# Who should MDs let die in a pandemic?



## Blackadder1916 (5 May 2008)

Though this article discusses recommendations from an American group, it does provide some food for thought for Canadians should such a pandemic occur.  

Who should MDs let die in a pandemic? Report offers answers


> By LINDSEY TANNER, AP Medical Writer Mon May 5, 9:47 AM ET
> 
> CHICAGO - Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster.  The gut-wrenching dilemma will be deciding who to let die.
> 
> ...


----------



## George Wallace (5 May 2008)

In Canada, the Civil Libertarians would tear that to shreads citing the Charter of Human Rights.


----------



## Michael OLeary (5 May 2008)

George Wallace said:
			
		

> In Canada, the Civil Libertarians would tear that to shreds citing the Charter of Human Rights.



Yup, they would demand that the available resources be spread so thin that the potential casualties were maximized as a result.


----------



## MedTechStudent (5 May 2008)

Anyone ever read "The Stand"?

Thats what this seams to be ramping up to....


----------



## Fusaki (5 May 2008)

Isn't there some sort of Canadian Law that would hand over the responsibility in a disaster such as this to the military? I always figured that it was perfectly legal to curb certain civil liberties in a state of emergency - and the authority to triage casualties seems perfectly rational in this case.

But then again, I assumed that someone already had this plan all sorted out. If The Bomb was dropped and the cold war went hot, someone must have had a plan for dealing with widespread casualties... right?

 ???


----------



## Michael OLeary (5 May 2008)

Wonderbread said:
			
		

> Isn't there some sort of Canadian Law that would hand over the responsibility in a disaster such as this to the military? I always figured that it was perfectly legal to curb certain civil liberties in a state of emergency - and the authority to triage casualties seems perfectly rational in this case.
> 
> But then again, I assumed that someone already had this plan all sorted out. If The Bomb was dropped and the cold war went hot, someone must have had a plan for dealing with widespread casualties... right?
> 
> ???



Start your reading here:

Emergencies Act ( 1985, c. 22 (4th Supp.) )
http://laws.justice.gc.ca/en/showtdm/cs/E-4.5


----------



## George Wallace (5 May 2008)

Wonderbread said:
			
		

> Isn't there some sort of Canadian Law that would hand over the responsibility in a disaster such as this to the military? I always figured that it was perfectly legal to curb certain civil liberties in a state of emergency - and the authority to triage casualties seems perfectly rational in this case.
> 
> But then again, I assumed that someone already had this plan all sorted out. If The Bomb was dropped and the cold war went hot, someone must have had a plan for dealing with widespread casualties... right?
> 
> ???



Unfortunately, since the Wall came down, it seems like the Federal Government has totally given up on the Emergency Measures Organization and all of its various incarnations.  Even with 911 to open up our eyes to some of life's perils, Canada seems to be going backwards, instead of forwards.  Problems found in all the studies done since 911 have not been solved.  Consolidated "Emergency Headquarters" have not been developed in major centers.  None of the various branches of Government seem to be cooperating with other branches, be they Federal, Provincial, Municipal, or Regional.  Sadly it seems as if the Chretien Liberals are still in the background saying: "If we ignore the problem, it will go away."


----------



## Bigmac (5 May 2008)

This could actually happen and Canada is definitely in the mix. The SARS outbreak was a warning to how unprepared this country really is. Immigration is increasing in Canada and with it is possibilities of outbreaks of diseases we have not seen in a long time. For example tuberculosis has returned. Many immigrants arrive without any immunizations and some refuse to be immunized out of cultural or religious reasoning. 

    An example of a scary thought is we no longer immunize for smallpox. Would this country be prepared for an outbreak of smallpox?? 

    Thankfully most schools have strict guidelines on immunizations for children. Believe it or not there are also many born Canadian families that believe it is wrong to immunize their children for reasons like home schooling. Unless your child lives in a sterile bubble they will be exposed to something sooner or later.  My advice to all, please , please immunize your children. The diseases are here and you are gambling with your children's lives if they do not get immunized!

   As far as worse case scenario of pandemics it can happen now. China is currently dealing with a new strain of Enterovirus outbreak in thousands of children with 26 deaths already. What happens if they can't control and isolate it??  How many people travel back and forth from China to other countries such as Canada?!

