November. Once again, it's that time of year when, if we're particularly good-hearted, we stop our busy lives for a moment to total up an assessment of what we're most thankful for. It's also the time of year when we're thinking a lot about food and what we're going to serve our families on the fourth Thursday of this month.

For someone like me — and I don't necessarily mean a kitchen wizard — it's not too far a stretch to imagine how most efficient processes depend on the right combination of factors. A recipe, if you will. So I got to thinking about the ingredients you have to have on hand if you want to serve up a heaping helping of surgery.

Of course, every facility's got its own secret family recipe, but I've found this one works for me.

Take one large OR suite (chilled to the surgeon's preference) and add the following items:

• Four highly talented and dysfunctional professionals: a surgeon, a circulator, a scrub tech and an anesthesia provider. (But make sure they're only dysfunctional outside of the operating room).
• One brilliant but temperamental superstar surgeon. (This is a fairly common commodity).
• Five pans of instruments whose combined weight is heavier than you are. (Easy to find in large quantities at any facility in the nation).
• One radiological technician who can practically move a C-arm around with one finger. (A refreshing alternative to us circulators, who do well just to keep it from rolling over our toes).
• One nurse's aide who's able to find anything you send her out after. (You might find one of these rarities per institution).
• One CRNA who you'd trust enough to sedate you or your family. (Some units are lucky enough to have several available).
• One anesthesiologist who can remain cool and calm in a crisis. (A very valuable and highly sought-after resource for any circulator. When found, use wisely).
• One in-the-loop supervisor. (This is a rare ingredient, but it can be found).
• One patient who presents a challenge both physically and hemodynamically. (Depending on the provider, this can be found in abundance).
• One OR table that will accommodate patients of 350 pounds and upwards. (Some parts of the country boast more of these than others. After Thanksgiving, we might all need them).
• One OR full of equipment that works right the first time, every time. (You might have to do without this ingredient, though. It's scarcer than hens' teeth).

Mix cautiously. Plan on stirring in all the things that can go wrong and often do, sometimes halfway through the process, but sometimes right off the bat. Fold in a large smile and shake of the head for when everything meets everyone's expectations. Sprinkle a bit of humor and understanding on top and, with any luck, serve warm with a generous helping of tolerance. Happy Thanksgiving.