Slim just left town: decisionmaking on an intensive care unit

The title of this paper comes from an incident that occurred while I was participating in morning rounds on the pediatric and surgical intensive care unit of a large, midwest tertiary care center. The patient under discussion was an eight-week-old girl who had been born without kidneys, and who had been cared for on the unit for seven weeks. In the previous week, the baby's condition had gone steadily downhill, as she experienced on medical catastrophe after another. One of the nurses asked the staff doctor who was leading rounds that morning, "What are the baby's chances?" The physician replied, "Her chances are slim." To which one of the young residents immediately answered, "Slim just left town."