They call you cautious Caroline for a reason, and it’s not because your name is Caroline. You want this patient optimised prior to any scope. The question is, will the patient ever be truly stable enough if you target homeostatic physiological perfection as may be in a young Adonis posing on a lovely summer’s day for a sculpture artist?

The endoscopy unit calls you to bring the patient over, even though his pulse is 91 rather than below 90 as you would have preferred.

Whilst the patient is being scoped and you are choosing your next pair of safety goggles for the post endoscopy Hb check, the endoscopist suggests you have a read of http://www.nejm.org/doi/full/10.1056/NEJMoa1211801