As many of you have written, our critical thinking ‘hats’ are always on to try and anticipate potential outcomes. An example of this is my practice relates to ensure that there are PRN meds available for my patients that are high risk for catastrophic events. A patient was recently admitted with end stage renal and liver disease. Due to the nature of the tumor burden and disease itself, she was high risk for terminal delirium and a bleed. She already had a history of melena stools and hemoptysis. Looking at her med list one Friday afternoon, I proactively spoke with her MRP to ensure we had an algorithm in place to plan for any catastrophic events or acute changes in behaviour. When changes happen as we know, it’s never Mon to Friday. This plan was communicated with family and oncoming staff as well so that we all were able to consistently provide care according to the plan and goals of care. Unfortunately this patient did start to bleed out slowly over 2 days and family needed a lot of emotional support. On a positive note, we had all the necessary medications on board so that she remained peaceful and comfortable.