 Before you got into medicine, how many of you had actually witnessed a dead body? A couple of you. How many of you had seen a death? Less hands. Well, maybe just about as many hands. But by far the majority of you had not. Let's talk a little bit about this. First, I'd like to ask you what you liked about what the doctor did. What did you like first? And then let's talk about what you would have done differently. How many are assisted by unpaid volunteer support from the community? Just give me a number. Shout it out. Ninety percent. Ten percent? Forty-five? Ninety. Eighty? Ninety? Less than two. My question to you is, first of all, has anyone around the table actually been there, done that, or been in a similar situation? How many people have been? So, good many people. Some questions for the people who have had this experience or many of these experiences. Your reactions to this? Did this sound like, feel like something that actually might have happened, could happen to you? Who wants to respond? And other things that the doctor did well? Yeah. She utilized moments of silence very well. Can you tell me more about that? Ah, good. Want to say more about what distress you think he was feeling? I think it cuts off the discussion. Because to ourselves more, if you would, about this cold business, abandonment is the big thing we want to avoid communicating, whether it's in body language, in verbal language, or in action. So, can you give me a little bit more about your response on this, Marianne? Anyone comment on how the partner was feeling? He's angry. Angry? Yes, that's right. Frustrated? Frustrated. He may actually be making the whole situation a little worse. Down at the end? He allowed her to continue with her hope. Okay. So, the issue of hope is here, it's palpable, and you felt like he allowed her hope for what sounds like full recovery to continue. Yeah. Okay? All right, over here, and then over here. And I'm just curious, how many people thought that here it would have been effective to do that that you would, if you were in a similar situation, have tried to at least hold a hand while you were telling people this? Okay, maybe about half, but not all. Interesting. The case we'll be looking at today, the video is a 34-year-old man who you've met previously. He has HIV disease, and he is visiting for a routine exam after pneumonia. And his partner is expressing concerns about recent changes in his behavior. So, we'll go to the video. We'll touch on the issue of prognostic uncertainty, and again, this is by definition a chaotic environment and multiple care providers, and that influences the whole milieu. So, with that as a setting, what I'd like to do is let's go to the trigger tape and then let's have some discussion after that. Today, we're going to be talking about medical futility, and we'd like to start out with a trigger tape, a tape to be able to discuss some of the issues. This is a case-based methodology. So, what we're going to do is we're going to have, look at the objectives, we're going to then look at the trigger tape as our first vignette, and then we'll go to the vignettes and the binders and indulge in a conversation around how we make decisions around a number of key symptoms. Let me pause there for a moment and invite your responses to the scenario you saw on the trigger tape. How did the doctor do? Was the patient with someone you recognize? Have you had conversations like that yourselves routinely with patients? Whatever came to your mind? Please, Barbara. What I'd like to do is, based on the case that you saw, is talk through some of these issues. I'm not going to use the slides at the moment. I'd like to start off by talking about neurological dysfunction. Was she fair? Was she honest? Did she do a good job? Any thoughts? Was she right? Did she mislead? Yes. I could say the message or the straight talk at the same time that he was trying to be supportive. Okay, other reactions. Larry. Yes. Sleeping how she was sleeping and she was getting enough sleep or was her dyspnea preventing her from sleeping? Sure. The whole issue of is this a symptom that's waking up her night because it may give you a lead to different causation? Sure. Other issues here that we feel we need more information? Yes. Well, maybe not more information, but she did voice some emotional distress about the problem with dyspnea. Sure. So her emotional distress. What did the doctor do well? The setting was, the choice of setting was good. It was private. Okay, so the setting was private. Okay, other things that the doctor did well. That's a lovely image, building blocks. I think that's important, that it's not all just laid out in one fell swoop. These are building blocks that happen over time. So as with any of the symptoms in the background, this is happening to a person who's dying and they need continuing support and reassurance and help as this goes through. So yes, very good points. And so I think for her that was essential. I think that's an excellent point. You guys have done a marvelous job in making my job easier and a lot of what I'm going to sort of say is a summary based on the great things that she did and the great advice about what you all would have done differently.