Background: End-of-life discussions present a challenge for many Hispanic families and physicians. Hesitancy to begin discussions and a language barrier hinder elderly Spanish-speaking patients and their families from making informed decisions about end-of-life care. We present a case of a confusing code status in an elderly Spanish-speaking woman with a rapidly declining condition.
Case presentation: An 81-year-old Hispanic Spanish-speaking female with a past medical history of hypertension, chronic kidney disease stage 3 and type 2 diabetes mellitus presents with generalized weakness, decreased appetite and a 10-pound weight loss over one month. She wished to be Do-Not-Intubate. Throughout her stay, she was diagnosed with pyelonephritis, acute renal failure requiring dialysis, atrial fibrillation and care was escalated to the ICU. Family discussions led to a change in code status to full code on Hospital Day (HD) 7. Her WBC trended up to 51,000 and she was diagnosed with diffuse large B-cell lymphoma on HD8. Palliative care was consulted on HD11. On HD14, the patient experienced respiratory distress and was intubated. She continued to deteriorate and on HD 16 the family decided to withdraw care and she died.
Conclusion: Latino patients, like ours, are less likely to have advanced directives and more likely to receive aggressive interventions in their final days. Barriers include lack of professional interpreter usage and limited health literacy. Our patient case exemplifies that in the chaos of an emergent situation and in the absence of appropriate end-of-life planning, Spanish-speaking patients may receive aggressive care conflicting with their initial wishes
