Brian cared for a patient who presented to the ED with back pain typical for a patient experiencing discomfort with a kidney stone. When CT scans resulted, the patient was discovered to have a ruptured renal artery. Brian immediately anticipated the patient needing surgical intervention and prepared the patient for the rapid consult by a surgeon followed by transfer to the operating room. The patient himself chose not to make any decisions regarding further treatment until his family arrived and they could all be present to talk with the surgeon. After about an hour of family discussion and consideration, the patient chose not to have the ruptured artery repaired, and instead chose palliative care. Brian was surprised at the decision made by the patient, but supported the patient's choice by constantly being at the bedside offering comfort measures to the patient and his family until a room was available for admission.

The patient asked Brian "how many hours do I have left" and stated it was very emotionally difficult for him to see the patient suffer. The patient was very stoic during transport trying to remain brave. The patient shook Brian's hand at the time of care handoff to the inpatient unit. Brian said that he parted with the patient by telling him what a pleasure and honor it was having met him. He said this case was especially difficult for him having formed an emotional connection to a man he considered to be such a neat person. He was sad to have to hand over care to the inpatient unit and would have preferred to remain his primary caregiver.

When Brian checked in on the unit the following day he sadly discovered that the patient had passed away.