Imagine you are the only pulmonologist in town. You have no surgical backup. The nearest hospital is 100 miles away. In the middle of the night, acute respiratory failure develops in your 24-year-old asthma patient, who will die without an artificial airway. You attempt intubation without success. Bilevel pressure ventilation is not an option. The patient needs a tracheotomy. You have never done one before. You look around the room. All eyes are on you. The family urges you to do something! Now you know how the main character feels in Mikhail Bulgakov’s “The Steel Windpipe.” In this short story, a young Russian physician finds himself alone in a rural community, where he encounters medical emergencies that severely test his skills. A closer look at the story reveals lessons for even experienced physicians as they struggle to achieve medical competence.