Alfonso took care of a patient in ICU for 2 consecutive days, a 91-year-old female who had emergent abdominal surgery and was in severe septic shock and metabolic acidosis after surgery, requiring mechanical ventilation and vasopressors. The family was having a difficult time processing the situation since the patient was very independent for a 91-year-old; she even just vacationed in Europe. Also, an important detail is that a majority of this patient's family was in the medical field (multiple physicians, a med student, a nutritionist, and a lab) so they were well-informed and had high standards of care that they expected.

Despite all of their knowledge and experience, the family was still having a difficult time coping with the situation and making decisions. The patient continued to get worse, and eventually, the family made the decision to transition to palliative care. The patient passed very quickly. The patient's daughter wrote a note and sent it to the unit expressing how thankful their family was to Alfonso and his great care during those two days. Her letter read:

"Alfonso- I cannot thank you enough for your wonderful, compassionate nursing expertise. You were always willing to listen and answer so many questions without being bothered, and just took the time to care. We all appreciated and are so grateful that we had you for our mom's care. As you know, it is a gut-wrenching time for all family members to lose a loved one. You helped us all get through the most difficult time. We will never forget you."