    The problem is we can speculate what diseases may potentially outbreak but Canada and many other countries are not fully prepared for the worse case scenario such as a pandemic.


----------



## daftandbarmy (6 May 2008)

Who should MDs let die in a pandemic? 

Lawyers. Well, personal injury lawyers anyways.

Then all those with bad piercings, followed closely by those old farts with fedoras driving in front of me at 5 mph, rude people in customer service roles, the crack head that broke into my truck and stole my DVD player (and all his crack head friends) and - of course - everyone who sports those sappy, motivational bumper stickers preaching idiotic 'isms' of one kind or another.

There, got the triage list going for you.


----------



## 1feral1 (6 May 2008)

Regardless of a pandemic situation look at New Orleans a few yrs back, when a certain storm blew in.

Imagine the carnage from coast to coast. Death would be everywhere, many of the already chronically ill would succumb to this disease anyways because of being weakened by their current ailments. I am sure the medical personnel would show compassion and empathy towards patients and their families, but the situation would be overwehlming to say the least.

Whether you are 10 and sick or 70 and sick, each of us has earned the equal right for appropiate medical treatment IMHO. To pick and choose who lives and dies would be a rough decision to make if it had to be.


----------



## ENGINEERS WIFE (6 May 2008)

daftandbarmy, could you be a little more specific? ;D


----------



## observor 69 (6 May 2008)

When asked what are some of the memorable books I have read this one always comes up:

The Great Influenza: The Epic Story of the Deadliest Plague In History (Hardcover)
by John M. Barry (Author) "ON SEPTEMBER 12, 1876, the crowd overflowing the auditorium of Baltimore's Academy of Music was in a mood of hopeful excitement, but excitement without frivolity..." 

http://www.amazon.com/Great-Influenza-Deadliest-Plague-History/dp/0670894737


----------



## Bigmac (6 May 2008)

> ON THE MONEY
> Plan for long life, without pandemic
> NANCY STANCILL
> Should doctors let people older than 85 die in a flu pandemic?
> ...



http://www.charlotte.com/business/story/611580.html

    Food for thought I guess? My grandmother just turned 90 and is as sharp and vibrant as ever. I would want the medical system to treat her the same as any other patient under normal circumstances. 

    But this thread is posing the question of a pandemic when the medical system is stretched to the limit, demand is higher than supply and decisions must be made quickly based on who has the best chance of survival. Triage would have to be done and unpopular decisions would have to be made.


----------



## Michael OLeary (6 May 2008)

Bigmac said:
			
		

> But this thread is posing the question of a pandemic when the medical system is stretched to the limit, demand is higher than supply and decisions must be made quickly based on who has the best chance of survival. Triage would have to be done and unpopular decisions would have to be made.



There are many who would say the medical system is already stretched to its limit, with staff and funding shortages already driving closure of hospitals and reductions in bed spaces.  The situations being discussed in this thread are when there is clearly not enough resources to deal with the number of sick and injured.  In that case, real decisions have to be made regarding who gets treated and who doesn't. It's not a matter of just trying to keep everyone "comfortable" until the doctor gets there, it's realizing that for some there will be no doctor, no matter how carefully the resources are managed.  No amount of rhetorical outrage over the potential for someone's grandmother to be triaged out of the equation is going to change the sheer mathematical reality of the situation.


----------



## PMedMoe (6 May 2008)

If it's a flu pandemic, you can include those who *didn't* get the flu shot!


----------



## MedTechStudent (6 May 2008)

PMedMoe said:
			
		

> If it's a flu pandemic, you can include those who *didn't* get the flu shot!



You mean that flu shot that I get every year as a formality and *still* get the flu?  

Thats not fair


----------



## Armymedic (6 May 2008)

There is two "types" of triage options in any given cas vs resources medical scenario.

1. its the massive amount of casualties overwhelms to resources avail (medical supplies, facilities)

2. The mass of casualties overwhelm the avail medical personnel. (MDs and nurses are also being killed off)

If in a pandemic, the 2nd triage option becomes an issue, no guidelines nor legal well-to-doers are going to be able to stop people from reducing their work from those who can't be saved to those they feel they can. People forget that our medical pers are people to who can and will be struck down in a viral pandemic.


