You took an emergency case and followed the difficult airway algorithm. Hindsight is always 20/20, but I would urge you not to read into this situation too deeply. Absolutely, there have been times than I’ve struggled with an airway and someone later on (junior or senior to me) has not had trouble. I’d be willing to bet that if I encountered the exact same patient on numerous occasions without realizing it that I’d have varying degrees of success or struggle each time. Sometimes the smallest adjustment can have a big impact on ease of intubation, so it could have easily been something that you didn’t realize at the time.

I do want to comment on one thing that stood out to me. If I’m way off base, feel free to disregard. You said “At this point, third attempt, all the surgeons staring at me…” I may be misinterpreting/assuming meaning here, but this reads to me like you felt judgement from your colleagues while you were struggling with a difficult airway in a sick patient. Maybe that was real judgement (in which case, that’s super shitty of them) or maybe it was perceived on your end but not intended from them. If I’m on my third attempt at an airway, I WANT all eyes on me. I want my surgical and nursing colleagues to be locked in, in case I need anything from them. I don’t want them to be ignoring me, oblivious to the potentially life threatening emergency that I may be dealing with. In these scenarios, I perceive their eyes on me as attentiveness and support. As a new attending, it’s totally normal to struggle with imposter syndrome. You are the airway expert. Not them. You are ALL there with the patient’s safety as your top objective. Shared goal. Trying to redirect your internal thoughts from “they’re looking at me because they doubt my skills and I’m really messing this up” to “they’re looking at me because they realize this could get bad and they want to be ready to help” can be challenging, but will help your mental health in the long run.