...is the wrong answer

Lesson for today - if the patient gets worse, sometimes it isn't your fault. (In fact, it may even be someone else's.)
Zac* is a 4 month old baby with a "mildly" hypoplastic left heart and critical aortic stenosis. He'd presented to a small hospital with shortness of breath and poor feeding, and oxygen saturations of 73% in air. He was treated with a prostagladin infusion to keep the ductus arteriosus open, then underwent stenting of the ductus, and banding of both pulmonary arteries. He recovered well and thrived. But he would eventually have run into complications, so he needed another operation. But which one?
It's like those multiple choice questions where options A and B both seem plausible but in fact the wrong option will give the opposite effect. For instance, to turn left when reversing, should you turn the steering wheel a)clockwise or b)anticlockwise? I've got that one wrong before and reversed into a post. The problem is when it's real life, and it's someone's heart.
By the time we receive patients in intensive care, the decisions (good or bad) about their management have often already been made. In the case of surgical patients, their anatomy has already been altered. There is only so much you can do by tweaking the physiology, so it isn't your fault if it doesn't quite work. Also, if all the major arteries and veins have been b**gered beforehand, it isn't your fault if you can't get a line in. But it took me all of today, looking after Zac to realise this.
I'm liking PICU a bit more this week; it does seem to be a thinking specialty (unlike neonates, which is completely protocol-driven), and there is certainly variety - patients from all specialties and of all ages. Yesterday there was a 70kg teenager in the next bed to a 2 month old baby.