Maunabo, Puerto Rico(CNN) Lourdes Rodriguez heard the scream early on the morning of January 6, before the sun rose and before the frogs began their chorus.
She instantly recognized the voice of her father, Natalio Rodriguez Lebron, 77, a former nurse who cared for the mentally ill, people he believed society had forgotten.
She darted up the stairs.
Her father's health had long been troubled. He had diabetes, lung disease, sleep apnea and congestive heart failure. And in the months since Hurricane Maria battered this coastal town, Lourdes watched his condition worsen. The sleep apnea machine he needed to help him breathe was useless for months because their hilltop neighborhood in Maunabo was entirely without electric power. In December, a business had donated a generator to power the machine at night, but the family struggled to afford the gasoline needed to keep it running.
As Lourdes reached the top of the stairs, she felt an uneasy stillness in the air. The sky was thick and black. No moon was visible. And the electric generator, a machine that sometimes rumbled like a car engine, had fallen eerily silent.
She swung open the living room door to find her father clutching his chest.
The machine was off. Her father appeared unable to breathe.
Her mother, Julia "Miriam" Rodriguez, stayed with Natalio while Lourdes rushed to restart the generator, which had run out of gas, and repower the breathing machine. Her mother felt Natalio's body go limp in her arms and then collapse to the floor, face down.
Frantic, they called 911 and tried to comfort him.
Waiting there on the floor, Julia Rodriguez told me, she felt a wind -- a physical gust -- leave her husband's body and pass into her own. She said it was as if the decades they'd spent together -- the moves from Puerto Rico to the mainland and back; the hours they both worked as nurses; the three children they raised -- hovered in the room, a tangible, living thing, and then became part of her.
Julia Rodriguez knew then that her husband might not survive.
All these months later, it seemed the storm may have won.
It's been nearly six months since Hurricane Maria.
Its howling winds, which topped 150 mph, long have dissipated. The storm that battered Puerto Rico on September 20 before hooking northward into the Atlantic is a memory.
Yet, in this US commonwealth, people are still dying in Maria's wake.
That's especially true of those who lack basic services like electricity.
Rodriguez died on January 6. In addition to his death, CNN identified five people who died in 2018 from causes that friends, family, doctors or funeral home directors consider to be related to Hurricane Maria and its aftermath.
It's not possible to say with 100% certainty that a death this long after a storm was "caused" by Hurricane Maria, experts told me. But that's beside the point. These deaths show dangerous conditions persist in Puerto Rico.
I spent several days in Maunabo, Rodriguez's town on the southeast coast, and other areas without power, to try to understand how communities are faring all these months later.
I had been to Puerto Rico several times since the storm, reporting for CNN on topics from uncounted deaths to water outages and an "exodus" to the US mainland. In December, I drove the entire path the eye of the storm took across the island. On that route, I met a woman whose clock was stopped at 3:27 -- the moment the hurricane swept through. Puerto Rico, it seemed, was an island frozen in time, doomed to relive that day again and again.
Would that still be the case after six months?
Metrics on the response to Hurricane Maria told me that might be the case, at least for some residents. So, too, did academics and others who study how we respond to hurricanes.
Puerto Rico, some of these experts said, appears to be stuck between the "emergency" and "recovery" phases of disaster response. Typically, in the United States, the emergency phase -- in which people lack necessities like food, water, shelter and power -- lasts for days or, at most, a few weeks, said Lori Peek, director of the Natural Hazards Center at the University of Colorado Boulder. Then comes recovery, when residents, government agencies and others start to rebuild.
"Here we are months after this storm and we are debating if we should still be sending these emergency -- really emergency, and life sustaining -- supports, or (should we) transition into this recovery process," Peek said. "That is just truly breathtaking."
It's true that progress has been made. Tourists are coming back to San Juan, and parts of the city are humming. Casinos are open in ritzy Condado and the bomba dancers are back in Río Piedras. A month after Maria, roughly 1 million of the 3.3 million American citizens here remained without running water service. Now, nearly everyone has it.
