The Relational Medicine project is growing. In 2014 we published our practice framework “Relational Medicine — Personalizing Modern Healthcare: The Practice of High-Tech Medicine As A Relational Act”. Building on this foundation, we now present a cutting-edge and fully developed single case recording analysis of consecutive encounter interactions in a dramatically accelerating life-and-death decision-making situation in the high-tech medical practice of Advanced Heart Failure during which practitioners, patient, and family face multiple uncertainties as the decision-making process unfolds and the patient’s condition deteriorates. We show how a multi-professional team including a cardiologist, cardiac surgeon, critical care unit nurse and fellows discuss life-prolonging options with their patient and family. We make visible the essential roles of each multi-disciplinary team member in helping frame for the patient and family what is going on and the changing options while attending to the patient’s PERSON-soul-mind-body-HOOD. In bringing different data, perspectives, and facets of understanding to bear, this book offers a novel approach to studying high-tech medical care grounded in Federica Raia’s Relational Ontology framework of understanding everyday practice. Using a micro-ethnographic data analysis and a participatory research strategy, we unravel a heretofore unrecognized universe of practice themes and present suggestions for medical education and training aimed at continuous practice improvement.