IMAGES IN EMERGENCY MEDICINE Yuan-Qiang Lu, MD, PhD 0196-0644/$-see front matter Copyright © 2019 by the American College of Emergency Physicians. https://doi.org/10.1016/j.annemergmed.2019.02.016 Figure 1. Ultrasonography of the carotid vessels, showing solid echoes in the internal (left arrow) and external (right arrow) carotid arteries. Figure 3. The largest fat embolus. Figure 2. A, Preoperative cerebral digital subtraction angiography showing the occluded right internal carotid artery (arrow). B, Postoperative digital subtraction angiography showing the restored forward flow of the right internal carotid artery and the middle and anterior cerebral arteries. [Ann Emerg Med. 2019;74:305.] A 30-year-old woman was transported to the emergency department with sudden new-onset seizures and collapse shortly after 5 mL of autologous fat granules was injected into the right side of her forehead during plastic surgery at a private clinic. Her Glasgow Coma Scale score was 7, blood pressure 122/68 mm Hg, pulse rate 68 beats/min, and respiration 18 breaths/ min. The emergency physician intubated the patient and obtained ultrasonography of the carotid vessels (Figure 1). Cerebral digital subtraction angiography confirmed the diagnosis (Figure 2). For the diagnosis and teaching points, see page 309. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 74, no. 2 : August 2019 Annals of Emergency Medicine 305 Lyon I choked back tears. What did I just do? My legs regained enough strength to stand, and I looked into the patient’s eyes as mine filled up. I held her head and leaned down. “I’m so sorry. I wish you didn’t have to experience that, because I have, and it sucks. I hope you can forgive me.” I exited the room as the first drop of saline was about to run down my face. I headed for my desk to start orders. .or regroup. “Excuse me. My husband would like a pillow.” A random lady was standing in front of me. Smile. “Sure. We’ll get one.” The room was dark. The glow of the monitors illuminated my patient’s face. ICU visits are uncommon for me, but I needed this one. Volume 74, no. 2 : August 2019 Change of Shift I leaned on the doorframe and listened to the ventilator’s steady cadence. I replayed the events from 2 days prior. I wanted to apologize. I wanted to hear she didn’t remember anything. I needed her forgiveness. Beep. Beep. Beep. Heart rate 62. Author affiliations: United States Air Force, Hurlburt Field, FL. Military disclaimer: The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Air Force, Department of Defense, or the US government. REFERENCE 1. Lyon RF. Take my breath away. Ann Emerg Med. 2017;69:253-254. Annals of Emergency Medicine 309