Value-based healthcare.

An elderly man with advanced esophageal cancer arrives in the operating room: his feeding tube has migrated out of his jejunum, spilling debris and bacteria into a previously sterile abdominal cavity. The OR clock fluoresces “2 AM.” With the patient’s immune system ringing alarm bells, his body has mobilized for biological warfare. His pulse races ... breathing hurries ... temperature climbs. A hint to the severity of his illness, his blood pressure sags, necessitating a vasopressive infusion. While I compress the patient’s cricoid cartilage against his alimentary canal, the senior anesthesiology resident injects conventional weight-based, rapid-sequenceinduction doses of an opioid, a hypnotic, and a muscle relaxant. Seconds later, the booming waves of his arterial line tracing flatten out to tiny ripples. A surgeon palpating the patient’s foot calls out, “He has no pulse.” Meanwhile, the laryngoscopist—a new trainee in our department—announces that she cannot visualize the patient’s larynx.