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ARTICLE |

Three Worlds

Carl M. Kjellstrand, MD
JAMA. 1984;251(24):3242. doi:10.1001/jama.1984.03340480028021.
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ABSTRACT

Her husband left her with us. He refused to dialyze her at home; lately she saw things that weren't there, was up all night, and slept at odd hours. They quarreled, and he wanted her treatment discontinued.

The first time we met, her eyes never rested. Sharp, like the rest of her face, they darted around. Now and then they fixed on empty places of the wall. She would suddenly smile and cackle, or shrink in fear.

"What are those men doing over in the corner ogling me? Why do they bring in people to my room to frighten me? Where did all those animals come from?"

Her body had shriveled with age, and four years of home dialysis had not changed this. The yellow-gray skin hung in loose, thick folds like that of some old people who have been much outdoors. Her belly was large and protruding. She was

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