From Chronic to Critical: A Latino Family Confronts End-of-Life Decisions
By Karen Peterson-Iyer
Gabriela Rivera is an 80-year-old Puerto Rican immigrant, who lives alone in her rent-controlled apartment in New York City. She has lived in the United States for almost 40 years and speaks some English, albeit somewhat hesitantly. Her primary language is Spanish. Although she is now retired, for years Gabriela worked in a factory where she was exposed to a variety of industrial chemicals now considered toxic. Gabriela's husband died four years ago of a massive heart attack. She has six adult children, three of whom now live out of state.
Gabriela is a devoted mother, calling her children as often as she can afford and even sending them homemade sweets. She raised her children through their teenage years in the same apartment in which she lives today. She is loath to leave it, although she now pays the rent only with great difficulty and substantial financial help from her children.
Gabriela has long suffered from high blood pressure, which she controls with medication. She also has type-2 diabetes. When she was originally diagnosed with diabetes, she met once with a nurse who advised her on diet, exercise, and weight control, but Gabriela has found it difficult to adapt her traditional tastes in food and her lifestyle to the recommendations the nurse offered. Subsequently, Gabriela's doctor prescribed medication to help keep her diabetes under control. She tries to take her medication whenever she can remember and when she can afford it. Recently, tests have revealed that her kidney function has been declining.
Gabriela's youngest son, Marcos, 49, lives near Gabriela. He speaks fluent Spanish and good (though heavily accented) English. He checks on his mother as frequently as he can. Marcos is a contract construction worker, married with three teenage children. His