Volcano can't stymie last wish
Internal Medicine Resident Mary LaSalvia, MD, confesses that there is a message she will never delete from her pager.
"It says 'Hi Mary, it's Ernestina. The patient made it home and until her last breath she will pray for all of us at BIDMC," LaSalvia shares.
This brief but professionally and emotionally meaningful page came after many days of uncertainty as three women from different departments fought time, volcanic ash and strict flight regulations to fulfill the wish of a terminally ill elderly patient who wanted nothing more than to die peacefully in her native Cape Verde.
LaSalvia had been caring for the patient when she expressed her desire to go home - some 3,400 miles away.
"It was refreshing for us because she was so sure of her decision. From a medical and personal standpoint, it was the best decision for her," LaSalvia says. "But day-to-day travel would be difficult for her and we had no supplies to get her to Cape Verde. Timing was a big factor, too. There was an urgency to get her home. Luckily, our staff helped get her through those barriers."
The first line of offense was interpreter Ernestina Damoura-Moreira. The lead of the Portuguese and Cape Verdean Creole interpreter team, Damoura-Moreira was familiar with the airline carriers that brought patients to that region of the world. She felt confident she could get this elderly woman and the son that would be accompanying her on a flight to Cape Verde on TACV Cabo Verde Airlines.
Yet, there were still foreseen and unforeseen obstacles to overcome. Ensuring two tickets quickly, securing an ambulance to drive the pair to the airport and finding an airline approved oxygen appliance were all issues racing through Damoura-Moreira's mind. Then throw into the mix the Icelandic volcanic ash and the impact this natural disaster was having on the frequency of international flights.
Damoura-Moreira knew a mechanic in Cape Verde who agreed to put extra oxygen concentrators on a plane bound to Boston from Cape Verde. The concentrator is run by a battery with a three- to four-hour life before recharging is needed. It filters room air and concentrates the oxygen in the machine to deliver medical grade oxygen to a patient.
But by the time the details were set, the plane had left. Knowing time was running out and that each airline carries an emergency supply of oxygen, Damoura-Moreira tried to see if a plane at Logan would be willing to take the woman to Cape Verde using the emergency supply to keep her alive. The airline manager left the decision up to the crew because if there was an emergency during the flight, there would be no other source of oxygen. The crew declined saying it was too risky.
Enter case manager Pam Chagnon. She called several companies that specialize in renting airline approved oxygen appliances. Not only was finding an available unit on such short notice a problem, but the concentrators cost $4,000 each to purchase. She said the companies who do provide the concentrator will provide for most domestic flights, but few provide for international flights.
"The patient had no insurance and our fiscal services department said there was nothing it could do," Chagnon said. "All of the services had to be donated."
Five days after the patient's original request and countless phone calls later, everything fell into place on April 20. Because of the relationship between Prompt Care, a provider of airline approved oxygen appliances, and BIDMC, the company felt comfortable lending a concentrator to the patient and even more so when company representatives met the family and Damoura-Moreira who gave her word on making sure the concentrator would be returned.
"Not many companies will do business on a handshake these days!" Chagnon said. "Prompt Care delivered within hours of receiving the call."
North Atlantic Medical donated a wheelchair and a walker. Armstrong Ambulance agreed to provide transportation from BIDMC to Logan International Airport and to keep the patient on oxygen until she was to board her flight, Chagnon said.
With the help of the palliative care service, LaSilvia and her team carefully planned all of the medications they would send the patient home with to keep her comfortable. They also had all of the paperwork ready to ensure she could have adequate communication about her care here with her doctors in Cape Verde.
In the meantime, Damoura-Moreira called the airline to book two emergency seats for the patient and her son. She was told there were no emergency seats available, but that there are always several passengers who book tickets and then do not show up for the flight. Damoura-Moreira crossed her fingers and accompanied the pair to the airport. The airline manager's prediction came true and the patient and her son boarded an 11 p.m. flight for Cape Verde.
"I woke up at 4:30 a.m. the next morning and my first thought was 'I wonder if they made it,'" Chagnon says. "The family was very gracious and it became a mission to get them home. The vendors were so generous. They wanted to help us out as much as we wanted to get this patient home. When I heard they made it, it gave me such a sense of fulfillment about my job here at BIDMC."