NEED FOR SPEED Extreme throughput is the new mantra.

Since we moved out of our main hospital to a freestanding surgery center, efficiency is better, start times are more predictable and anesthesia is really bringing their "A" game. Trouble is I have to work like a jackrabbit on steroids. If I don't enter the room for my last case before 3 p.m., I am threatened to take my last case to that dreaded abyss known as the main hospital. Great: teaching is drop-kicked, I have enough caffeine in my body to make Mrs. Olson (the "Folgers Coffee Woman") envious and lunch is reduced to 3 cashews. The pressure to perform is packaged into several segments:

• The pre-emptive strike. Whenever I enter the surgicenter in the morning and am greeted by the head nurse with the words, "We have to talk," I immediately re-experience the dread I felt when I was called to Mother Superior's office in grade school. This is not good. The head nurse then proceeds to explain that next week's caseload is "unrealistic." Ouch. The exhortation to change my schedule is generally fruitless since I am hesitant to disrupt the schedules of patients who have waited several weeks for their surgery.
• The gloom-and-doom forecast. On especially busy days, the first encounter with the charge nurse results with comments along the lines of, "We are watching you today!" or "I hope you brought your skates!" or even better, "Who does your scheduling, Speedy Gonzales?" What a way to start the day!
• Pace call. I love the pace call, whereupon early in the afternoon the charge nurse saunters into my room and politely mentions, "I hate to be the bearer of bad news but it's not looking good today." Great. What else do you want to say to brighten my spirits? Never mind that the last patient didn't tell anyone they had aspirin this morning and their surgery looked like a scene from Buffy the Vampire Slayer. Never mind the instruments for the last case are so old the tray is labelled in Latin, or that it looks like Nanook of the North engineered the drill guide. Not to mention, there's no suture retriever. I was reduced to grasping suture arthroscopically with a crochet hook. Afghan, anyone? The mere mention of "going across the street" to the hospital generates a few PVCs in my chest. There, the purported 5 p.m. start time is always bumped by the small bowel obstruction or open femur fracture du jour. Besides, it's too cold to go outside!

• Hate mail. This is the true post-mortem. In the event of any indiscretion whereupon I ran past the 5:30 p.m. witching hour, a panoply of hate mail ensues the next day. Numerous charges against me are levied to the effect of "You promised you would finish on time!" to "You are generating extra expenses!" to even "Did you get your license back?" It's times like these when I recall the words of the late Rodney Dangerfield: "I get no respect."

Brotherly love
Like any new endeavor, the surgicenter is indeed a work in progress. I am certain that in time the kinks will be resolved and end times will become much more compatible with predictions. In the meantime, I have trained my identical twin brother (good-looking guy) to run my second room. He is a lawyer, but boy he does a wicked good cuff repair!