As a new ICU nurse, I sometimes feel overwhelmed by how fast everything happens. I see patients-or, more often, family members-having to make complex ethical choices with little time to spare. Last week, for example, a patient's adult children learned that standard antibiotics weren't controlling their father's virulent infection. The physician asked if they wanted to try a new and very expensive drug that wasn't covered by insurance. They hadto decide right away because the drug needed to be ordered and rushed to the hospital by helicopter. Of course they said yes. But later I overheard the patient's daughter and her husband discussing whether they'd still be able to afford to send their son to college.

How can we handle these situations better without adding to patients' and family members' stress?-E.B., ILL.

It's true that many patients and families are simply unprepared for the grave issues facing them in critical care settings. You can help by finding appropriate resource people who will be available as needed. Your best bets are chaplains, social workers and, if your hospital has a working ethics committee, members of that group. Look for individuals with exceptional people skills.

How can you get these resource people on board to help you handle complex situations? Cultivate them. For example, ask them to describe what they can contribute, how they'd like to be involved, how and when to call them, and what hours they're available. Try to build up a network that will give you 24/7 coverage for unexpected dilemmas.

Some hospitals have written policies with step-by-step guidelines to manage ethical dilemmas. These are good, but I've found that knowing the right people is even more effective than knowing the right policies.