Generally, the "routine" cardiac surgery patient is designated as an American Society of Anesthesiologists (ASA) class 4. No one undertakes cardiac surgery on a whim and as such anesthesia consent should be direct and sobering to avoid excessive optimism in patients and their families. All patients are informed of the inherent risk of death, stroke, neurological dysfunction, or renal failure. The risk/benefits of transesophageal echocardiography (TEE) should likewise be discussed with the patient preoperatively. Although the risk of stroke following bypass surgery is low (3%)1 and that of death even lower, cardiac surgery is associated with multiple postoperative morbidities including cognitive dysfunction, renal failure, gut ischemia, and potentially prolonged ICU care. Because both the surgeon and the anesthesia team influence the patient's hemodynamic performance it is often difficult to discern whether surgery or anesthesia is responsible for an adverse outcome. Ideally both the surgery and cardiac anesthesia groups function as a team sharing the joy when difficult patients are safely managed and sharing the anguish when the inevitable death or brain injury occurs. Anesthesiologists entering into cardiac anesthesia practice should be aware that outcomes are often disappointing and there is the ever-present risk of litigation even if the anesthesiologist has practiced according to all possible standards of care. Unfortunately, adverse events happen to people during cardiac surgery as a consequence of both patient illness and the numerous techniques necessary to repair the dysfunctional heart. Careful documentation and frank discussions with patients and their family are essential in cardiac anesthesia practice.