The choice is heartbreaking: stay to help other families, or leave to help your own.

That's the calculation thousands in Puerto Rico are making. The bankruptcy of the U.S. commonwealth, the culmination of years of decline, has accelerated an exodus that's adding to the island's economic misery.

“I had to choose for my family,” said Aledie Amariah Navas Nazario, 39, a pediatric pulmonologist who left behind young asthma patients when she, her husband and two small daughters moved to Orlando.