Had to make a tough decision on a 88 year old cancer patient deemed to be DNR due to intra-abdominal cancer with liver mets but neurologically intact who presented with hypoxia and respiratory distress in the setting of no previous lung disease, lung cancer or COPD. He was a good 88 with functionality of a 65 year old who still road a bike daily for his groceries. He had signed a DNR because he was told he had incurable colon cancer. When he presented to us, there was an empyema with surrounding pleural effusion. It was pneumonia season and he had been visiting a nursing home where a few friends were residents. He had respiratory fatigue and if we were going to decompress this empyema and infected pleural effusion which had nothing to do with his malignancy we were going to have to intubate him and put in a chest tube. Would you cancel the DNR? The patient was not understanding all this due to his condition, PCO2 of 100, temp of 39.5 with tachypnea and altered level of cognition (related to infection). I was convinced that this man’s respiratory illness was curable and nothing to do with the malignancy from which he was slowly dying. What would you do?