Premium ContentClick on Premium Content on the Featured navigation bar for information.Alfonso Madrid sat in the hospital room, reading Psalm 23 aloud in Spanish.
"Even though I walk through the valley of the shadow of death ..."
His 22-year-old son lay on the bed.
"... I will fear no evil ..."
Irvin had been in a coma for 17 months. But Alfonso believed.
He believed his son would get better, would walk again, talk again, play soccer again.
"... For you are with me ..."
The father took his son's listless hand and placed it between the pages of the Bible, touching the verses.
He had been reading that psalm to Irvin for more than a year.
Alfonso and Irvin spent most of their evenings together in that hospital room, 2,000 miles from the homeland they had left in search of a better life.
Many times Alfonso wouldn't arrive until 10 or 11 at night. He had to work late sometimes on his job in Lincoln, laying carpet. He would drive to the Nebraska Medical Center in Omaha, get a wristband from nurses for an after-hours visit, then ride the elevator to the eighth floor of the adult intensive care unit.
After making sure his son was clean and comfortable, Alfonso would sit in a chair in the darkened room and pray.
He took breaks to massage and move Irvin's muscles, something his cousin — a doctor back in Honduras — recommended.
The Omaha doctors treating Irvin had long regarded his condition as unrecoverable. Unresponsive. Unable to breathe without a ventilator.
His case baffled his doctors in some ways.
But by late June they made a unanimous decision: It was best to take Irvin Madrid off life support.
They called his father. Again and again, they tried to reach him.
No answer.
***
Irvin grew up near Tegucigalpa, the capital of Honduras, with his parents, older sister and younger brother.
He loved soccer — had loved it since he was a toddler, playing the game daily with neighborhood friends and becoming an avid fan of Olimpia, a Honduran club team.
Irvin also loved to act in school plays and to dance — both the traditional folk dances performed at school in flowing, colorful clothes and the modern break dancing that youths performed on the street.
When Irvin was 9 his father left for the United States on a work visa.
After middle school, Irvin enrolled in a vocational school, studying to become an electrician. But in his third year, he decided he had had enough. He wanted to join his father, get a job to help support the family and study subjects such as English and history.
Alfonso urged him to finish his last year at home and apply for a work visa.
Instead, at 17, without telling his parents or siblings, Irvin left.
He planned to travel through Guatemala and Mexico, across the Arizona desert and on to his father's home.
Alfonso believes that three miracles guided his son to Lincoln.
Irvin traveled with a group of other immigrants to Mexico. When immigration officers discovered them, everyone scattered.
Miracle one: Irvin escaped.
Only he and another boy remained together. They managed to cross the border but then got lost in the Arizona desert and went without food or water for days. After they happened onto a main road, immigration officers found them and took them to a hospital, severely dehydrated.
Miracle two: Irvin survived.
Immigration officials called Alfonso, whose relief overcame any lingering anger over his son running away. Even though Irvin came to the States illegally, he was allowed to get a temporary visa to visit his father. Alfonso bought his son a plane ticket to Lincoln.
Miracle three: Irvin succeeded.
He enrolled at Lincoln North Star High School in August 2007, making friends and learning English.
A shared love of soccer made him instant friends with classmates Miguel Contreras and Denis Martinez. Unlike the many die-hard Cornhusker fans at school, they loved fútbol, not football.
Irvin's friends describe him as passionate, funny and adventurous, unafraid to approach the "cute girls." Denis said Irvin was also serious about his studies, especially about learning English.
Reading teacher Angela Christensen-Fischer called him a good listener.
"He really looked engaged, and as a teacher, we don't always get that," she said.
By the fall of 2009, though, Irvin had other responsibilities: He had fathered a child.
Science teacher Tracie Chapo said Irvin was working to earn good grades and to be a good parent.
"He was doing a very good job of juggling multiple roles," Chapo said.
Then, during finals week, teachers and friends noticed he was sick.
He was on Chapo's spring roster, but he never showed up for class.
***
It started out with dizziness.
Then Irvin's stomach would churn. His vision became blurred. His words wouldn't come.
The left side of his face was numb and drooped. His right arm was clumsy.
The Madrids visited Lincoln emergency rooms twice that winter before Irvin was admitted to BryanLGH Medical Center East on Jan. 21, 2010.
By that time, Irvin's temporary visa had expired. Out of fear, the family gave the hospital a false name.
An MRI detected three lesions on his brain.
His speech became more slurred and faint every day, until he stopped talking completely.
By the start of February, Irvin had fallen into a coma. Doctors recommended transferring him to the care of neurologists at the Nebraska Medical Center in Omaha. Irvin made the move on Feb. 3, 2010.
