Pride is a Fall Risk

Stick with it.

I’m good at intubating (the procedure by which a tube is passed through the vocal cords into the trachea to assist ventilation). I’m not the world’s expert, and I haven’t written a book about it, but I know what I’m about. I was trained by people who knew what they were doing, and I (and my patients) owe them a debt of gratitude. (Lotta I’s there, sorry).

Very occasionally, I get to help out my partners in Emergency Medicine practice when they’re in a bind with this procedure, and I do.  It’s always fun, and a little gratifying, to ‘get the tube’ when a colleague (and their patient) is in trouble.

As Ron White says, “I told you that story so I could tell you this one…”

Pride goeth before the fall.

I have come to learn that one of the worst sins of a physician is Pride. This is strictly different and separable from confidence, in that confidence is a normal and rational belief in ones self and abilities whereas Pride is based in ego, irrespective of confidence. Or logic, for that matter.

The worm turns, and I’m the one who cannot get the tube in the trachea. I’ve preoxygenated, sedated, RSI’d, and taken 3 tries. I’ve changed tubes, blades (the laryngoscope has differently sized and shaped blades), and patient positioning which are among the things that should be adjusted in the event of intubating failure. The good news? This patient can be oxygenated and ventilated easily with the bag valve mask. The bad? I’m now no closer to getting the airway secured with a cuffed tube than I was when I started.

This is where not having Pride came in: I asked for help. The Prideful EM doc (or the one in solo practice, and I respect the heck out of all of you) will keep trying, and will eventually help the patient and assuage their ego (or their situation) by getting The Tube. This can come at a cost to the patient in airway trauma or worse, and it’s desirable to avoid that.

My colleague physician came in, smiled, and helped my patient and me out of a bind. Colleague made it look ridiculously easy, with a first attempt intubation. Just like I’ve done before…

He was amazingly humble, and didn’t rub my nose in my failure to intubate. I truly hope I’ve been as nice to my colleagues in the same situation. Really, he was as nice as a human could have been while pulling chestnuts from a fire. Mine, to wit.

And I surprised myself by asking for help with a procedure I’m normally good at. No Pride, no Ego, just what’s good for the patient. I’m getting this Doc thing.



  1. Mrs. Fred says:

    Don’t know what he did that you didn’t do, but — glad the outcome was successful.
    And — I LIKE your definitions of confidence and pride. We’ve all had these experiences in our lives, and glad this one turned out well.

  2. Jonethan DeLaughter says:

    Great post, and a great reminder that all of us, no matter how great our procedural and psychomotor skills are, will need to put aside our own self-indulgence and ask for help, for the sake of another.

    Thanks for sharing!

  3. An impressive story and quite a lesson. The proudest ones make most mistakes for being not humble enough to ask those who know.

  4. Canuck ER MD says:

    Magnificent post.

    I look in the mirror every morning.

    And laugh at myself.

    It serves as a useful reminder not to take myself too seriously.

  5. Beary Potter says:

    I’m proud of you.

  6. Love the story. Thanks for sharing. Medicine is about the patients, not about us. Ego is good because it gives us the confidence to shove giant tubes and needles into scary parts. But it should also be the first thing to leave the room, and its good to know our limits.

  7. Ditto Beary Potter!