It's not unusual to be dispatched to one problem and discover something completely different when you arrive. Patients and family members will tell dispatch what they feel is the problem, and dispatch, without the benefit of being on scene, can only pass along the complaint as it was given to them. Upon arrival back at base, the attending paramedic in this case was asking himself questions like, "What if I had done this differently?" and "Did I miss something?" At the conclusion of every patient interaction, there is an opportunity for EMS to review its actions and [table: see text] change its approach to similar cases in the future. The benefit of public-safety agencies providing service in nonemergent situations is the opportunity to "practice" for true crisis incidents. This case, however, did not present many opportunities to improve care or change the outcome. The paramedic's assessment identified the need for the patient to be transported immediately. Immediate packaging of the patient, intubation and pacing were performed on scene--you known this crew was moving. The ED physician concurred that this was a "load and go" situation. The crew is to be commended for taking charge of a critical situation and performing in an expeditious manner. Oxygen, pacing, i.v. and meds were all given in a timely fashion. Unfortunately, this patient's cancer had progressed to a critical point, and the patient was not going to survive even with optimal care. This EMS crew unfortunately walked into an end-of-life event. Despite their best efforts (a total on-scene time of seven minutes and a five-minute transport) and performing every function flawlessly, this patient still died. This patient was given excellent medical service, but perhaps more important, at his critical moment, was in the presence of people who cared. One of the first things we learn in EMS is that people die. Sometimes our job is simply to provide comfort, relieve suffering and communicate with the survivors. Since all humans must die, it is just as important for us to service their needs at that moment in time. From there, we move on to the next call.