Initially the surgery went well; Harriet was extubated 5 days after surgery and transferred to a stepdown unit. Then, Harriet developed renal failure and was started on hemodialysis with her consent. When it became apparent that Harriet was not going to tolerate extubation, she was asked if she wanted a tracheostomy, to which she immediately responded, “Yes.” Harriet’s brother and some of her friends asked the nurses, “Why are you still doing all this ? She’s been through it once already, isn’t that enough?”