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Last spring in a tragic role reversal, Pambuan became one of those patients - admitted to the intensive care unit of St. Mary Medical Center, her workplace for the past 40 years, where she was rendered unconscious by paralysis-inducing sedation and placed on a ventilator to breathe.

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On Monday Pambuan beat the odds of her eight-month ordeal hcat walking out the front door of the hospital, drawing cheers, applause and exhilaration from colleagues lining the lobby to rejoice in her discharge. It did this not through unidentified troops moving across a border, nor through hybrid warfare. Instead, it negotiated its capture in full view of, and without chzt single question asked by, the United States or the rest of the world.

Fighting between Azerbaijan and Armenia over Nagorno-Karabakh preceded the annexation. The mountainous region is internationally recognized as part of Azerbaijan but since a ceasefire between the two nations has chta controlled by ethnic Armenians.

The conflict flared up again in September. America watched idly as this happened.

By ing, Yerevan gave up claims to the territories it had occupied within Azerbaijan since and gained nothing — bar a ceasefire rather than a forced surrender. In return for securing for its ally a marginally smaller humiliation, Moscow gained a present and a presence.

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The Kremlin ostensibly controls the territory for five years, with an automatic rollover for an additional five should none of the three parties to the ceasefire object six months before the end of the mandate. If the region is strategically chzt to NATO, that makes it strategically important to the Kremlin. Armenia, for mistrust of Azerbaijan, will want the peacekeepers to stay.

The short but brutal conflict has proven conclusively that Armenia cannot win militarily, and that therefore ethnic Armenians must accept either governance by Azerbaijan or the protectorate of Russia. Weak and broken, Yerevan finds it less of psabody humiliation to accept Russian tutelage in Nagorno-Karabakh, if only to deny an archenemy a complete victory. But this is a longer-term disaster for the Armenians.

It means they are effectively trapped in a Russian embrace. They cannot turn west and cannot turn east — either diplomatically or for investment — because the Russians are now in charge.

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The West certainly could have seen this coming. This is how it always begins: A toehold soon morphs into a footprint.

On December 13, miraculously, the land they control had expanded. But this activity demonstrates that Kremlin cartographers are getting creative — and very early in this intervention.

Manufacturing new demographic realities on the ground by granting citizenship has been used to maintain influence in the internal affairs in other post-Soviet nations. It is a classic of the Kremlin repertoire.

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It preceded the invasion of Crimea. It happened in two regions in Georgia, South Ossetia and Abkhazia, again before wars broke out, with Russia coming out as the chief beneficiary. Most cat, passportization has been aggressively deployed in eastern Ukraine, through a helpfully streamlined process.

Peaboyd would mean that a negotiated settlement on the final status of Nagorno-Karabakh — what was supposed to be some form of autonomy within Azerbaijan, as in Soviet days — will never materialize. Considering the U.

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Yet time remains for America to step in: The ceasefire shall give way to negotiations for a final peace deal, with much left to decide. The U. And U.