Traits I loathe in academic attendings

[ProRealDoc]

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Micromanagers. Some are so anal that they even want to set the gas flows themselves.

Stressers. A royal pain in the ass who make a big deal about insignificant issues. You ain't done sliding the blade in for DL and are already asking "what do you see". They like to put on a show and scare everyone in the OR by acting like the world is falling apart. Had this attenidng in OB who upon placing a spinal would yell at the patient to lie down immediately while simultanously pulling the patient's shoulders and forcing them to lie down. He then would start going crazy looking for the ephedrine syringe and start huffing and puffing about the patient being hypotensive.

Overbearing: these even want to tell you how to hold the angio cath when you're about to drop in a-line and insist on using the seldinger technique.

CRNA Panderers: They will screw the resident as long as he/she keeps the CRNA happy.

Cowards: always ready to blame any adverse outcome on the resident to cover their own ass, even if the resident had nothing to do with it. I've been on the receiving end of it.

 

[Masseter Spasm]

What about the "Seagull"? That individual who shows up unannounced, makes alot of noise, and when she/he departs you are left with an unpleasant mess.

 

[Gern Blansten]

Those are good ones. I think we all know or remember someone that fits all of those profiles. Those who fit more than one of those listed are the worst of all. I know of one who prides themselves on being the black cloud, always with the toughest cases or the most difficult situations. Nobody really buys that except them. Everyone who has ever worked with this individual knows that they create their own difficulties because of rigid policy and "my way or the highway" mentality.
One of my former faculty used to tell me that relative invisibility in the OR was actually a good thing. He said, "anybody can make something look difficult. Your job is to make it look easy." You may give some the impression that you are not working hard, but the people that matter know differently.
So, to sum it up, any idiot can turn a situation into a complete disaster. It takes great skill to navigate a tricky situation seamlessly and make it appear routine. THAT is what we should all strive for.
People who have a need to be noticed and want to make sure everyone in the room knows they are in charge do not grasp this concept.

 

[fastosprintini]

another one to mention is the the academician who spends most of his time torturing rats or attending research meetings, these so called "physicians " have no skills or confidence in the or or clinics and tend to hate residents and fellows who can run circles around them...
fasto

 

[Frank Rizzo]

What about the "Seagull"? That individual who shows up unannounced, makes alot of noise, and when she/he departs you are left with an unpleasant mess.

I hate seagulls

 

[DO4lifer]

great things to look forward to as a CA-1...😳

 

[zack_morris]

Micromanager: During a liver transplant, a particular attending told a fellow resident (during CA-2, halfway through the year)- "you're job is not to think. If you have a thought, let me know about it. You are not to push a medication. You are not to touch the vent settings/gas flow."

Same attending, another liver transplant- threw out half the meds that the resident drew up on the cart, stating that they were going to administer "clean anesthesia". Halfway through surgery, the patient goes asystolic and the attending is running around like a chicken with his head cut off, scrambling to draw up atropine and epi.

 

[Calilove]

This thread is hilarious! I am literally placing half of the attendings I've worked with in one of these categories.... or several!

 

[Licoricestick]

One of my former faculty used to tell me that relative invisibility in the OR was actually a good thing. He said, "anybody can make something look difficult. Your job is to make it look easy." You may give some the impression that you are not working hard, but the people that matter know differently.
So, to sum it up, any idiot can turn a situation into a complete disaster. It takes great skill to navigate a tricky situation seamlessly and make it appear routine. THAT is what we should all strive for.

Whilst I would normally never listen to a surgeon regarding what makes a good anaesthetist, there was one who told me that the difference between a registrar and a good consultant is that when there is a problem during a case he does with a registrar, he knows about it during the case; but when it is with a good consultant, he MIGHT hear about it after the list.

 

[Planktonmd]

Whilst I would normally never listen to a surgeon regarding what makes a good anaesthetist, there was one who told me that the difference between a registrar and a good consultant is that when there is a problem during a case he does with a registrar, he knows about it during the case; but when it is with a good consultant, he MIGHT hear about it after the list.

😀
I like to think that some surgeons are still interested in knowing about complications when they happen not later.

 

[ProRealDoc]

Some attendings think that being anal retentive about gas flows, way you tape the tube, whether you wait exactly two minutes after administering roc before you take a look, etc is what defines a good anesthesiologist.

