Following induction of anesthesia and intubation of a patient undergoing coronary artery bypass graft surgery (CABG), the anesthesiology resident successfully places a right internal jugular central line under supervision of the attending anesthesiologist. Immediately following, a cuff leak is detected in the endotracheal tube (ETT). The ETT is promptly and successfully exchanged. During this time, the cardiac surgeon enters the O.R. and with his hands in the air asks everyone, “Why is everything taking so long this morning and holding me up?” The nurse explains the situation, and the cardiac surgeon asks to speak to the attending anesthesiologist. During a brief, heated side-conversation away from the patient, the surgeon confronts the anesthesiologist, asking, “What complication just occurred with my patient?” The case proceeds uneventfully. It is remarked by staff in the room that this anesthesiologist and cardiac surgeon “have had words before” and “we are used to this.”


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