In late December, only about a third of temporary roof requests had been met by the US Army Corps of Engineers, leaving some people sleeping in homes where it rained inside at night. Months later, nearly all those requests for professionally installed tarps have been fulfilled. Formal shelters for hurricane victims are now empty, according to federal officials.
Yet inequities remain, especially when it comes to electricity.
As of March 7, more than 10% of electric customers in Puerto Rico were still without power, according to figures reported to the US Department of Energy by the local utility. Maybe that sounds small -- but it represents nearly 156,000 customers, and likely more than that number of people, since the average Puerto Rican household is about three individuals.
Also consider that figure in the context of other recent storms.
Hurricane Harvey hit the Gulf Coast of Texas on August 25. The next day, an estimated 304,000 customers were without power -- yet all but about 2,600 had electricity restored in 19 days, according to data provided to CNN by the Public Utility Commission of Texas. Florida after Hurricane Irma? That storm left an estimated 6.2 million customers in Florida without electricity on September 11, according to the Florida Public Service Commission, which, like the commission in Texas, collects data from electric utilities. In a little more than two weeks, virtually all power was back.
These comparisons are, of course, imprecise. No two storms are the same in terms of intensity, needs or geography. Puerto Rico is an island and, as federal officials have said repeatedly since the storm, you can't just drive in supplies from another state. Communications systems were down and many roads were impassible in the first weeks after the storm. The island's power grid also was in lousy shape, by many accounts, before Hurricane Maria. Comparing that grid to Florida's, which is the gold standard for preparedness, is somewhat unfair, said Seth Guikema, an associate professor of engineering at the University of Michigan, who studies grids and disaster response. After Hurricane Andrew in 1992, he said, some Florida utilities built concrete posts and took other measures to ensure power could be restored faster after storms.
The US Federal Emergency Management Agency, FEMA, which oversees disaster recovery, says it is doing everything possible to ensure basic services are restored to Puerto Rico.
Michael Byrne, FEMA's federal coordinating officer for Puerto Rico, told me in an interview that Puerto Rico's unique logistical challenges fully explain the delays. No other US disaster has presented these unique and difficult circumstances, he said, which meant FEMA had to invent a strategy for how to respond to the crisis. The unique situation here also makes comparisons between the response to Maria and responses to other storms problematic, he said.
If storm-related deaths are continuing, he said, his heart goes out to affected families. "The initial reaction is the reaction anyone would have: I'm sorry to hear that. Truly. One of the things that you don't stop being, no matter your job, is a human being." There are programs, he added, to help bring generators and financial assistance to storm victims, especially those who are in vital need of medical services.
In a statement emailed to CNN this week, the US Army Corps of Engineers, which is helping with power restoration, said back-to-back 2017 disasters, the remoteness of the island and the fact that some supplies had to be manufactured for installation in Puerto Rico, slowed down work on the electric system. "Helicopters have been used to airlift poles, materials and people into remote locations to perform repair work," the Corps said.
Yet these explanations matter little to many of those who have been living without electricity for nearly six months, and have gone without running water for much of that time.
They know another truth: The longer the wait, the more a person is at risk.
The family legend goes like this: The first of Natalio Rodriguez's ancestors to arrive in Maunabo was hidden in a barrel aboard a ship from Africa. He may have arrived as a free man, they said. This much is sure: Rodriguez roots travel deep into this fertile soil. The family has been here as long as anyone can remember.
By the time Natalio Rodriguez was born in December 1940, the 11th of 12 children, much had changed in Puerto Rico -- and yet little had, as well. Rodriguez grew up helping his father, Juan Ines Rodriguez Monclova, work the verdant sugar cane fields behind their home on the side of a shark-tooth mountain. This was the work of his ancestors, too. The Spanish enslaved Africans and, before that, indigenous Taino people -- who gave Maunabo its name -- to work in that industry.
