I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient. She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives. Pick option A, and the patient might die. Pick option B, and the patient might still die.
We discussed whether there were other options for treatment (none that we could see). We debated the pros and cons of each option (essentially equal). We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen). In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.
And it feels terrible. It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision. There is no longer an attending who takes responsibility for everything. We are the attendings now. And at times it is completely and utterly terrifying.