We talk a lot in critical care medicine about liberating patients from ventilators. Vents are getting a lot of deserved attention for saving lives in the COVID-19 era. But the machine has downsides that get worse the longer the patient needs it. Because we’re obsessed with taking great care of our patients, we in ICU medicine obsess about ventilator liberation. There are thousands of publications on the topic. Vent weaning protocols ...

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I had a great case the other night. Around midnight on a Friday, the hospitalist physician called me to evaluate an incarcerated femoral hernia. I thought this elderly and medically ill patient would likely die no matter what I did. I spent a grim half-hour at bedside explaining the dilemma to the patient and her family. She needed surgery, but surgery would probably kill her. The patient chose surgery. And she ...

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