Natalio Rodriguez and his neighbors had all those stories coursing through their veins. His original ancestor in Maunabo is said to have married a Spanish woman, which is how relatives explain the fact that some of their cousins and aunts have bright blue or green eyes, while Natalio's and Lourdes' eyes and skin carry the deep hues of espresso and midnight.
When Rodriguez was a boy, slavery had long been abolished, of course; and the Spanish had been kicked out of Puerto Rico by a new colonial power: the United States. The US, which occupied Puerto Rico in 1898 after the Spanish-American War, granted Puerto Ricans citizenship about two decades before Rodriguez's birth. Still, his family members and neighbors couldn't elect their own governor until 1948. Even today, Puerto Ricans, while subject to US laws and given US aid, can't vote for president or elect full, voting members of Congress.
Despite all that, young Rodriguez remained enchanted by American culture.
He loved Western movies and books and grew up galloping the family's horses down from the mountains and into the valley, which was home to the town square, not far from a lighthouse and the radiant turquoise coast. His childhood nickname was "Hormiguero," Spanish for anthill, his longtime friend, Damian Lopez, 70, told me. I laughed and asked about the origin of that name. The kid was something of a living verb, Lopez said -- always moving, never still.
That restlessness would take him places his father never saw.
Some of Rodriguez's older brothers enlisted in the US military (one lost part of his hand in the Korean War, according to Julia Rodriguez) and, as a teenager, Natalio Rodriguez tried to do the same. Unable to join the service because of a heart arrhythmia, according to his wife, he found other ways to follow in their footsteps. After one brother moved to New York -- bringing home exotic northeastern foods like cod, cherries and white grapes to a family that grew avocado, grapefruit and oranges -- Rodriguez decided, after high school, to move there, too. He would become a big man like his dad -- 5-foot-9 and 300 pounds -- and not averse to physical labor. But he began to resent helping in the sugar fields. Maunabo was, and is, desperately poor. (Fifty-six percent live below the poverty line, according to the US Census Bureau). Some of his relatives still plowed up their fields with bulls tied to oxcarts. The brother who moved away seemed so much happier, and so much richer. In the United States, Rodriguez thought, he'd have a better life, too.
So, in his late teens, Rodriguez boarded a plane for New York.
"Right after getting out of the cab, he stepped on a pile of dog s---."
Natalio loved to tell this story, his wife, Julia, said.
"He'd go, like, 'Wow, so this is how you all live here, dodging piles of poop in the streets!?'"
Julia Rodriguez grew up in Maunabo, too, just up the hill from Natalio and his family. The couple raised three children together, primarily on the US mainland.
For him, the 50 states were a place of promise and of hope -- a place of purpose and duty.
Still, strangely, that first New York impression -- the muck on the street -- stuck with him, too.
He never felt fully settled, his wife told me.
He yearned for home.
In 2009, he and Julia finally resettled in Maunabo.
"Look," says Luis Lafuente, Maunabo's vice-mayor.
He points at a perfectly circular hole extending from the roof of city hall.
"That's where the clock used to be."
It was busted by Hurricane Maria.
Time hasn't just stopped in this town, which is at the southeast corner of Puerto Rico, near where Maria delivered its first punches. After the storm, it's almost irrelevant. On this day, March 9, Lafuente tells me exactly 0% of the area's 11,500 residents have been reconnected to the electric grid -- the same as the day Hurricane Maria struck. Between 35% and 50% of residents do have electricity, he said, from three emergency generators installed on December 23 by the US government. But those generators are prone to failure, he said, and don't reach mountain communities. (The Army Corps said the alleged "failures" result from generator switch-overs, not from problems with the equipment. The Puerto Rican power authority -- PREPA -- told CNN 37% of customers in Maunabo had power as of March 13, but did not specify the source of that electricity.)
At dusk, those mountains turn to charcoal silhouettes. Few lights shine. Only the lucky and the wealthy can afford personal generators.
