear that there’s no other option.

9:30pm.

They have been at three private medical center and all three have refused to admit “Mami”.

They reach Las Garzas, hold their breath and prepare for the worst. But the hospital’s intensive care unit has been recently refurnished. Everything is new and clean, it clashes with the decay all around it.

They scramble to the emergency room. They are met by a Doctor who quickly checks Mami’s vital signs.

“Your mother is agonizing,” she says “but we are going to admit her”. She lowers her voice and says to Martha “You should prepare…”

The ambulance needs to leave, another patient, another hospital. They beg the family to call immediately if they need to go somewhere else. They won’t accept payment.

All four are now stranded inside Las Garzas, which is patrolled by the National Guard. It’s dangerous to venture outside the hospital. They plan to spend the night there.

María goes inside with Mami. They take x-rays and hook her up to monitors and other apparatus. The outlook is grim.

It’s 1:00am

María comes out with two vacutainer tubes and paperwork requesting lab tests. Las Garza’s lab is not working, so, all lab work is being taken to other medical centers via the patients family or caretakers.

They call a neighbor, he’s happy to help and quickly goes to the hospital to pick them up. They spend the next hour looking for a lab that has the necessary reagents to perform the tests.

They finally return to Centro Medico Total, they only have reagents for two of the four tests. It will have to do.

It’s 3:00 am. 

Maria takes the first night shift. There’s no sofa or cot or even a chair. She stands at times, or sits on the floor next to the bed. The room has three other patients, who complain and moan in pain. Only one family member per patient is allowed.

Mami does not sleep. She does not moan. She just stares at the ceiling with her eyes wide open and her body clenched.

It’s 8am. 

María is tired and sore. The night was long, the sleep intermittent and the floor uncomfortable. Mami’s labored breathing can still be heard through the beeping of the monitors. Maria stretches out. Her sister Martha texts her on the phone, she is outside with breakfast.

María doesn’t want to go, she is worried, and tired, she needs to stay close. The family convinces her to go home and come back at night, rested.

“Mami” she whispers at her ear “I’m going home, to take a shower and freshen up, I’ll be back soon”.

Martha sneaks inside and kisses “Mami’ softly on the forehead. She can’t bear to see her like this, so she returns to the waiting room.

Then Sula takes her place. She strokes Mami’s hair softly.

Outside, the rest of the family just waits. The phones ring without end, family, friends and neighbors calling to check.

12:00 noon

Sula holds Mami closely and kisses her all over her face.

Mami struggles, she wants to say something, she needs to say something, but she can’t.

“I know what you want to say Mami, don’t worry, you don’t have to worry about us, we’re going to be OK, thank you, be calm and rest”

***

Carlota del Valle “Mami” Tillero Subero was born in Pampatar, Nueva Esparta on November 4th 1931

She gave birth to six children, spoiled rotten 17 grandchildren and held in her arms 16 great grandchildren.

Like many women of her time, she faced many economic hardships and a backlash for being a single mother, yet she always remained kind, generous and altruistic.

She passed away on January 3rd 2015, at 12:05 pm.

She was my grandmother.

The Tillero family would like to thank the Doctors and nurses from Las Garzas who despite it all, have kept their human warmth and empathy with the patients and their family members. We want to thank the unbelievably hardworking paramedics from Asociacion Venezolana Banda Ciudadana, César Sánchez, Marisol Viña, Argenis Aponte and  Aníbal González.  Who, day after day, faced with impossible odds, keep giving families hope and solace. We want to thank our friends, family and neighbors who offered their time, attention and hearts and did not forget us in out time of need.

My family asked me to write this account, so our experience does not go unnoticed. My Grandmother had Parkinson’s disease, and was surely in her last stages, this we had made our peace with, but not with the helpless anguish that we went through in her final hours. She deserved a calm and pain-free sending off from this world. We all do.