Maria* found her way to Open Door through a friend. She called to make an appointment for urgent cardiovascular care, though she was only in her early twenties.
Middlebury, Vermont
Before reaching us, Maria had arrived from Central America and presented to a major medical center in another state, pregnant with her first child and in acute heart failure. The cardiovascular and obstetric teams there, remarkably, enabled her to deliver a healthy baby boy. She then moved to Vermont to live with her sister. Maria arrived in Addison County in August 2023 with an infant, needing open heart surgery for a double valve replacement. When she contacted us, ODC’s bilingual Clinical Director recognized immediately that we needed to connect her with UVM Medical Center Cardiology.
Working with an interpreter, we established a volunteer physician as Maria’s provider within ODC. He called a specialist at UVMMC to share her complex case history. At the same time, our Patient Services Coordinator worked with Maria to schedule multiple follow-up appointments and prepare a patient financial aid application for UVMMC. This allowed her to access the extensive care she would need at low or no cost. We sent Maria home with a gift of food and items from our mercadito, our tiny in-clinic free store. The volunteer provider followed Maria’s case, meeting by phone and at Tuesday evening clinics to help her understand the life-changing surgical choices she faced, and to prepare for the pre-op, post-op, and lifelong care implications of her surgery.
Given the close connection between oral and heart health, Maria’s surgery required dental clearance. Our Dental Coordinator set her up to be assessed and treated by our Dental Hygienist and Extern, with support from our Dental Assistant. Over four visits, they deep-cleaned Maria’s teeth, including below the gumline, and repaired multiple cavities so she could proceed with surgery just after the new year.
Meanwhile, ODC’s Communications Coordinator translated key pre- and post-surgical information from Maria’s cardiothoracic care team and interpreted phone appointments between Maria and our provider to support continuity. She also prepared a formal letter in support of Maria’s parents’ travel visa application. They wanted to be present to support her care, since she would be unable to lift more than 12 lbs—less than the weight of her baby—for three months after her operation.
Just after the new year, Maria was wheeled into the OR for successful placement of two mechanical valves. When she was discharged from UVMMC to a medically required housing situation in the Burlington area, we learned it would take Maria 8 -10 months to access a primary care provider there. So, ODC continued to act as her primary care home, providing case coordination and speaking with her cardiothoracic nurse about post-surgical care.
Our volunteer provider visited Maria weekly to set up her pill box. He coordinated required labs, initially bringing Maria to the lab 2-3 times a week to check her INR (clotting time) so her blood thinner dosage could be adjusted accordingly. In the fourth month out from surgery, ODC took over management of Maria’s now-weekly labs. We continued to coordinate check-in calls with her post-op surgical care team. By May, Maria was doing well, able to lift her baby son again, and expected to live a normal life.
*The patient’s name has been changed to respect privacy, protect identity, and assure confidentiality