BTW- My personal opinion says it is wrong to set and age...there are unhealthy people in their 20-40's. And what of those thousands of immuno-comprimised people (HIV), do we "waste" vaccines on them?


----------



## Gunner98 (6 May 2008)

Just remember the heartache and criticism that was expressed over the elderly abandoned during Hurricane Katrina in New Orleans.  Never easy to make these choices, despite their necessity.  Hospital and nursing home evacuations are challenging at the best of times.


----------



## observor 69 (6 May 2008)

St. Micheals Medical Team said:
			
		

> There is two "types" of triage options in any given case vs resources medical scenario.
> 
> 1. its the massive amount of casualties overwhelms to resources avail (medical supplies, facilities)
> 
> ...



During the SARS crisis in Toronto health care workers and their families were concerned about what might be brought home from the hospital.


----------



## Blackadder1916 (6 May 2008)

I've had a chance to briefly view the referenced article (actually 5 articles) in Chest and found that it makes good reading for anyone interested in disaster planning, whether from a health sector perspective or not.  While it makes good copy to focus on a "perception" that the authors of this report (and one of the principals is from Canada) are suggesting that no medical services be provided to individuals who fall into defined categories, closer examination of the report shows that it is not such a cut and dried recommendation.

The following are abstracts (and link to the full text) of the articles in Chest.

Summary of Suggestions From the Task Force for Mass Critical Care Summit, January 26–27, 2007*   full text


> Executive Summary
> This Supplement on the management of mass critical care for ill patients represents the consensus opinion of a multidisciplinary panel convened under the umbrella of the Critical Care Collaborative Initiative. Expert recommendations on this subject are needed. Most countries have insufficient critical care staff, medical equipment, and ICU space to provide timely, usual critical care to a surge of critically ill victims. If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health-care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing. As a result, US and Canadian authorities have called for the development of comprehensive plans for managing mass casualty events, particularly for the provision of critical care. This Supplement includes the following: (1) a review of current US and Canadian baseline critical care preparedness and response capabilities and limitations, (2) a suggested framework for critical care surge capacity, (3) suggestions for minimum resources ICUs will need for mass critical care, and (4) a suggested framework for allocation of scarce critical care resources when critical care surge capacity remains insufficient to meet need. This Supplement is intended to aid clinicians and disaster planners in providing a coordinated and uniform response to mass critical care.
> 
> Mass casualty events occur frequently worldwide.3 Fortunately, the vast majority of these do not generate overwhelming numbers of critically ill victims. Attention to mass critical care, however, has been stimulated by the severe acute respiratory syndrome epidemic of 2002–2003,45 recent natural disasters, concern for intentional catastrophes, and the looming threat of a serious influenza pandemic.  To guide preparedness for such events, the Task Force for Mass Critical Care (hereafter referred to as the Task Force) was convened. It comprised 37 experts from fields including bioethics, critical care, disaster preparedness and response, emergency medical services, emergency medicine, infectious diseases, hospital medicine, law, military medicine, nursing, pharmacy, respiratory care, and local, state, and federal government planning and response. Several members of the Critical Care Collaborative (http://www.chestnet.org/institutes/cci/ccc.php) initiated the project and assembled a steering committee for project development and administration. Members of this steering committee included representatives from the organizational members of the Critical Care Collaborative as well as several unaffiliated North American disaster experts. This steering committee then selected members of the broader Task Force on the basis of their expertise and experience.



Definitive Care for the Critically Ill During a Disaster:

Current Capabilities and Limitations       full text


> In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.


