For our first grand rounds of the academic year, Dr. Paulsen challenged us with her Admit/Discharge/Transfer lecture which made us ponder the disposition of several difficult cases. This was followed by a case-based and interactive discussion on how to break bad news to patients in the ED by Dr. McDonough. Last but not certainly not least, our Department Chair Dr. Pancioli took us through the past, present, and future of EM, it’s triumphs, and potential threats to the way we practice.