We drive Lafuente's Jeep Renegade around the town where he's spent his life. Parts of it are unrecognizable to him. Playgrounds are twisted. A truck barn turned to scrap metal. Power lines are draped over posts like wet noodles. Some electric posts are so off-kilter, they look like they're doing pushups.
The hospital had to be relocated to another municipal building, which most recently had been home to emergency management workers and police. Those officers and workers, in turn, had to move into a public school that closed before the storm. The hospital still has a sign that says "Emergencia 24 Horas," indicating the emergency room never closes. The reconfigured hospital, however, opens at 7 a.m. and closes at 11 p.m. Many of those who require emergency assistance earlier or later than that have to drive through an unlit mountain tunnel -- it feels like something out of "The Walking Dead" -- to seek medical help.
Maunabo's five schools reopened in late November. But students leave class at 12:30 p.m. because there's no power. A school principal I met told me she drives to other towns to make photocopies so students can take tests. Teachers assign very little homework, she says, because the students are so overwhelmed already.
We stop by the lighthouse, perhaps the most iconic site in Maunabo, to find that its searchlight and glass have been shattered by Maria. The Coast Guard hadn't used it since the 1990s, anyway, according to Wanda Marín Rivera, board president of the town's cultural center. But Lafuente and others had hoped tourism might revive the town, with the lighthouse as a destination, since sugar cane, plantains and crab fishing haven't been providing stable work. (Maunabo became known as a hub for crab fishing. Crab images are stamped into the sidewalks and painted on walls; a crab statue sits in front of the baseball stadium, which was heavily damaged, and a smaller one perches on the mayor's desk).
Despite the state of things, Lafuente says Maunabo will improve. Tourists will come. Industry will pick back up. Already, he says, crabbers are setting traps by flashlight at night.
"The people of Maunabo are very motivated and anxious to grow and make the town even better than it was before," he tells me. "We will rise again. We are rising."
At first, the mountain protected them.
The day Maria hit, Natalio Rodriguez huddled in a small bathroom with his wife, his daughter Lourdes, her two children, and, nearby, Natalio's elderly sister. "We were crammed like tuna in a can," Lourdes Rodriguez recalled. Water poured under the door. Natalio told everyone to stay calm, Lourdes told me. Meanwhile, she said, the house "shook like Jell-O."
Still, they survived. Most of the house did, too. The hillside, which had raised so many of their ancestors and grown so many of their crops, sheltered them from the worst of it.
It was after Maria that the real danger began.
The power was out. Water, too. Food was scarce. For several days, the winding, steep-pitched road to their mountain home was blocked, Lourdes said. It was a week before she was able to wait in hourslong lines for gasoline and get her car to a hill in a neighboring city, Caguas, where she could call their many relatives on the mainland to say they had outlasted the hurricane. Communications systems in Maunabo remained essentially inoperable for months, she told me. Island-wide, according to Puerto Rico government data, only 25% of cell towers were functional by October 20.
It was in these isolated circumstances that Natalio Rodriguez's medical conditions began to worsen. The labored breathing was especially troubling for his wife and daughter. The sleep apnea machine he used at night to get oxygen into his lungs wasn't working without electricity. That meant he and his wife could not rest, much less sleep. He paced the house at night and walked the neighborhood by day. In desperation, the family made cardboard fans for him to use to try to move air around his face. No one thought it would help him breathe, really, but it was something.
"All of a sudden he became a quiet person. He was a talker. Pepito enjoyed long conversations," Julia Rodriguez said, using Natalio's family nickname. "He could spend hours and hours talking. But then (after the storm) he didn't speak much."
The family worried also about the insulin he used for diabetes. It required refrigeration. They had no working refrigerator without power. And ice was difficult to come by.
What they really needed, of course, was electricity.
On November 17, Maunabo plaza and city hall got power from a small generator -- purchased for $35,000 by the municipality, according to the mayor, Jorge Márquez. From their home in the mountains, Lourdes Rodriguez said, the family could see a faint glow. It looked like the town downhill was on another planet.
