Ladies and gentlemen, boys and girls, welcome to surgery, the greatest show on earth. Every facility is its own 3-ring circus. Just inside the big top, you'll find the carnival barker who runs the schedule board. Sometimes it takes more than one to keep track of all the attractions. Other times it's hard to understand why there are 6 people sitting at the desk to manage the day's sparse goings-on and telling us where to step right up, step right up.

See the pre-op and PACU nurses who line up the anxious patients going in and the groggy patients coming out, marching one after the next like a parade of elephants. The trainers crack their whips and they are dancing without hesitation. A colossal sight every time.

Our fearless scrub techs constantly walk a tightrope as they seek to keep the surgeon happy and keep a case going without so much as a minor snafu. Balanced on a whim, anticipating the next request, stopping suddenly and changing directions at the circulator's command.

The circulator, meanwhile, is deftly, dexterously keeping all the plates spinning as phones are ringing, pagers are going off, the surgeon is making demands, the anesthesia provider is asking for assistance and the med student is contaminating himself every time she turns her back.

Thrill to the sight of the knife-throwing surgeons (who always hit their mark) and the sword-swallowing endoscopy patients (I sure hope they got enough sedation). You'll be enthralled by the skillful moves of the trapeze artists from materials management, who fly between the supply room and the OR, stocking and pulling supplies and making sure the things you need from the preference cards are there when you need them. Don't overlook the equipment tech strongman, who moves the towers, pushes the C-arm and positions the fracture table.

Our central sterile crew works like trained seals. Who else performs so diligently, clapping their fins for such a small amount of credit? Where would we be without them? I'll tell you where we'd be: Down in central sterile, washing, rinsing, drying, counting, wrapping and autoclaving all the instruments ourselves.

I haven't even mentioned the dog-and-pony show of manufacturers' reps trotting in and out of the OR. Everyone knows they're here to drum up business. But really, by this point they know so much more than even the surgeon does about the expensive, streamlined titanium implant that's about to become part of the patient, that it's reassuring to have them around.

And we can't fail to salute the ringmaster at the administrator's desk. No one jumps through so many hoops to keep a facility running: From nimbly balancing the budget, to daringly juggling the surgeons who want block time and the surgeons who are going to lose block time, to deftly entertaining the clowns wearing the big shoes of a survey organization. Sometimes in the trenches of surgery, we gripe that they have no idea what our jobs are like, but I wouldn't want to trade places with them.

Whichever performer you are, and whichever ring you're starring in, it takes all of us to fill that big top. Some days you can't help feeling like the human cannonball, just hoping you'll land in that net, but most days it's great to have a front-row seat.