Through out the day, I couldn’t help but keep thinking about the importance of communication between the healthcare team and the patients that they serve. If there is no transparency, patients and their loved ones (even those well-versed with the medical system) feel like they are left in the dark — during the most stressful time of their lives, they have the added burden of trying to figure out what it is their doctors, nurses, and auxiliary team are actually doing. Lewis Blackman’s story is powerful in that it illustrates the importance of honesty. Watching the video left me with so many ‘if; statements. If the resident or intern working with the nurses had taken pause to discuss Lewis’s worsening condition, could this all have been avoided? What if the doctors and nurses had been more upfront about their lack of understanding of Lewis’s situation? What if Helen had been able to directly contact the attending, would he/she have listened to her pleas and ordered tests to reveal the ulcer? What if there had been a system implemented in the EMR to alert attendings when vital signs were out of whack? As an engineer by training, I believe we should create a framework so that even when humans make mistakes, the system in which we operate is able to provide a safety net to catch that one mistake that could mean life or death