Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.