Michele — This Is My Why, Now Let's Find the Way…

Abstract

After a protracted hospital course for the management of cardiogenic shock in my home country of Venezuela, Michele was discharged with the hope for native heart recovery. The next several months would prove to be grueling—he had recently lost medical insurance coverage, so as a very close family friend I took responsibility for leading his medical care. Hypotension limited medical options and recurrent pleural effusions, unresponsive to diuretic therapy, quickly became a challenge. With only rudimentary supplies available to us, colleagues and I performed repeated thoracenteses while the family worked around hurdles to get an indwelling pleural catheter delivered from the United States. The need for advanced heart failure therapies became abundantly clear, and this turned out to be the first time I found myself doing extensive research on durable left ventricular assist devices and heart transplantation—almost 10 years ago now. Together with his family, we contacted several institutions outside of the country (including in Italy, his native country) to inquire about heart transplant candidacy criteria for international residents—the process was disheartening. One night I received a call that Michele was acutely short of breath and had become increasingly lethargic. I happened to be working a night shift in a nearby emergency department, so the family immediately brought him over. He arrived in pulseless electrical activity. To this day, it has been the most difficult code I have ever had to run and terminating resuscitation attempts was devastating. I witnessed many tragic events during my training and early years in medical practice in Venezuela, but recognizing that Michele's care was largely dictated by where he lived still haunts me.