My dear friend, Andrea Coffaro, has been a cardiac nurse for 15 years. We have seen patients who were resuscitated, whether or not we thought it was ethically correct. We have seen families get hope when there was clearly none. Andrea has found the resuscitation of terminal or very frail and old people very hard. If patients haven't made a plan about what they want, they will be resuscitated; including this 54-year-old man diagnosed with esophageal cancer, who was clearly suffering. He had been a patient on our floor for a number of days. When Andrea walked into his room that Saturday morning, she felt, she just knew, that something wasn't right. This sense is part of that ever-important skill-set of critical thinking, but it's also a separate entity altogether. It's one of those skills that seasoned nurses just "have". I'm not sure if it's something we witness, repeat, learn, see, or simply acquire through experience. Maybe it's just that tried and true "learn as you go" skill? Honestly, I really don't know how it's acquired. I just know it exists. I have seen and experienced it myself on a number of occasions. Andrea knew that something was off and knew in her heart that she had to have a conversation with the doctor, which happened very early in the day. The doctor told the patient that his electrolytes were all out of range and it could put him at increased risk for a cardiac arrest. He asked the patient if he would want to be resuscitated and without hesitation, he said "NO"! And then the doctor walked out and Andrea was left there with the patient. There was so much information that had to be explained, and she used her words very carefully and with so much compassion. The patient asked her to call his wife and she did. She wanted both the patient and wife to understand what was happening. When his wife came in, Andrea took their special needs daughter out of the room and walked her around the unit and just talked with her, making her feel safe. This gave the patient and his wife some time alone, which Andrea knew they both needed. The afternoon progressed quickly and Andrea saw that the patient was deteriorating and fought for him to receive comfort care. He was in so much pain and his breathing was labored. He began receiving IV pain medication and he passed away later that night. This day was exhausting in every way, spiritually, psychologically and emotionally, but my friend rose to the occasion and put this patient and his family first. He was able to die peacefully and with dignity. She made a difference and everyone who was at work that day felt it.