About a month later, the family received a small power inverter, Lourdes Rodriguez said. It ran for only two or three hours before running out of fuel, she said.
A bigger generator was donated later, but the family had trouble affording the gasoline needed to run it, she told me. The fuel alone cost them $60 per week while her father was alive, Lourdes Rodriguez said. Plus, there were filters, oil and repairs.
When the machine was on, they said, Natalio calmed some.
But they could not keep it going.
Some of them died during the storm.
A mudslide in Utuado, Puerto Rico, killed two "bedridden" sisters. Another person drowned in Toa Baja. But the aftermath of Hurricane Maria appears to have been most deadly.
More than 1,000 "excess deaths" occurred after the storm, in September and October 2017, than during the same timeframe in 2016 and 2015, according to Alexis Santos, a professor at Penn State University who analyzed Puerto Rican government mortality statistics.
That doesn't tell you 1,000 people certainly died directly because of Hurricane Maria. But it does indicate an unusual number of people were dying -- and well into October.
The only difference, Santos said, was the hurricane.
In November, I put together a CNN team to survey the funeral homes in Puerto Rico. We were only able to reach about half, but those directors and other staff members told us they had seen at least 499 deaths they considered to be hurricane related, based primarily on their conversations with family members. We then documented the deaths of several uncounted people who died in the weeks after the hurricane, not only the day the storm hit. They included an older man in Cayey who died in a fire set by a lantern he wouldn't have been using if he'd had electricity; a man in Canóvanas who committed suicide in the storm's aftermath; and a woman in Corozal who lacked access to medical treatment. (Two deaths we highlighted were later added to the Puerto Rico government's list of official hurricane-related deaths).
Still, I didn't expect deaths would continue into 2018.
It's impossible to use statistics to prove that they are, because the Puerto Rican Demographic Registry has not released data for this year. (CNN and Puerto Rico's Centro de Periodismo Investigativo are suing that agency for access to death records). Trends suggest the aggregate loss of life in Puerto Rico is slowing and may have normalized, Santos told me.
Still, I was able to document several deaths that occurred this year and appear related to Maria's frantic aftermath.
Several of the deaths I researched occurred in Maunabo.
Braulio Salinas Santiago, 71, died of an apparent heart attack in the parking lot of Maunabo's makeshift hospital on January 18, according to his wife, Margarita Baerga Diaz. It was about 5 a.m., she said, before the hospital, which operated 24-7 before the hurricane, had opened.
Similarly, Fulgencio Velazquez Chevalier died on February 20 in the car of his wife, Litza Rodriguez Figueroa. The 50-year-old suffered depression and intense anxiety after the storm, according to Rodriguez Figueroa, who is a nurse. She believes that stress, along with a related increased smoking, contributed to her husband's cardiac arrest. When she drove by the closed Maunabo hospital, she told me, Velazquez was still alive.
Carmen Rodriguez Martinez died on January 25 at age 71.
Her doctor, Arturo Torres Borges, wrote two words on the death certificate in a spot reserved for circumstances that may have contributed to the death: "Huracán Maria."
The causes of death included respiratory failure and heart disease.
Rodriguez Martinez required an oxygen machine to breathe, according to her daughter, Iris Janette de Jesus Rodriguez, 54. They still didn't have electricity from the grid when I visited in late February. A generator hadn't been enough, she said.
In Corozal, farther into the mountains, Victor Manuel Belen Santiago wept as he told me that his mother, Zoraida Santiago Torres, 58, had saved his life by helping him kick drug addiction.
Their home was destroyed by the storm, and Belen Santiago rebuilt it by hand, puzzling scraps of the roof and walls together like a reassembled house of cards. But he couldn't restore the power his mother needed to run an oxygen machine. She died on February 13, he said, after getting fluid in her lungs that could not be cleared. Her death certificate lists organ failure and a bacterial infection among the causes of death, along with chronic liver disease.
After the loss, Belen Santiago said he contemplated suicide.
