The decisions that doctors make are formed in part through ways in which medical care is organized. Given that structure of a situation affects people's actions in context of medical care, it is a matter of moral concern in any attempt to create cultures of safety in a medical environment, Physicians bring their unique strengths and weaknesses to their work, but they exercise them within structures that shape decisions they make. An illness and death in a pediatric intensive care unit illustrates how such structures can affect medical care and why organization of care is therefore a matter of moral concern. As a sociologist with training in qualitative research methods, I have studied aspects of contemporary health care by observing encounters between mentally ill homeless persons and outreach workers; physical settings of emergency shelters, soup kitchens, and streets; professional disciplines involved in community psychiatry; and mental health institutions that constitute environment of those encounters. (1) I have also learned about health care relationships and context of those relationships, which I will call the structure of situation, from personal experience with my son, Jesse, who died in 1995 from complications of a liver transplant. The latter experience, coupled with my background in social science research and theory, has given me some insight into high-intensity medical care and ethical concerns related to organization of that care. The approach I will take here--combining a highly personal story with analysis of it--is somewhat unconventional and deserves some explanation. I had already written a memoir about my son, followed by a series of articles that directly addressed themes implicit in book, before writing this article. (2) In those other texts, I avoided wearing my social science hat, putting it on at odd moments as happened naturally and unobtrusively. One series of events during my son's 1995 hospitalization, however, seemed to call for a more focused analysis. I acknowledge that engaging in such an analysis represents, in part, another way for me to try to make meaning out of my son's death, not in sense of rendering his death acceptable or as serving a greater good, but in sense of finding that, irrevocable having happened, meaning, for myself or others or both, might still be gleaned from it. In this case, I hope that events of one evening on a pediatric intensive care unit in mid-1990s may yield some lessons regarding organization of critical-care practice today. Jesse Jesse Harlan-Rowe was born in 1975. As an infant he had hydrocephalus, his ventricles, spaces in brain that produce cerebrospinal fluid to cushion brain from otherwise jarring blows of walking, sitting, and standing, did not drain their excess fluid into his blood, and became engorged. The standard intervention for hydrocephalus: is placement of a shunt through skull at back of head into one of ventricles. A plastic tube connected to shunt under skin is then threaded down to abdominal cavity, where it drains off excess cerebrospinal fluid. Without such intervention or in absence of spontaneous remission, head becomes enlarged, as brain is squeezed and choked. The child may die at an early age. Jesse had three operations for hydrocephalus in first year and a half of his life and was in remission for rest of it. He had no other serious physical problems until 1991, when he was diagnosed with ulcerative colitis, an intestinal disease characterized by ulcerations of colon, rectal bleeding and cramping, and diarrhea. In 1992, he was diagnosed with a mild case of sclerosing cholangitis, a scarring and narrowing of bile ducts going into liver. A year later, he had an operation to correct his ulcerative colitis. At that time he was diagnosed with early stage cirrhosis of liver. …