AB is a seventy-four-year-old man with longstanding chronic kidney disease related to diabetes. Six months ago, his kidney disease progressed, and he began hemodialysis three times weekly. Since then, he has been hospitalized five times for various problems including cardiac arrhythmias, low blood pressure, fluid overload, and pneumonia.One week ago, AB developed acute back pain; narcotics offered little relief. He was brought to the emergency room by his only son, FB, who is his primary caregiver. A scan revealed a bacterial abscess near his spine. In spite of appropriate antibiotics over three days, AB's mental state declined. He became disoriented and difficult to arouse.
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