Early in my career, I stood in our PICU manager's office, apologizing for something I' d done earlier that day. It wasn't only me who had participated, but, as the attending of record "in charge" of the PICU team, I felt like the transgression was mine to own. Frankly, as a lifetime rule-follower, I was still shocked by what I had done. Our team had taken an intubated patient and their family outside, across a street where I had to block traffic, for family photos prior to what would likely be a terminal extubation.Earlier in the day, I' d had no plans of an excursion like the one we took or a concept that it was possible. I' d led family-centered rounds at my patient's room, talked to the family and consultants about our plan for extubation later that day, and validated the family's hope that my patient would survive to discharge so they could spend time at home with extended family. Then, I' d set about seeing my other patients and writing my notes in order to allow me to return later for the extubation.Unbeknownst to me, our experienced bedside nurse had been talking to my patient's family about their hopes and plans, uncovering more of their story than physicians like me are able to during the brief moments we flit in and out of our patient's rooms. In the late morning, she approached me with her idea: take my patient and their family outside for pictures because they had never been able to take them before. Before truly understanding what was required, I happily replied yes, if we had the necessary team members. She told me that our respiratory therapist, nurse tech, and resident physician had already agreed, so we planned a time that worked for all of us. I arrived at the room just prior to our scheduled departure, asking where on the hospital patio we' d be going to take the photos. The reply I received from the patient's nurse was unexpected."We are going to the park across the street. It's more private, " she said. I hesitated and considered canceling, knowing the risks and potential policy violations involved in transporting an intubated patient "across a street. " However, the excitement radiating from my patient's parents and the team was palpable. So, I proceeded, the risk-related hesitancy lingering within me.Prior to leaving, we discussed one point that had been overlooked prior to the trip: what if my patient extubates during the transport? Their code status was do not resuscitate, which had been discussed in prior conversations. However, this seemed different. If my patient extubated while traveling, I would feel a heavy sense of responsibility if they died. I didn't know if I could live with it."We don't want the breathing tube back in, " the parents replied matter-of-factly, seeming more at ease with their decision than I was.I again considered deferring, but upon again observing the family's joy at the prospect of a photo session, I decided to keep my concerns to myself. Everyone else likely knew the risks, but they were more focused on the reward. We packed