I am starting to realize that I don't really give a rat's ass about bull**** details or whether you run the propofol infusion at 100 vs 125mcg/kg/min. Who cares, really. What I enjoy about the anesthesia is thinking about how the patient's medical issues will affect the anesthetic plan. Everything else is total BS.

 

[Planktonmd]

Some attendings think that being anal retentive about gas flows, way you tape the tube, whether you wait exactly two minutes after administering roc before you take a look, etc is what defines a good anesthesiologist.

I am starting to realize that I don't really give a rat's ass about bull**** details or whether you run the propofol infusion at 100 vs 125mcg/kg/min. Who cares, really. What I enjoy about the anesthesia is thinking about how the patient's medical issues will affect the anesthetic plan. Everything else is total BS.

Exactly! 👍
What we do is not exact science and every time I see a new guy trying to precisely calculate the induction dose of propofol for the patient's weight and calculate the exact tidal volume I wonder how long it's going to take them to get it and chill.

 

[Licoricestick]

😀
I like to think that some surgeons are still interested in knowing about complications when they happen not later.

Your colorectal surgeons really care about the patient that desaturates intraop?

 

[Planktonmd]

Your colorectal surgeons really care about the patient that desaturates intraop?

Some of them actually do.

 

[gasspasser]

I don't want to generalize and I certainly don't mean to insult any of our esteemed academic colleagues, but a lot of people who remain in academics are self-selected because they know that they can't or don't want to survive out in solo practice. The production pressures and the *need* to be slick and efficient (both from a time and reputation perspective) simply aren't there in an academic setting in the same capacity as private practice.

But all the same, it's important that academic physicians exist. We all learn from them during residency, and it is only from our exposure to them that we discover the qualities that we want to strive to emulate and those that we simply cannot stomach.

 

[ProRealDoc]

Exactly! 👍
What we do is not exact science and every time I see a new guy trying to precisely calculate the induction dose of propofol for the patient's weight and calculate the exact tidal volume I wonder how long it's going to take them to get it and chill.

I will make an exception for pediatric patients.

 

[Planktonmd]

I will make an exception for pediatric patients.

Even then, things are not as exact as they teach you and there is always some margin for variation (a smaller margin for smaller patients 😉).

 

[dhb]

If you can't do something... teach it 😉

 

[Mofeen]

Our cefazolin comes in 1 gram vials that needs to be reconstituted before administration. Had one attending berate me in front of everyone because I used 5ml of sterile water vs. the 2.5mL that is called for on the label. The berating continued when I proceeded to shake the vial in order to reconstitute rather than swirl it. No joke.

He really "let me have it" when then I proceeded to tape the patients arms to the armboard with a sterile OR blue towel in between the tape and patients arm, rather than an ABD pad, stating that the OR towel is too rough on the skin. What a dork.

 

[powermd]

We have one particular attending notorious for psychotic antics in the OR.
On a simple gyn case I had my cart, tray, and patient area nicely set up, patient was asleep, we're just getting ready to drape. This attending notices something he didn't like, proceeds to mess up my machine tray, causing a few items to fall on the floor. Next he says, "okay, look at THEIR setup" (pointing to the scrub nurse and instrument tray), "now look at YOUR setup" "See the difference??" He waits for me to give a goofy 'okay, yah got me' look before leaving the room. The surgeon just rolled his eyes and we all had a good laugh.

Same attending, different resident (CA-1, one of my classmates at the time, brilliant guy, if *slightly* irreverent). Attending cranks the gas to 1.7 MAC Sevo. Resident says "isn't that a little high, Dr. Nutso?"
"No, the patient is getting the appropriate anesthetic. DON'T TOUCH ANYTHING."
Attending leaves and returns 30 minutes later, to find the gas flows and Sevo untouched. 1.7 MAC.
"Great".
Then he looks at the anesthetic record.
Phenylephrine 200 200 200 200 200 200
"Get out."

That one was priceless.

 

[fakin' the funk]

He really "let me have it" when then I proceeded to tape the patients arms to the armboard with a sterile OR blue towel in between the tape and patients arm, rather than an ABD pad, stating that the OR towel is too rough on the skin. What a dork.

😱

I don't understand why people who have such insane, strict, and unfounded preferences don't do their own cases.

Actually I think that was answered before in Gasspasser's post.

