Thank you, Dr Dao, for this beautiful and personal essay. You faced an issue we will all face with parents and siblings, or in my age group, our partners and our selves. I am glad you had the courage to do the right thing and I am pleased that fortune was on your side with all the right tools at your hospital. I worry often about my patients in rural areas and sometimes see that not enough resources are available to them. I have seen bad outcomes. I am not sure of how will provide adequate rheumatology service to such communities let alone service in so many specialty areas. I am glad to you did not just accept Jack's thoughts about DNR (wise as he is) but formed your own ideas.