A Framework for Optimizing Critical Care Surge Capacity     full text


> Background: Plausible disasters may yield hundreds or thousands of critically ill victims. However, most countries, including those with widely available critical care services, lack sufficient specialized staff, medical equipment, and ICU space to provide timely, usual critical care for a large influx of additional patients. Shifting critical care disaster preparedness efforts to augment limited, essential critical care (emergency mass critical care [EMCC]), rather than to marginally increase unrestricted, individual-focused critical care may provide many additional people with access to life-sustaining interventions. In 2007, in response to the increasing concern over a severe influenza pandemic, the Task Force on Mass Critical Care (hereafter called the Task Force) convened to suggest the essential critical care therapeutics and interventions for EMCC.
> 
> Task Force suggestions: EMCC should include the following: (1) mechanical ventilation, (2) IV fluid resuscitation, (3) vasopressor administration, (4) medication administration for specific disease states (eg, antimicrobials and antidotes), (5) sedation and analgesia, and (6) select practices to reduce adverse consequences of critical illness and critical care delivery. Also, all hospitals with ICUs should prepare to deliver EMCC for a daily critical care census at three times their usual ICU capacity for up to 10 days.
> 
> Discussion: By using the Task Force suggestions for EMCC, communities may better prepare to deliver augmented critical care in response to disasters. In light of current mass critical care data limitations, the Task Force suggestions were developed to guide preparedness but are not intended as strict policy mandates. Additional research is required to evaluate EMCC and revise the strategy as warranted.


Medical Resources for Surge Capacity*       full text


> Background: Mass numbers of critically ill disaster victims will stress the abilities of health-care systems to maintain usual critical care services for all in need. To enhance the number of patients who can receive life-sustaining interventions, the Task Force on Mass Critical Care (hereafter termed the Task Force) has suggested a framework for providing limited, essential critical care, termed emergency mass critical care (EMCC). This article suggests medical equipment, concepts to expand treatment spaces, and staffing models for EMCC.
> 
> Methods: Consensus suggestions for EMCC were derived from published clinical practice guidelines and medical resource utilization data for the everyday critical care conditions that are anticipated to predominate during mass critical care events. When necessary, expert opinion was used.
> 
> ...


A Framework for Allocation of Scarce Resources in Mass Critical Care*       full text


> Background: Anticipated circumstances during the next severe influenza pandemic highlight the insufficiency of staff and equipment to meet the needs of all critically ill victims. It is plausible that an entire country could face simultaneous limitations, resulting in severe shortages of critical care resources to the point where patients could no longer receive all of the care that would usually be required and expected. There may even be such resource shortfalls that some patients would not be able to access even the most basic of life-sustaining interventions. Rationing of critical care in this circumstance would be difficult, yet may be unavoidable. Without planning, the provision of care would assuredly be chaotic, inequitable, and unfair. The Task Force for Mass Critical Care Working Group met in Chicago in January 2007 to proactively suggest guidance for allocating scarce critical care resources.
> 
> Task Force suggestions: In order to allocate critical care resources when systems are overwhelmed, the Task Force for Mass Critical Care Working Group suggests the following: (1) an equitable triage process utilizing the Sequential Organ Failure Assessment scoring system; (2) the concept of triage by a senior clinician(s) without direct clinical obligation, and a support system to implement and manage the triage process; (3) legal and ethical constructs underpinning the allocation of scarce resources; and (4) a mechanism for rapid revision of the triage process as further disaster experiences, research, planning, and modeling come to light.



For those who may be interested in how Canada is approaching a potential problem with pandemic influenza they can read The Canadian Pandemic Influenza Plan for the Health Sector.


----------



## Fusaki (6 May 2008)

> For those who may be interested in how Canada is approaching a potential problem with pandemic influenza they can read The Canadian Pandemic Influenza Plan for the Health Sector.



And more specifically, ANNEX D

http://www.phac-aspc.gc.ca/cpip-pclcpi/ann-d-eng.php



> Annex D
> Recommendations for the Prioritized Use of Pandemic Vaccine...
> 
> ...3. Recommended Priority Groups for Pandemic Vaccination Program Implementation
> ...



High Five for Group 2!! Yipee!!


----------



## Blackadder1916 (7 May 2008)

Wonderbread said:
			
		

> And more specifically, ANNEX D
> 
> http://www.phac-aspc.gc.ca/cpip-pclcpi/ann-d-eng.php
> 
> High Five for Group 2!! Yipee!!



You may have misconceptions about the course that an influenza pandemic may take and the availability and efficacy of a vaccine.  Influenza currently strikes the population every year.  Sometimes the vaccine developed for a particular year helped in ameliorating the effects of the disease and sometimes it made no difference because the disease was of a different influenza strain than the ones in the vaccine. Amazingly, just because the vaccine had been of a different strain did not necessarily translate into the morbidity and mortality rates being excessive that year.  

