Harriet was awake and able to understand what was occurring to her when the cardiac surgeon at her local hospital explained that her chances of surviving a second operation on the valve while she had endocarditis were slim. He stated that the infection was not responding to antibiotics, so surgery was necessary, but was also risky and could not be performed locally. He informed her that she had two choices: recognize that she was not likely to recover and forego surgery, or transfer to a teching hospital and see if they were willing to operate. Harriet chose to transfer and have surgery.hemodialysis, and to have cardiopulmonary resuscitation, should they be necessary. In addition, she gave her brother power to make healthcare decisions for her should she become incapacitated.