ARMEN KOUYOUMDJIAN’S FINAL DAYS
Armen Kouyoumdjian’s comparison of Europe’s current economic woes with the Latin Ameircan debt crisis in the 1980s was much appreciated by our readers. Roberto’s account of his father’s last days amounts to a shocking indictment of Chile’s private healthcare, with lessons for us all.
His advice would be ‘never get ill on a long weekend’
By Roberto Kouyoumdjian, 21 October 2011
Many of you have enjoyed my father’s essays over the years. Some of you have perhaps taken them more seriously than others but I’d like to think they’ll be missed. It was important for my father to connect intellectually with people and give his opinions, however critical and self-consciously ironic they could sometimes be. My father had the talent of being able to discuss any topic and making it sound interesting by providing it with a different, unique angle. This essay will perhaps not be full of the quirky, cut throat remarks that you identify with him, but is a story that my mother has insisted I tell on his behalf. This will be the last essay you will receive from or on behalf of Armen Kouyoumdjian, following his sad death on Friday the 21st of October 2011.
This should never have been the last essay for the simple reason that my father should not be dead. We are all convinced that, had it not been for the inefficiencies in the health system in Chile, he would still be very much alive.
My father would never apologise for telling the truth but I feel I should advise you that the rest of this paper may be explicit and occasionally hard to accept, because we are dealing with someone we all knew that was sadly mistreated and ignored by the system.
It seems that, in Chile, if you require emergency treatment on a weekend you will find it very difficult. If it’s on a long weekend, you are in the hands of the gods.
In May, this year my father became one of nearly 350 million people worldwide who has been diagnosed with diabetes. He had seen a specialist who recommended a strict regime of exercise and diet but just after that my father was experiencing various symptoms including nausea and severe constipation which were getting gradually worse..
On Saturday the 8th of October at around 6pm, my mother realised that his symptoms were reaching unprecedented levels and tried to convince my father to go to hospital and have him checked. My father insisted it would be a waste of time as it was on a Saturday, on a long weekend and no hospital would take him in as there would be nobody there with the expertise to treat him. Dismissing his attitude as another one of his outrageous rants she rang a good family friend, a doctor who works at the Hospital Naval in Vina del Mar, to explain the situation. Being such a well known and respected private hospital, my mother was convinced that he would be received in such a place and was desperate to have him seen. Our friend responded that it was on a Saturday, on a long weekend and hospitals would only have a basic, skeleton staff and there would be nobody there with the expertise to treat him properly. My father had it spot on. Undeterred, she rang the Clinica del Mar of 13 norte and had the same response.
My father then had the idea of calling the privately run ambulance/medical service ‘HELP’, with whom we have a contract, to send a doctor over. Being a long weekend, presumably they were short of doctors so could only provide a basic consultation over the phone so sent my mother to get some medicine that would help, which she did. When she returned, his symptoms had worsened and the medicine had absolutely no effect so she rang HELP again who said a doctor would come and visit as soon as possible.
Approximately two hours after, a doctor arrived, attached a drip, ‘stabilised him’ and said, unequivocally that he did not require urgent hospital attention and that on Tuesday, in 3 days time, she should contact a gastroenterologist and take it from there. My mother pleaded to take him to the hospital but she insisted there was nothing to worry about in the short term as he’d be feeling better soon. This all took place around 9pm.
At approximately 3.30am my father started vomiting blood uncontrollably due to a severe gastric haemorrhage. In a complete panic my mother called HELP and this time they told her that they would send an ambulance urgently which arrived about 20 mins after and again, ‘stabilised’ him, and the doctor (a different one) started to ring the various emergency units in the region’s hospitals to get him checked in.
This is where the real nightmare begins. He called my father’s preference, the aforementioned Hospital Naval who declined on the aforementioned grounds of not having the necessary resources to deal with such a case. Clinica Renaca said the same. As you can imagine, after that, it’s all a bit of a blur for my mother but she knows he tried every other hospital in the region, all of which had the same response: it was a Saturday, on a long weekend and hospitals would only have a basic, skeleton staff and there would be nobody there with the expertise to treat him properly. On top of that she had to hear the doctor over the phone saying, ”si, tienen plata” (”yes, they have money”) and “se ve que es gente con medios” (you can tell these people have money). My mother was desperately trying to tell him that money was not a problem, that we did have an excellent international private insurance that would cover all eventualities.