His beloved mother was gone. He had no job -- no prospect for a job after the debt crisis, which struck Puerto Rico before the hurricane. It was unclear if life ever would feel safe again.
"We are the forgotten people," he said. "It's like we don't exist."
The morning of January 5 started like so many others, with a tap-tap-tap of her father's cane on the second-story patio -- Natalio Rodriguez's way of waking his daughter up for the day.
Lourdes Rodriguez rolled her eyes playfully and walked upstairs to see what he wanted this time. She and her two children, ages 13 and 8, had been sleeping on twin beds in a room downstairs since the storm. The roof of a new home they had been building was torn off by Maria.
She would awake to her father's screams the following night, but this day now occupies a different territory in her memory. She considers it one of the best days of her life.
Her father seemed so healthy, so alive.
He wanted to go everywhere that day, see everything. He carried his cane with him while visiting his sister, a nun, in Ponce, a city on the south coast. But he kept it in his elbow crease -- more ornament than crutch. At an ice cream shop, he pretended to be a clueless American tourist -- using affected Spanish, asking to see tourist attractions on the other side of the island. The store's workers laughed when he broke the gag, Lourdes Rodriguez said. He ordered his favorite flavor: passion fruit with pineapple. That night, they ate seafood at a restaurant near the beach.
Now, Lourdes Rodriguez wonders why that day was different.
Maybe it was the upcoming holiday? January 6 is Three Kings Day in Puerto Rico, or Epiphany, when Christians commemorate the arrival of wise men visiting the infant Jesus.
Her father had been talking about it for some time, telling her children to prepare their best clothes (the truth was that most of their clothing had been donated after the storm) so they could go to a pig roast in a neighboring community. In years past, they'd gathered up guitars, pots and sticks and gone caroling up and down the hillside -- a Puerto Rican parranda -- growing the party as they visited one house and then the next, offering food and drinks and collecting stories.
Maybe he was living in anticipation of that day?
Or maybe this day was his way of saying goodbye.
What's taking so long?
That question nagged at me as I reported on Puerto Rico's ongoing electrical outages. And it's a question that clearly haunts many Puerto Ricans.
Experts offered some theories.
"They're Americans but they're not represented in Congress," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University in New York. That means there are few political repercussions for a botched disaster response, he said, and few advocates for funding. "It really gets down to money and poverty and politics."
"It's unconscionable and unreasonable that it has taken so long" to restore power, he said. "You have to ask yourself, 'why is that?' It's money and politics, the common denominator for so many things. ... Can you imagine no (electric) power in Beaumont or Port Arthur or Rockport, Texas, for this amount of time? I don't care what kind of disaster it was. You would never see this."
Byrne, the FEMA official, said this disaster has been adequately funded and the federal government is responding to the crisis in Puerto Rico in the same way it would in the 50 states. "We're not leaving," he said. "We're here until we take care of all of the requirements that are needed."
As of March 15, FEMA had spent $1.1 billion in Puerto Rico; $1.6 billion in Texas; and $993 million in Florida for individual assistance following the fall 2017 hurricanes. "That's the initial, quickest payment to individual citizens for immediate needs, but the real cost is in long-term recovery dollars for infrastructure projects, like buildings, roads and other public facilities," which is not included in those figures, said Chris Currie, director of emergency management issues at the US Government Accountability Office.
Congressional appropriations for disaster response and recovery in recent months are not always itemized by storm, he said, making it difficult to say which hurricanes ultimately will be given the most federal funding. An estimated $23.2 billion has been appropriated specifically for Puerto Rico, according to The Center for Puerto Rican Studies at Hunter College in New York.
The National Oceanic and Atmospheric Administration estimates Maria caused $90 billion in damages; Harvey, $125 billion; and Irma, $50 billion.
Regardless of financing, the relative slowness of the recovery in Puerto Rico is seen by some people here as dehumanizing.
In a way, Maria has revealed the ugly colonial relationship between the island and the United States, said Silvia Álvarez Curbelo, a historian and director of the research center at the University of Puerto Rico's school of communications.
