Feeling for a pulse that obviously wasn’t there, it began to sink in that Miguel had finally died. We had spent weeks buying time, trying to allow his organs to recover from the trauma of colliding with a tree at 70 mph. First, he was treated with blood transfusions, vasopressors, mechanical ventilation and antibiotics. Next, we tried veno-venous extracorporeal life support for his severe ARDS and continuous renal replacement therapy for his acute kidney injury. But these injuries unmasked underlying liver dysfunction, which was its own denouement. So, we pivoted. This was like asking an entire orchestra to stand up, turn their chairs, and face due west. We focused on his comfort and allowed him to die. As Miguel’s death was announced, his brother cracked a joke. Giggles gave way to hearty laughter as his family gathered around his...

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