 

[guitarguy09]

Same attending, different resident (CA-1, one of my classmates at the time, brilliant guy, if *slightly* irreverent). Attending cranks the gas to 1.7 MAC Sevo. Resident says "isn't that a little high, Dr. Nutso?"
"No, the patient is getting the appropriate anesthetic. DON'T TOUCH ANYTHING."
Attending leaves and returns 30 minutes later, to find the gas flows and Sevo untouched. 1.7 MAC.
"Great".
Then he looks at the anesthetic record.
Phenylephrine 200 200 200 200 200 200
"Get out."

That one was priceless.

hahaha... AWESOME!

 

[coprolalia]

I don't understand why people who have such insane, strict, and unfounded preferences don't do their own cases.

Because they would kill people. And, deep down, they know it.

In psychology, compensation is a strategy whereby one covers up, consciously or unconsciously, weaknesses, frustrations, desires, feelings of inadequacy or incompetence in one life area through the gratification or (drive towards) excellence in another area. Compensation can cover up either real or imagined deficiencies and personal or physical inferiority. The compensation strategy, however does not truly address the source of this inferiority. Positive compensations may help one to overcome one’s difficulties. On the other hand, negative compensations do not, which results in a reinforced feeling of inferiority. There are two kinds of negative compensation:

Overcompensation, characterized by a superiority goal, leads to striving for power, dominance, self-esteem and self-devaluation.

Undercompensation, which includes a demand for help, leads to a lack of courage and a fear for life.

http://en.wikipedia.org/wiki/Compensation_(psychology)

-copro

 

[pgy13]

😱

I don't understand why people who have such insane, strict, and unfounded preferences don't do their own cases.

Actually I think that was answered before in Gasspasser's post.

Which is why applicants should be looking for programs where attendings do their own cases some of the time. Keeps them honest.

 

[nightflight747]

Same attending, different resident (CA-1, one of my classmates at the time, brilliant guy, if *slightly* irreverent). Attending cranks the gas to 1.7 MAC Sevo. Resident says "isn't that a little high, Dr. Nutso?"
"No, the patient is getting the appropriate anesthetic. DON'T TOUCH ANYTHING."
Attending leaves and returns 30 minutes later, to find the gas flows and Sevo untouched. 1.7 MAC.
"Great".
Then he looks at the anesthetic record.
Phenylephrine 200 200 200 200 200 200
"Get out."

That one was priceless.

HAHAHAAA...
That is the funniest story I've read on SDN so far!

 

[CambieMD]

No one has mentioned that the attending is the individual who is ultimately responsible for a given case. When the CRNA and resident have left for the day I am the one who has to explain any adverse event or poor outcome to the surgeon or my colleagues during faculty QA or a meeting with risk management.

Cambie

 

[proman]

You're right Cambie. But how many times were you involved in those aspects as a resident? I know I'm not. There's a lot that goes on behind the scenes.

 

[ProRealDoc]

Our cefazolin comes in 1 gram vials that needs to be reconstituted before administration. Had one attending berate me in front of everyone because I used 5ml of sterile water vs. the 2.5mL that is called for on the label. The berating continued when I proceeded to shake the vial in order to reconstitute rather than swirl it. No joke.

He really "let me have it" when then I proceeded to tape the patients arms to the armboard with a sterile OR blue towel in between the tape and patients arm, rather than an ABD pad, stating that the OR towel is too rough on the skin. What a dork.

I always reconstitute cefazolin with 10ml of NS. Never give a small dose to ensure the patient does not have an allergic reaction. I push the whole stick.

 

[dfk]

No one has mentioned that the attending is the individual who is ultimately responsible for a given case. When the CRNA and resident have left for the day I am the one who has to explain any adverse event or poor outcome to the surgeon or my colleagues during faculty QA or a meeting with risk management.

Cambie

in defense to you cambie, no, you are not correct. as a crna, we would be held liable for any legal concerns to patient outcomes if the incident(s) occurred on our watch (unless you deliberately did something untoward). at least, in NYS anyway. unfortunately, you might get a brunt from the surgeon or whomever.

 

[ProRealDoc]

No one has mentioned that the attending is the individual who is ultimately responsible for a given case. When the CRNA and resident have left for the day I am the one who has to explain any adverse event or poor outcome to the surgeon or my colleagues during faculty QA or a meeting with risk management.

