Invasive procedures

doi:10.1136/bmj.331.7530.1461

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Victoria Thomas, foundation year 2 doctor (v.e.thomas@ncl.ac.uk)

University Hospital of Hartlepool, Newcastle upon Tyne

Another busy night shift as a medical house officer. At about 2 am my bleep shrills, and I call the number with a resigned sigh. I'm told about a sick patient in the high dependency unit, an elderly man who had coronary artery bypass grafting to treat his ischaemic heart disease 18 years ago. He has known heart failure, peripheral vascular disease, sepsis, and renal failure. No resuscitation decision made as yet. Just another call about just another sick patient with a dismal prognosis.

But, of course, it wasn't. The …