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At Mount Sinai Hospital, surgeons performed a craniectomy, a procedure which removes a fragment of the patient’s skull to avoid compressing a swollen brain. The portion of Ramirez’s skull remains surgically implanted under the skin and fat of his abdomen to keep it alive.

His activity is limited to tracking motion with his eyes and moving a sluggish left index finger. The staff is unable to accurately gauge his level of cognition.

For one, his name might not even be Juan Ramirez.

It is also assumed that Ramirez is 42, though he has no birth certificate or social security number. He also may not be Mexican, as every effort to contact possible relatives through embassies, consulates or private investigators has come up empty.

Even in his incapacitated state Ramirez requires 24-hour care, but without insurance, a privately-owned nursing home, the most logical destination, has no incentive to accept him.

Without a future care plan or discharge date, Ramirez hangs in limbo.

“It’s an inappropriate use of resources,” said Dr. Michelle Gitler, Ramirez’s attending physician. “This is not the right place for him.” Gitler says it is impractical to devote one of the unit’s 20 beds to a long-term care patient when another rehab patient could be benefiting from Schwab’s services.

“It’s a very frustrating situation because there’s a person who really needs care,” Pacione said. “It’s not in his best interest, healthwise, to be in a hospital, but there isn’t anywhere for him to go that’s appropriate.”

Efforts to contact family

For undocumented immigrants who are alone who become severely injured in the U.S., hospitals attempt to connect the person with his or her home country. Through a common practice of repatriation, the patient can be sent home safely.

A private investigator followed the few leads available, narrowing the list to a few families in Albany Park and a sister in El Paso, Texas, that Ramirez had listed as an emergency contact, but no one could be reached.

Until he can be placed with a family, a possible return to Mexico is out of the question.

“We encounter this on a regular basis,” Navarrete said. “Not always cases as sad as Mr. Ramirez’s, but people who either want to return to their home country or they cannot afford the care here.”

A call for health care reform

With about 12 million undocumented immigrants in the U.S., recent versions of the health care reform bill could provide insurance at additional costs or outlaw coverage entirely.

Horacio Esparza, director of the Progress Center for Independent Living in Forest Park, has been fighting for Latino health care rights in cases similar to Ramirez’s.

With the county-run Oak Forest Hospital having transferred the last of its undocumented immigrant patients to nursing homes in 2007, Esparza said Cook County has not provided a suitable alternative for new patients requiring long term care.

An uncertain future

Nurses help Ramirez pass the time by having him watch Latino and sports channels on TV and listen to the radio. Jennifer Gimenez, a resident nurse who works closely with Ramirez, tries to make him feel at home.

“The staff, we keep him company, sometimes we put him at the nursing station and interact with him, we make sure that he is taken care of,” Gimenez said. “We love Juan. We’re really going to miss him if he leaves.”

Disability Resource Coordinator Ramon Canellada spends time him each week, working to see if Ramirez can communicate when spoken to in Spanish.

“There has to be somebody in the world that cares about him, that knows him,” he said. “He needs every opportunity to integrate, every opportunity to live.”