What starts as back pain on the Big Island quickly spirals into a high-stakes battle with sepsis, acute respiratory failure, atrial fibrillation, and a massive loculated pleural effusion. In this episode, we take you inside the twists and turns of a case where early decisions, critical thinking, and teamwork made all the difference. From thoracentesis to the call for surgical decortication, we’ll break down how pathophysiology, rapid intervention, and nursing vigilance intersected to shape the outcome. This is real-world clinical adventure at its most intense — let’s dive in!