Cambie

Agreed, but what difference does it make in the patient's outcome if the endotracheal tube is taped one way vs. another?

Are you an academic attending?

 

[ProRealDoc]

Our cefazolin comes in 1 gram vials that needs to be reconstituted before administration. Had one attending berate me in front of everyone because I used 5ml of sterile water vs. the 2.5mL that is called for on the label. The berating continued when I proceeded to shake the vial in order to reconstitute rather than swirl it. No joke.

He really "let me have it" when then I proceeded to tape the patients arms to the armboard with a sterile OR blue towel in between the tape and patients arm, rather than an ABD pad, stating that the OR towel is too rough on the skin. What a dork.

ridiculous. I use non-sterile OR towels to cover patient's arms and never had a problem.

 

[OB1🤙]

What's most amusing to me about these kinds of things is that these attendings know that 90% of their colleagues are doing what they're claiming is a mortal threat to the patient. Why then aren't they standing up there in front of the whole department giving grand rounds about the ill-understood dangers of OR towel arm-wrapping or diluting antibiotic into a whopping 5cc of water before further diluting it into 6 liters of blood?

 

[coprolalia]

What's most amusing to me about these kinds of things is that these attendings know that 90% of their colleagues are doing what they're claiming is a mortal threat to the patient. Why then aren't they standing up there in front of the whole department giving grand rounds about the ill-understood dangers of OR towel arm-wrapping or diluting antibiotic into a whopping 5cc of water before further diluting it into 6 liters of blood?

I don't know about that.

As residents, we get the opportunity to work with almost all the attendings in the department on a regular basis. We get to see what is consistent, and what is not, across the panoply of ability.

They do not.

They, however, get to see what is "average" performance across the resident class, where we do not. For example, you might right now think that Joe Blow, MD who's your CA-2 colleague is a stud because he walks around with a swagger and answers all the questions correctly during lecture. But, he may be a bumbling ***** in the OR. You wouldn't know because you don't directly observe how he gives an anesthetic.

Same holds true for attendings. They don't observe each other. Chances are they didn't train with each other. And, at the attending level, there appears to be more of a "respectful deferrment" to their way of doing things than there is at our level.

So, I wouldn't be so sure that your statement is true, and chances are if they did something like that at Grand Rounds they'd only be hanging themselves in front of an audience... and, remember, most physicians are spineless chickensh*ts when it comes right down to it.

-copro

 

[Planktonmd]

Actually, You are wrong,
In all academia (and most private practices with supervised CRNA's) the attending is responsible for the anesthetic and he/she will be the one to deal with other physicians, risk management and M&M.
It might be true that a CRNA caused a complication but it is always seen as the role of the supervising physician to prevent that complication.
This is different where CRNA's are practicing independently because in that situation the CRNA and the surgeon will share the liability.
I don't want to transform this thread into a CRNA versus MD thing but please don't confuse AANA propaganda with what actually happens in reality.

in defense to you cambie, no, you are not correct. as a crna, we would be held liable for any legal concerns to patient outcomes if the incident(s) occurred on our watch (unless you deliberately did something untoward). at least, in NYS anyway. unfortunately, you might get a brunt from the surgeon or whomever.

 

[dfk]

Actually, You are wrong,
In all academia (and most private practices with supervised CRNA's) the attending is responsible for the anesthetic and he/she will be the one to deal with other physicians, risk management and M&M.
It might be true that a CRNA caused a complication but it is always seen as the role of the supervising physician to prevent that complication.
This is different where CRNA's are practicing independently because in that situation the CRNA and the surgeon will share the liability.
I don't want to transform this thread into a CRNA versus MD thing but please don't confuse AANA propaganda with what actually happens in reality.

hey plank, this wasn't an attempt to turn anything into a crna v md thing. but, just to reiterate, if a crna does something foolish during a case, the liability falls with the crna, whether ACT or PP. case law proves this. what is important is what the hospital's regs and bylaws specify. but, in a court of law, my errors wouldn't reflect on you.

