Following Independence Day 2021, COVID infectivity rates surge again, once again increasing the demand for ECMO machines and staffing resources. With optimism on the decline, Carlos continues to demonstrate his desire to live – exhibiting the fight and determination that the Kennestone ICU team has come to know so well. Nonetheless, his condition has deteriorated, and the team recognizes the need to consult the Ethics service. Difficult conversations are made even more challenging in light of the strong emotional attachments between Carlos and his caregivers.