Social Death

"Social death — in which patients are considered “as good as dead” — also applies to entire groups of people who are treated as nonpersons. This concept can help clinicians recognize the importance of clinical encounters and medical records to the processes by which vulnerable populations are abandoned. Clinicians have the power to intervene or interrupt these processes by recognizing and acknowledging patients’ humanity."

New England Journal of Medicine--January 2021

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The lady above is Mirlande (name changed). I first examined her in November 2020 when she was brought to me by her husband. She was too weak to get out of the car. 

Her husband told me that Mirlande had recently been hospitalized in a hospital in the countryside but had been discharged on no medication. He brought the results of an echocardiogram that she had done as an outpatient. 

Mirlande had severe peripartum cardiomyopathy with a very low ejection fraction measuring in the teens. Peripartum cardiomyopathy is a type of heart failure that occurs during pregnancy or right after delivery. The condition weakens the heart muscle and causes it to become enlarged. As a result, the heart cannot pump blood properly to the rest of the body. 

After I saw her, Mirlande was hospitalized in the General Hospital in Port-au-Prince where she was diuresed and lost a significant amount of water weight that had accumulated from her congestive heart failure. And she started to feel better. 

During her hospitalization in the General Hospital, a young resident physician was kidnapped in front of the hospital and the staff closed the hospital and even threw beds out on the street. They were very upset that the state of affairs in Haiti had dropped so low that even young doctors could not be protected. 

So Mirlande was taken home from the hospital by her husband. A few weeks later, after the young physician was released unharmed, Mirlande returned to the General Hospital where she was treated again. 

However, in January 2020, Mirlande died at home. And she left five kids and her husband. 

Mirlande was not treated well at all in the last months of her life. In my opinion, she was treated as a "nonperson". Recognizing humanity and strengthening infrastructure is so important if we want to improve our society. And maybe Miralnde would not have survived even in a well-functioning society, but she deserved the chance at our best effort.