Neurologists performed diagnostic brain surgery but concluded the lesions were too close to his brain stem to remove.
Biopsies were reviewed multiple times but yielded no clues to what triggered the lesions.
No further diagnostic procedures were performed. Irvin was in a persistent vegetative state, his life sustained with a ventilator and a feeding tube.
The lesions kept him in a coma, their genesis unknown. His girlfriend stopped visiting.
His dad made the drive as often as he could. Irvin spent many days alone.
***
Alfonso couldn't always be there to monitor his son's care, and he became distrustful of hospital staff.
When he visited unannounced, he would find saliva dripping from Irvin's mouth. Sometimes Irvin's eyes would be encrusted.
Alfonso worried his son wasn't being fed enough.
He consulted Lincoln attorney Jefferson Downing, who acted as a "bridge for communication" between the doctors and Alfonso and filed the paperwork for legal guardianship.
Downing also helped send some medical records to Alfonso's cousin, a doctor in Honduras, for a second opinion.
Misinterpretation, Alfonso said, was common between the family and the medical team in Omaha.
One day this spring, he said, he quoted Psalm 91:7 through an interpreter to Dr. David Gannon, Irvin's primary doctor.
"Though a thousand fall at your side, though ten thousand are dying around you, these evils will not touch you."
Alfonso resolved to remain steadfast that his son would not die. That the "evil" of ending Irvin's life would not become reality.
It's unclear how the doctor interpreted the incident, but after that, Alfonso said, he was told he had to enter the hospital through the emergency room, which has metal detectors.
After Irvin had been in a persistent vegetative state for more than a year, the doctor concluded that continued life support was no longer in Irvin's best interest. He didn't believe Irvin would ever recover.
Alfonso, who by then had started prayer groups in Honduras, Guatemala and the United States, disagreed. He was adamant that he would not give permission to remove life support.
He wouldn't sign anything, he insisted over and over.
The father clung to small actions: how Irvin would squeeze his hand, and respond when his father massaged the balls of his feet.
Doctors interpreted these movements as spastic movements of his extremities, common with a patient in a vegetative state.
Irvin was not brain dead, but an apnea test revealed that his brain was very sick.
Disagreements between surrogates and doctors usually are resolved, eventually. But Alfonso wasn't budging.
So staff members consulted Dr. Patrick G. Meyers of the Midwest Pulmonary Critical Care in Omaha for an outside opinion.
"This is progressive and now without basic brain stem function," Meyers concluded in late May. "There is no chance for recovery, continued care is futile for any recovery. I would recommend end of life care and withdrawal of extraordinary life sustaining treatment."
Even Alfonso's cousin in Honduras agreed by now.
In such cases, a family can seek out another physician or another care facility.
No one would take Irvin, because he was uninsured.
Medicaid covers the care of illegal immigrants in a life-threatening medical situation, but only until the medical condition is stabilized. After that the hospital was left with Irvin's bill of several million dollars.
The cost of such "uncompensated care" totaled about $35 million for the more than 8,000 patients without the insurance or finances to pay their medical center bills during the last fiscal year. Such costs ultimately are passed on to other patients in the form of increased charges for services.
Hospital staff reviewed Irvin's case on June 24.
Four days later, the chairwoman of the hospital's medical ethics committee approved the decision:
End of life.
After multiple attempts to reach Alfonso, hospital staff notified him of the decision by mail.
Alfonso finally called the doctor back but refused to agree to a date when the life support system could be disconnected.
Eventually the hospital informed him Irvin would be disconnected whether Alfonso was present or not.
***
It had been 17 months, nine days.
On the morning of Tuesday, July 12, Irvin lay in his bed. The ventilator beeped. It circulated air in and out of his lungs.
And Alfonso did come.
He prayed for peace as extended family members filed into the hospital room.
Some cried.
The nurse made preparations. Dr. Gannon stood by in his teal medical gown.
More people filled the room. Pastors, friends.
Alfonso took one of Irvin's hands. Tears streamed. A friend, Maria Salazar, took the other.
Irvin's tube was unhooked. The machine went silent.
Gannon left the room, to watch from outside.
Irvin's muscles twitched.
After 15 minutes, Irvin Madrid's life ended.
Several days later, friends and family gathered for a wake at Heafey Heafey Hoffmann Dworak & Cutler's West Center Chapel.
The Rev. Freddy Ramos sang a hymn in Spanish, his clear tenor voice filling the room. Alfonso's brow furrowed with grief. He covered his face and wept briefly.
Music and Scripture help Alfonso cope. They help him feel.
On Tuesday, Irvin's body arrived in Honduras, home to the mother who hadn't seen him since he ran away at age 17.
Contact the writer:
402-444-1084, ellen.hirst@owh.com
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