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Odler Robert Jeanlouie, MD

 Carmel has only one leg left. But, this is not what kept the entire team up last night.  Her failing heart is unable to pump her blood forward, so her lungs were drowned.  She came to the floor on the brink of a respiratory arrest.  In no time, she had a bi-pap mask on her face.  The mask delivers air under pressure, while at the same time, dilating the alveoli and allowing exchanges of oxygen for carbon dioxide.  Carmel was not cooperating.  Her hands had to be tied to the bed. Imperfect picture, but there was no other way to prevent her from pulling the mask and yanking the intravenous off her arms.  Some sedative would better serve, but it would further depress her respiration.  Carmel was also treated with furosemide, a diuretic, a medication which makes the patient pee. She urinated two liters of clear fluid in a few hours.  That relieved the pressure in her chest, in her lungs. She could breathe again.  Finally, after ten hours of a watchful guard, Carmel, exhausted, fell asleep.  She drifted out of the reach of a sudden fatal outcome.  Would she go home tomorrow? No. She does not have a home, she does not have a family. She lives in a nursing home. And, even if she is discharged, she will be back to the emergency room for another reason. That revolving door has been swinging for years.  She carries a number of diagnoses: heart diseases, diabetes, kidney insufficiency, hypertension, diseases of the blood vessels, anemia, near blindness, an amputated leg, recurrent urinary infections, etc...  And, she is already 99 year old (born on January 17, 1901!). No one on earth cares about her and she is of no use to anyone, not even to herself since she suffers from severe dementia (inability to remember anything or to recognize anyone).  Nevertheless, her care costs at least one million dollars a year to the system, right out of every taxpayer's wallet or purse and places an enormous strain on physicians, nurses and therapists.  And, the number of people like Carmel increases every day in America.  Next week she comes back to the Emergency Room with fever, or bleeding or another episode of respiratory failure.  What do you think should be done then? Should our society revise its guidelines?  (OdlerRobert Jeanlouie, Sunday, April 9, 2000)

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