Doing certain procedures are always a little nerve racking. Not usually because of fear for the patient but because of the technical challenges that often present themselves. For instance, doing a central line on a very large patient - I generally an not afraid of causing any damage (I pretty much never do a subclavian approach to avoid the chance of pneumothorax and *knock on wood* have never had a significant carotid artery puncture during an IJ approach) but it can get frustrating getting the damn thing in due to the patient’s anatomy. On the other hand, there are some instances where the difficulty in doing the procedure lies in my (and to some lessor extent, the patient’s) anxiety. No time is this more evident when the patient is another physician who does the indicated procedure on a regular basis! I had a patient who recently was in need of a lumbar puncture (something I do pretty often but not more than once or twice per week at most). My general level of annoyance in the time requirement in doing the procedure (and the subsequent back up of the rest of the dept) was amplified x 100 in the form of performance anxiety when I found out that the patient was a physician who does LP’s nearly every day! I am sure the patient’s anxiety was exhibited by the intense questioning I got ahead of time about what gauge needle I was going to use, how many I have done, what my rate of spinal headaches are, what position I tend to prefer for the procedure, etc. This served only to heighten my adrenalin levels thank you very much! Still, I had to do it so envisioning that this was just like any other ordinary patient (luckily not an obese one!), I slowly got everything together and maintained a casual chit-chat going while I did the LP. The first shot was off slightly, getting nothing except to make me more nervous. Luckily the second attempt was a winner and I was rewarded with the appearance of clear fluid in the collection tubes! Whew! I think I just increased the respectability of my field a little.