I had the distinct pleasure working with Josh during a terminal extubation of a patient I had been seeing as an outpatient. This patient was only in the ICU for a few days, as her terminal condition was rapidly progressing. I was able to witness Josh speaking both kindly and honestly with the patient and family. The patient did not have a POA, despite several attempts during the weeks prior by palliative care. Josh was able to describe what he was seeing now and what would likely happen next, based on symptoms presenting. He allowed the patient full autonomy right up to her last hours. During her final hours, Josh continued to provide excellent bedside care as well as excellent collaboration and medical foresight with the hospitalist and the palliative NP. Josh took direction well and had additional medication orders requested in anticipation of ineffective doses. The patient passed away peacefully with family at bedside. Josh remained present to provide medications as needed but also allowed family their privacy. Post-death, Josh offered appropriate grief and bereavement support, as well as time with the patient. It was beautiful to witness medical/nursing greatness by Josh!