The planning for a flu pandemic is based on an expectation that a "novel" (and thus more virulent) strain of flu virus will show up eventually, because , well, it's been a while since we had one.  Such a pandemic will probably not suddenly pop up, it may be a relatively gradual process.  Your glee about vaccine for the military may be somewhat premature.  Some of the "planning assumptions" from Annex H.



> For the purposes of resource planning for pandemic influenza the following assumptions have been made.
> 
> a) It is unlikely that there will be a “Declaration of Emergency”.
> 
> ...



Planning for a vaccine is discussed more in the Preparedness section of the plan.



> 2.2.2 Planning Principles and Assumptions
> The vaccines currently available in Canada are inactivated vaccines that are manufactured in fertilized hens' eggs. This production depends on egg availability, and it is characterized by stringent time requirements for the identification of vaccine candidate strains, the preparation of seed lots, testing and licensing, and manufacturing and distribution. *Manufacturers typically require a minimum of 48 days from the availability of the seed strain to the production of the first lot of vaccine for testing*.  Delays in the production of pandemic vaccine seed strains may occur as highlighted by the difficulties encountered in trying to produce a vaccine against the H5N1 virus that was involved during the 1997 Hong Kong outbreak. Consequently, *vaccine may not be available when the first wave of the pandemic strikes Canada*.
> 
> The figure of a minimum of 48 days for availability of first lot (through to availablility of internal quality control tests) assumes delivery of seed virus on day 0 and receipt of the ncessary reagent on later than 13 days after the seed strain has been provided.
> ...


----------



## Gunner98 (7 May 2008)

There is an entire sub-culture industry and academia built on Pandemic planning.  I don't think MDs will be making the decisions on who lives/dies, it will be a bureaucratic decision process that will result in an escalating death toll, anarchy and create chaos. Just like in the movies. :'(


----------



## mariomike (27 Feb 2009)

Baden  Guy said:
			
		

> During the SARS crisis in Toronto health care workers and their families were concerned about what might be brought home from the hospital.



With the Moderators permission, I would like to add to this topic. 
During the outbreak, of Toronto EMS's 850 paramedics, over 600 were placed in a 10-day home quarantine, which meant being isolated from those persons within the home, continuously wearing an N95 respirator, and taking their temperature twice a day. SARS-like illnesses developed in 62 paramedics, and suspected or probable SARS requiring hospitalization developed in 5 others. That was a "working quarantine". ie: they had to isolate themselves in their homes after each shift. Not eat within nine metres of another human being, and use a separate bathroom.
I should like to add, after the official quarantine ended, Dr. Gerry Goldberg, the Toronto EMS staff psychologist, reported TEMS Paramedics were avoided by the public because of their contact with sick people. 
He said Paramedics experienced and continue to experience the "Tim Hortons effect." 
"They would go into a Tim Hortons and see the line parting in front of them because they were definitely being avoided by the public." 
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1060289763522_30//

AMEMSO ( Association of Municipal EMS in Ontario ) wrote that consideration will be given for Paramedics to complete the Medical Certificates of Death under the 2008 Ontario Health Plan for an Influenza Epidemic. Plans involve moving the deceased to ice rinks where bodies may have to be stacked. Mass graves may become a reality.


----------



## ModlrMike (28 Feb 2009)

daftandbarmy said:
			
		

> Who should MDs let die in a pandemic?
> 
> Lawyers. Well, personal injury lawyers anyways.
> 
> ...



You forgot the guy with 20 items standing in front of me in the 10 item express line at the grocery.


----------



## Kat Stevens (28 Feb 2009)

ModlrMike said:
			
		

> You forgot the guy with 20 items standing in front of me in the 10 item express line at the grocery.



...and all the Manchester United players, management, fans, and all the people in Singapore sweat shops producing their jerseys.


----------



## old medic (28 Feb 2009)

Read this article yesterday and found it interesting. 
In this case, faulty flu vaccine was released containing live avian flu virus. 
The few bold highlights are my own. 

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090227/Bird_Flu_090227/20090227?hub=Health

Baxter admits flu product contained live bird flu virus
Fri. Feb. 27 2009
The Canadian Press

TORONTO -- The company that released contaminated flu virus material from a plant in Austria confirmed Friday that the experimental product contained live H5N1 avian flu viruses.