"This raw nerve of colonialism comes creeping in in every conversation" these days, she told me. "It's this feeling of subordination. The people -- common people -- have no way (to respond) except to wait. Wait for this letter. Wait to see if FEMA comes to town. Wait to see if the federal government comes (though) with the money they told us they would give us for recovery."
Such frustrations reached a boiling point in the past.
There were plenty of other factors at play, but Spain's failure to address a humanitarian and economic crisis after an 1867 hurricane in Puerto Rico "provided the context for the first political movement for independence on the island," Stuart Schwartz, a Yale history professor, writes in "Sea of Storms."
The uprising, however, was "crushed immediately," said Álvarez Curbelo, from the University of Puerto Rico. Nothing like that ever would be tried today, she said. While Puerto Ricans have worked hard to create a national cultural identity, and while the idea of independence was popular decades ago, few Puerto Ricans in recent years have supported political independence from the United States, according to Florida International University anthropologist Jorge Duany.
If anything, Álvarez Curbelo expects Puerto Rico to sink further into "political paralysis" and become more US-dependent after Maria.
She doesn't see the United States granting Puerto Rico full rights as the 51st state, a move that likely would require the approval of Congress. Remember, she said, this storm follows a massive debt crisis in which the island's government declared bankruptcy. What does Puerto Rico have to offer the United States now? A fiscal oversight board, appointed by the US President, is steering austerity measures. Meanwhile, Puerto Ricans have been taught, generation after generation, she said, to believe that they cannot survive without the help of a colonial power.
"I'm not a pessimistic person," she told me. "I'm a historian. I tend to be sober. I watch the long trends. But I don't see the light -- in the total sense of the word 'light.' The thing about power is it's a metaphor for the island. The fragility of the energy system -- of the power system -- is the perfect metaphor for our condition: The light comes and goes. There is no sense of future."
The ambulance arrived at 2:18 a.m. on January 6, records show.
It was too late.
Natalio Rodriguez Lebron died at 1:23 a.m.
According to the death certificate, Rodriguez's death was caused by chronic lung disease, hypertension and diabetes. In the notes on that document, a doctor from the Puerto Rico Bureau of Forensic Sciences also mentioned that he was a smoker and obese.
That bureau, in San Juan, is the only laboratory in Puerto Rico authorized to classify deaths as hurricane-related. In the months after Maria, the office has come under criticism, including from CNN, for possibly missing dozens if not hundreds of "indirect" hurricane deaths.
The official death toll has stood at 64 since early December.
In February, Gov. Ricardo Rosselló announced Puerto Rico had enlisted the help of George Washington University to study the mortality that followed Hurricane Maria. That analysis, due out in coming months, will focus on deaths from September through February.
To date, Natalio Rodriguez's death has not been classified as hurricane-related. Puerto Rico's Department of Public Safety, which oversees the forensics bureau, did not respond to repeat requests for comment on his death and others in this story.
Rodriguez's family believes his death was related to Hurricane Maria. His doctor, Pedro Lopez Lopez, shares that view. Rodriguez's health deteriorated in the conditions Maria left behind, he told me. He saw Natalio about two weeks before his death; and he was "stable" then, he said.
The body was not delivered to the forensics office until 2:38 the following afternoon, a time that forensics documents confirm. By afternoon, the body had started to decompose. The family was told it would be impossible to have an open-casket service, as is the norm in Puerto Rico.
The closed casket was the hardest part of the funeral, a longtime friend told me.
"It was terrible," Damian Lopez said. "If you love someone, you'd like to see him for one last time."
There was also the matter of the expense.
The Federal Emergency Management Agency manages a program that can cover some funeral expenses for eligible families after hurricanes. But those deaths typically must be certified as hurricane-related in order to qualify.
The Rodriguez family already put $4,000 toward his funeral, a receipt shows.
They still owe $1,115.