My mother swears to god that when she got in the ambulance with my dying father, in the middle of the second largest city of one of the world’s most ‘up and coming’ countries, they did not have a hospital to go to. At some stage on this journey, in a last ditch attempt to save my father whose blood loss was getting worse, the doctor tells the ambulance driver to take him to the Hospital Naval and just hope for the best.
Once there, they took him in quickly, someone examined him and the only surgeon there was overheard by my mother as saying that he did not want to take the responsibility on his own and needed someone else to help with the operation. As far as we know, they eventually managed, around 5.00am, to find someone to assist, and the operation finally took place.
The agonising waiting game for my family starts. A mixture of all sorts of emotions wrapped in a bubble of incredulity at how a developed country can fail to provide such basic service.
Just before 8am on Sunday, one of the surgeons, briefcase in hand and ready to leave, spoke to my mother and brother and family in the hospital hallway and casually remarked that my father’s haemorrhage was contained, that it was caused by a invasive tumour in his stomach and that part of his stomach was taken out. The tumour was so invasive that all his organs had been affected, and that if he survived the aftermath of the operation he would not last long. 2 months were mentioned in case of a miracle.
Over the whole of Sunday and Monday, the same diagnostic was given to us again and again. Gastric cancer with absolutely no hope of a proper recovery. The biopsy, with the results would be ready in a few days but, as one doctor told us, the results ,in this case would only confirm their diagnosis.
On Tuesday, things started to change. Doctors started to appear in the hospital (incredible, I know). Nurses, support staff and general signs of life started to fill the wards and the place had changed completely. My father was put under the care of one of the hospital’s best surgeons and examinations, scanners and a whole variety of treatments started to take place. The long weekend was definitely over and it was time to start work again. My father recovered well from the first operation and even came off the artificial respirator on this day. Despite the verdict, there were good signs. Then, this new doctor seemed to show doubts as to the initial diagnosis made by his colleagues after reviewing the scans.
Without going into details, my father’s health started to deteriorate again and he made the decision to operate on him on Friday to find out what was causing the pain. After his intervention, he summoned the family and said that, in his opinion, there were no signs of any cancer and that his diagnosis was at this stage: peritonitis and that the haemorrhage must have being caused by a gastrointesntinal tract. In other words, a stomach ulcer. Although the first operation had been a mess, chances were that my father would, as you’d expect, recover from this. It was of course a far better scenario than the cancer that was going to kill him any minute.
On Monday the 17th of October, after seeing the results of the biopsy the doctor concluded that it was definitely not cancer.
He recovered exceptionally well from this second intervention but unfortunately only for a couple of days. On Tuesday the 18th of October things started to go downhill again and my father was put back in intensive care as his organs were again showing signs of deterioration. The doctor said that he had contracted an internal infection, but did not know where it came from. In light of this, my father was given heavy sedatives and was once again connected to all the necessary equipment. He was not responding.
The next day, the doctor decided to operate for the 3rd time as again many of his vital organs were deteriorating because of further infections, potentially caused by the other operations. Whether we admitted this or not, we were starting to realise that something, somewhere had gone wrong and that my father would not get out of this one alive.
The 3rd operation had gone well and they had filled his body with antibiotics to try and kill the infections but my father’s body had, by this stage, stopped responding.
On Friday the 21st of October at 6.15am, my father was pronounced dead.
We got a suit ready for him and an Armenian cross to stay with him, took them to hospital and did all the necessary (is it?) paperwork. Next day we went to pick him up at the morgue at the designated time. Despite having given them notice the day before, my father was not ready, dressed or anything. To make matters worse, they had lost the cross. It all took over 2 hours to sort out.
We are convinced that my father died because of the failures in the system to give him the right treatment when he needed it, despite living in a large, urbanised and developed city.
For us, writing this is a chance to vent our feelings of frustration but also to fulfil, what, we believe, would have been his wishes. To tell this story to you. Such a tragic story, both on a personal and an institutional level. A story that digs deep into the very nature of human spirit. Is a human life really that worthless that a man can survive or not depending on what day of the week he gets ill? Are institutions morally obligated to look after us? Should the health care system be more closely regulated? And most importantly, what can we do to prevent this from happening again?
I, on behalf of my mother Pilar and brother David, would like to thank you for reading this and my father’s many papers over the years. He took great pleasure in writing and for us, the very notion that there were so many of you out there reading them, fills us with joy.