On a Friday afternoon last summer, a patient, “Barb,” texted me: “Call me. I can’t breathe.” As a heart failure nurse serving rural patients, getting messages like Barb’s launches my adrenaline. I called her immediately.

A month earlier, I’d trained Barb to send daily vital signs via my clinic’s digital portal—blood pressure, weight, heart rate, and oxygen saturation.

Barb was suffering from a congestive heart failure exacerbation: her lungs were filling with fluid. If we didn’t remove it, she’d need to be hospitalized or worse.

Once I was sure she wasn’t in emergency distress, I called the clinic’s cardiologist for instructions. Then I phoned Barb’s pharmacy and ordered a new diuretic to add to her regimen—a water pill so powerful in its fluid off-loading effect that I’ve nicknamed it the Bellagio. Within two hours, Barb had taken the pill and begun to urinate out the fluid flooding her lungs. By the next morning, she was breathing comfortably.

Without access to a telehealth program, Barb would probably have gone to the emergency room, then to the intensive care unit for expensive intravenous medications. 

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