"Do Everything" versus realistic surgical interventions: navigating the road to shared decision-making in trauma surgery.

"DO EVERYTHING!!" How many times have you heard that phrase from a distressed family member? We routinely receive this desperate plea, and our knee-jerk reaction is to press on, push harder, be more aggressive. We, as acute care surgeons, have spent our lives learning a craft geared towards "doing everything" to heal patients so this response comes naturally. However, how do we respond to "do everything" when the probability of a meaningful recovery is extremely low or non-existent? These situations create moral tension for surgeons who must reconcile the desire to preserve life with the obligation to avoid harm, respect patient values, and provide care that is medically appropriate. We will explore three components of this challenging topic: (1) the utility and limitations of risk calculators and prognostic tools in trauma, (2) the best case/worst case model as a structured communication strategy and (3) approaches to counseling families when expectations for recovery are not realistic. Together, these elements provide a framework for decision-making that is compassionate, ethically grounded, and anchored in clinical reality.