Physician Riddhi Shah’s chapter is a clinical reflection of a case involving an elderly man with COVID-19 in the early months of 2020. She describes a situation of using ECMO (also known as heart lung bypass), as a last resort in a patient who deteriorated dramatically due to COVID-19. Despite the lack of evidence-based medicine in the case, she and the healthcare team worked collaboratively—and outside the box—to provide the best care for their patient. The case was memorable because it revealed the importance of collaborative teamwork and advocating for one’s patient when the best care was not available at one’s institution. It forced her to rely on and trust her training, although ultimately, in the case of COVID-19, dealing with an unknown pathogen was a skill not necessarily taught in medical school.