 

[maceo]

hey plank, this wasn't an attempt to turn anything into a crna v md thing. but, just to reiterate, if a crna does something foolish during a case, the liability falls with the crna, whether ACT or PP. case law proves this. what is important is what the hospital's regs and bylaws specify. but, in a court of law, my errors wouldn't reflect on you.

hey dfk this is not a crna v md and i dont wanna turn it into that but wait until crnas get competition from the Anesthesiology Assistants and PAs. The climate will be much much better for all involved. We will get to choose who we get to work with. ANd the time is coming where AAs will be licenses everywhere.. Schools are opening up.

 

[dfk]

hey dfk this is not a crna v md and i dont wanna turn it into that but wait until crnas get competition from the Anesthesiology Assistants and PAs. The climate will be much much better for all involved. We will get to choose who we get to work with. ANd the time is coming where AAs will be licenses everywhere.. Schools are opening up.

i don't see how this has anything to do with the discussion at hand.

 

[Planktonmd]

hey plank, this wasn't an attempt to turn anything into a crna v md thing. but, just to reiterate, if a crna does something foolish during a case, the liability falls with the crna, whether ACT or PP. case law proves this. what is important is what the hospital's regs and bylaws specify. but, in a court of law, my errors wouldn't reflect on you.

We are not talking about case law, we are talking about how things are in hospitals in the real world and I apologize in advance if that does not agree with how you would like things to be or how your organization wants you to think.
Here is what usually happens (in simple English) :
Something goes wrong, CRNA is supervised by a physician, the physician is the one who has to talk to the surgeon, family, administration, and goes to M&M to defend the management.
Case law is great and I know that you guys memorize that because it's the answer they tell you to use every time you don't know what to say, but this is not the subject here.
Sorry buddy.

 

[CambieMD]

Actually, You are wrong,
In all academia (and most private practices with supervised CRNA's) the attending is responsible for the anesthetic and he/she will be the one to deal with other physicians, risk management and M&M.
It might be true that a CRNA caused a complication but it is always seen as the role of the supervising physician to prevent that complication.
This is different where CRNA's are practicing independently because in that situation the CRNA and the surgeon will share the liability.
I don't want to transform this thread into a CRNA versus MD thing but please don't confuse AANA propaganda with what actually happens in reality.

That's correct. In faculty QA the attending is asked," why did that happen.?"
They can blame the resident or CRNA but the blame rest squarely on their shoulders.

It seems unfair to say that the person who is ultimately responsible for a case is picky about how the case is administered. Open up your minds and become receptive to doing things in different ways. Take the good and leave the bad behind. Ask why, not to challenge the attending but to understand their reasoning for what they are doing. You can learn from anyone. I try to learn something new every day. Some days I may learn what not to do in a given situation.

I enjoy working with residents. They are highly motivated and hard workers. I learn from them. I prefer to maintain a collegial relationship with my team. That is better for patient safety.

Cambie

 

[maceo]

i don't see how this has anything to do with the discussion at hand.

it has everything to do with your previous statement. Moreover, I just wanted to inform you of what anesthesiologists think of crnas and the Anesthesia Care team of the future will consisit of AAs, PAs and ANesthesiologist with CRNAs where we cant find AAs.

 

[OB1🤙]

I don't know about that.

As residents, we get the opportunity to work with almost all the attendings in the department on a regular basis. We get to see what is consistent, and what is not, across the panoply of ability.

They do not.

I have found, when challenged by a particular attending on something the majority of the department does, that the attending does know that the others do it this way. The residents tell them.

"Why would you ever do that?" "Uhhhhh, I was taught that way by attending x...." That kinda thing.

I think for the most part, they're aware of what the others are doing, at least for major things. For ticky-tack stuff like arm restraining, probably not.

 

[Arch Guillotti]

but, in a court of law, my errors wouldn't reflect on you.

This is absolute nonsense.

 

[geogil]

Is there something in the SDN anesthesia forum that parallels Godwin's law in other forums? I think I will dub it the 'Armygas law' if it has not previously been named, and it goes as follows: as the length of a thread approaches infinity, the probability that said thread will degenerate into a CRNA v. Anesthesiologist pissing match approaches 1. In practical terms, as soon as thread has more than 25 posts, the probability of a pissing match approaches 1.

And now, back to the pissing match at hand.

 

[QofQuimica]

Ok, so can we turn this thread into something constructive as opposed to a free-for-all bash-fest of academic attendings and yet another CRNA/MDA war? Obviously, *someone* has to train residents, and I don't recall hearing about all these cowboy PP folks taking the time away from their busy clinical schedules to do it. In a nutshell, if you're a hotshot anesthesiologist, then you had some good teachers who helped you get to where you are. For those of us who plan to be academic attendings, how about some helpful tips on how to do a good job training future anesthesiologists?

