People who are intubated are often at least somewhat awake. They try to communicate with us by mouthing words, but it is almost impossible to read lips with nothing in the way, much less with a tube extruding from their mouth. One afternoon I was talking to an intubated patient who was becoming very frustrated with trying to communicate with me. One of our specialists had just left and must have been in a hurry because the patient was visibly upset at something. I found a pen and pad for them to write with and put it in their hands. They scribbled furiously for about 30 seconds, writing what I thought was a question or a request for something before turning the paper over to show me what they had jotted down. In all caps, written over the entire page was a single question: "THAT OTHER DOCTOR WAS AN A**HOLE! ARE YOU ONE, TOO?"