Every OR has one: the sergeant at arms, the tough guy, the hit man. We affectionately call ours the enforcer. He keeps the surgeons in line and the schedule on time. He makes the hard calls and the necessary statements like:

• "You are late … again. What part of 7:30 start don't you understand?"
• "You said this case would take 1 hour. The trays are getting cobwebs!"
• "What were you drinking when you booked all these cases?"
• "When you said finished by 5, did you mean Eastern time?"
• "I don't care how much snow is in your driveway. Your first patient has been here an hour."
• And my favorite: "Is this the same case?"

'Did you bring your sleeping bag?'
Our enforcer, Mark Collington, has the demeanor of a Marine drill sergeant at Camp Lejeune. Tall, burly and with a voice right off the set of "Full Metal Jacket," Mark truly keeps me in line and our schedule running on time. Daily, Mark will greet me with a no-nonsense command such as:

• "Dr. K, if you don't sign the patient's shoulder in Bed 4, you'll lose your room to the hemorrhoid service."
• "Dr. Kel, we can't send for the next patient until you get your Irish fanny downstairs and sign the consent."
• "JK, your next patient has a blood alcohol level higher than my GPA in high school."
• "Special K, the next patient in the holding area is making coffee nervous."
• "Kel, did you bring your sleeping bag tonight?"
• "JDK, are you sure you can run 2 rooms?"

Thank God for Mark. He keeps things running smoothly and ensures (most days) I get home at a reasonable time. Yes, perhaps there are times when I feel that a little diplomacy may be in order, but Mark has been the best thing for my married life since Pre-Cana. Thanks to Mark, the OR pajama parties are becoming fewer and fewer. My wife, Marie, and I intend to include him in our will.

Hard time saying 'no'
I suffer from a profound case of Irish disease — no, not alcoholism (although many would beg to differ), but the inability to say "no." I'm particularly challenged when a patient pleads with me that his surgery has to be performed immediately.

Reasons range from: "I can't take the pain any longer" to "My insurance runs out next week" to "This must be done before my formal."

Often when I look at the next day's OR schedule Dr. Phil's words come to mind: (Oklahoma accent) "Whaaaat in the worrrrrld were youuuu thinkin?" Thank God my wife is a saint and can handle the late nights, but the most difficult aspect of a large caseload is the prospect of being bumped. Yes, elective scheduled surgeries can be halted because of the incremental OR downsize: 3:30, 5 and 7 p.m. all bring with them the mandate to close rooms in hospitals. Personnel are the issue and usually it is anesthesia manpower shortages.

When I get bumped, after I throw objects and proclaim words football coaches have taught me (just kidding), my first impulse is to approach the nurse anesthetist about to leave and ask: "What's your price?" If I'm lucky, the response is "a quart of Johnny Walker Blue." Other times it's a dollar figure only Trump can afford. Sometimes, the response disarms me. "Dr Kelly, for you, I'll stay." Or, "Because you asked so nicely, I'll hang around so you can finish."

Nice guys don't finish last. Kindness is contagious. I had the blessing of good parents (and the nuns) who taught me to treat everyone first-class. Surgeons, sow kindness and maybe the only bumps you'll experience will be from the OR light handles.