In December, FEMA did grant the family $4,000 for home repairs and $3,000 to replace household items that were damaged in Maria, Lourdes Rodriguez said. Julia Rodriguez told me friends and relatives tried to offer the family money after the storm but that her husband turned away the help. He was a proud person, she said, and generous. He also knew that everyone in the community was suffering.
People will keep dying until power is restored.
That's the stark assessment Arturo Torres Borges shared with my colleagues Leyla Santiago and Khushbu Shah, who tipped me off to the possibility of continued deaths in Maunabo. Torres is the medical doctor who wrote "Huracán Maria" on the death certificate of a local woman.
Natalio Rodriguez's doctor puts it this way: "This is a public health crisis." I met plenty of people at risk in Maunabo.
Some are so sick of the situation they try to laugh it off.
Across the street from Litza Rodriguez Figueroa, whose husband died in February, lives Ana Ramos Davila, a 74-year-old who will insist you drink her bottled water and then ask if you have any cute gringo friends who would drink Coors Light and play dominoes with her.
That's the dream! she said -- gringos, Coors and dominoes.
Post-Maria has included little of that.
"Christ! When is this going to be over?" she said of the storm. "I've spent $100 or more just on bags of ice" to try to keep food cool without power. "No one is helping me, my dear."
"I already told my psychologist if you get a call that I took my life, don't be amazed," she said, serious. "I'm so tired of this -- looking for supplies, finding water, lighting candles. I'm so tired."
A few houses up the street, I met David Torres and Juanita Guzman, who were having their home repainted. Torres showed me a breathing machine he's supposed to use at night but doesn't, he said, because it requires a steady power source and could short circuit without one. He has a small generator -- "I use it to turn on one light and one fan; if I turn on the light, I have to turn off the fan." It doesn't provide steady enough power to run the machine, he said.
"I need my oxygen mask. One of these days my wife is going to wake up and find me dead by her side," he said. "She told me that in the night she hears me having trouble breathing."
"If it's my time to die, I'll die," he said, laughing. "There's nothing I can do."
Experts say post-storm stress and depression can be deadly.
Poverty exacerbates the risks, said Redlener, from Columbia University.
The way people interpret a disaster matters, too. If they believe the disaster is simply weather-related rather than manmade, they're more likely to accept it, said Peek, from the University of Colorado. What she fears is that Puerto Ricans are struggling because of the human response to the hurricane.
"It's like the despair effect," she said. "People who feel forgotten and neglected -- they may suffer negative mental health effects."
Up the hill from the Rodriguez family live Miguel Amaro Leon, 79, and Maria Morales Ortiz, 76. They welcomed me onto their outdoor patio just as the sun was setting. A generator roared behind our conversation as they told me how hard it's been to keep the thing running.
"It's been really difficult because we have to pay for the gas," Amaro Leon said. "We only use the generator three or four hours daily. If not, we would have to spend more money."
Can they keep their insulin cold?
"More or less."
"We try to eat food that doesn't need to be in the refrigerator."
As we talked, the generator ran out of gas.
Frogs chirped in the night.
"Things are getting better little by little," Amaro Leon said. "We just need power."
On my last evening in Maunabo, Lourdes Rodriguez took me to see her father's grave. It's in a cemetery in the valley, not far from the town plaza. Looking across the property, you can see the foggy mountains in the distance where so many of Lourdes' relatives cut sugar cane and plowed the earth, first under the rule of the Spanish and now the United States commonwealth.
Tears streamed down her cheeks.
Her father's family nickname -- "Pepito" -- was written by hand in wet cement.
The family hasn't been able to pay for a headstone.
"I can't fix it," she said, sobbing. "It's hard for me to see it that way."
Álvarez Curbelo, the professor at the University of Puerto Rico, told me earlier that she wished Hurricane Maria's dead could speak. That way they would not be ignored.
I asked Lourdes what she thought her father would say if he could talk with us now.
"He would tell us to keep calm," she said, somber. "That was always his saying: 'Take it one day at a time.' Don't think about the next week or the next month.
"Take it one day at a time."