And an official of the World Health Organization's European operation said the body is closely monitoring the investigation into the events that took place at Baxter International's research facility in Orth-Donau, Austria.

"At this juncture we are confident in saying that public health and occupational risk is minimal at present," medical officer Roberta Andraghetti said from Copenhagen, Denmark.

"But what remains unanswered are the circumstances surrounding the incident in the Baxter facility in Orth-Donau."
*
The contaminated product, a mix of H3N2 seasonal flu viruses and unlabelled H5N1 viruses*, was supplied to an Austrian research company. The Austrian firm, Avir Green Hills Biotechnology, then sent portions of it to sub-contractors in the Czech Republic, Slovenia and Germany.

The contamination incident, which is being investigated by the four European countries, came to light when the subcontractor in the Czech Republic *inoculated ferrets with the product and they died. *Ferrets shouldn't die from exposure to human H3N2 flu viruses.

Public health authorities concerned about what has been described as a "serious error" on Baxter's part have assumed the death of the ferrets meant the H5N1 virus in the product was live. But the company, Baxter International Inc., has been parsimonious about the amount of information it has released about the event.

On Friday, the company's director of global bioscience communications confirmed what scientists have suspected.

"It was live," Christopher Bona said in an email.

The contaminated product, which Baxter calls "experimental virus material," was made at the Orth-Donau research facility. Baxter makes its flu vaccine -- including a human H5N1 vaccine for which a licence is expected shortly -- at a facility in the Czech Republic.

People familiar with biosecurity rules are dismayed by evidence that human H3N2 and avian H5N1 viruses somehow co-mingled in the Orth-Donau facility. That is a dangerous practice that should not be allowed to happen, a number of experts insisted.

Accidental release of a mixture of live H5N1 and H3N2 viruses could have resulted in dire consequences.

While H5N1 doesn't easily infect people, H3N2 viruses do. If someone exposed to a mixture of the two had been simultaneously infected with both strains, he or she could have served as an incubator for a hybrid virus able to transmit easily to and among people.

That mixing process, called reassortment, is one of two ways pandemic viruses are created.

There is no suggestion that happened because of this accident, however.

"We have no evidence of any reassortment, that any reassortment may have occurred," said Andraghetti.

"And we have no evidence of any increased transmissibility of the viruses that were involved in the experiment with the ferrets in the Czech Republic."

Baxter hasn't shed much light -- at least not publicly -- on how the accident happened. Earlier this week Bona called the mistake the result of a combination of "just the process itself, (and) technical and human error in this procedure."

He said he couldn't reveal more information because it would give away proprietary information about Baxter's production process.

Andraghetti said Friday the four investigating governments are co-operating closely with the WHO and the European Centre for Disease Control in Stockholm, Sweden.

"We are in very close contact with Austrian authorities to understand what the circumstances of the incident in their laboratory were," she said.

"And the reason for us wishing to know what has happened is to prevent similar events in the future and to share lessons that can be learned from this event with others to prevent similar events. ... This is very important."


----------



## mariomike (2 Mar 2009)

A friend of mine was quarantined at Etobicoke General Hospital during the Toronto Lassa Fever scare in 1976. He was working the night shift on our isolation ambulance at the time and had this to say:
"By the eighth morning, our arms were getting sore from the daily blood tests. It was at this point that the hospital officials made a diagnosis that I may have also contracted LASSA FEVER.  
I was immediately masked, the clinic was cleared, two fully isolated nurses then escourted me from the basement clinic to the 9th floor isolation area.  
As I was being escorted through the halls, the few people remaining in the hospital were warned to stand clear, because a "Lassa Fever" patient was coming through. I now know what a condemned prisoner feels when going to the gallows. I was escourted to a room adjacent to the infected patient I had brought in three weeks earlier.  In the background, I could hear her respirator working as I was given strict orders that I was not permitted to leave the room under any circumstances. 
What started out as a routine call had now turned out to be my death sentence. 
Later that morning, the specialists deemed me not to be infected and permitted me to leave. I think I was out of there before they finished their sentence."
Sorry if this doesn't answer the big subject question.


----------

