As the on-call pulmonary critical care fellow, I listened to a family member plead with me to "do right by Mama." The emergency department team consulted me for possible intensive care unit (ICU) admission on a frail octogenarian with metastatic lung cancer and pneumonia. The treatment algorithm for impending respiratory failure suggested imminent intubation; however, the most valuable lesson pulmonary critical care fellows learn when rescuing patients with respiratory distress is deciding when not to intubate.

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