 

[ProRealDoc]

Ok, so can we turn this thread into something constructive as opposed to a free-for-all bash-fest of academic attendings and yet another CRNA/MDA war? Obviously, *someone* has to train residents, and I don't recall hearing about all these cowboy PP folks taking the time away from their busy clinical schedules to do it. In a nutshell, if you're a hotshot anesthesiologist, then you had some good teachers who helped you get to where you are. For those of us who plan to be academic attendings, how about some helpful tips on how to do a good job training future anesthesiologists?

Read my original post and don't emulate any of those traits.

 

[Planktonmd]

Ok, so can we turn this thread into something constructive as opposed to a free-for-all bash-fest of academic attendings and yet another CRNA/MDA war? Obviously, *someone* has to train residents, and I don't recall hearing about all these cowboy PP folks taking the time away from their busy clinical schedules to do it. In a nutshell, if you're a hotshot anesthesiologist, then you had some good teachers who helped you get to where you are. For those of us who plan to be academic attendings, how about some helpful tips on how to do a good job training future anesthesiologists?

Here is the deal:
In academia there is more prestige and less money, so if you like the relative prestige and are willing to accept less money to get it then you belong in academia.
The problem is once you start your career in academia it is very difficult to transition later to PP, while it is very easy to go from PP to academia if you want to.
So, unless you are 100% sure that you want to be in academia for the rest of your life I think you should start your career in PP then go back to academic anesthesia after a few years if that's what makes you happy.

 

[proman]

Here is the deal:
In academia there is more prestige and less money, so if you like the relative prestige and are willing to accept less money to get it then you belong in academia.
The problem is once you start your career in academia it is very difficult to transition later to PP, while it is very easy to go from PP to academia if you want to.
So, unless you are 100% sure that you want to be in academia for the rest of your life I think you should start your career in PP then go back to academic anesthesia after a few years if that's what makes you happy.

I think you're completely wrong. Maybe some people do academics for prestige, but to claim that is the motive for doing academics is short sighted and frankly insulting. Money isn't the only thing in the world. Some people value advancing their field through a variety of research, clinical and non clinical. Some people value teaching others their practice. Some value doing challenging cases that the PP hospitals ship to the academic centers (because they can't provide the service, aren't willing to take do something high risk, or just want to dump a non paying patient).

Plenty of people go from academics to PP just fine. Academic attendings don't always have a limited practice and many centers they'll do a variety of cases. Volume counts for proficiency but one can certainly catch up.

I think the inverse is true. PP going to academics is very difficult to be have a productive career. Many research projects are started early in a career and takes years to develop. Most of the people I have worked with who have done PP then switched just do clinical work and have no hope for advancement.

Plankton, you bring an interesting perspective to these forums but you should be a little more appreciative to those who taught you to be a physician and an anesthesiologist.

 

[maceo]

H
The problem is once you start your career in academia it is very difficult to transition later to PP, while it is very easy to go from PP to academia if you want to.
.

why would you say that?

 

[maceo]

Ill sum it up for you all by ralph waldo emerson


As to methods there may be a million and then some, but principles are few. The man who grasps principles can successfully choose his own methods. The man who tries methods, ignoring principles is sure to have trouble. Ralph Waldo Emerson.


Basically, lay off of your attendings. they are trying to teach you. SOme are pains in the necks sure. but someone has to point things out to you. Just keep the main principles in mind. When I was supervising I cant tell you how many anesthetists lost the forest for the trees. The couldnt see the forest because they never had the core principles of the specialty down pat. And once they are practicing you can no longer train them to see the forest. I dont know why but you cant.

 

[RxBoy]

Is there something in the SDN anesthesia forum that parallels Godwin's law in other forums? I think I will dub it the 'Armygas law' if it has not previously been named, and it goes as follows: as the length of a thread approaches infinity, the probability that said thread will degenerate into a CRNA v. Anesthesiologist pissing match approaches 1. In practical terms, as soon as thread has more than 25 posts, the probability of a pissing match approaches 1.

And now, back to the pissing match at hand.

That was great.
Needs a wiki