GOT THE TIME? Anyone interested in doing a little surgery today?

Sometimes getting a surgical team together for a case is like herding squirrels. You could call it a comedy of errors, but it's not funny. Well, maybe it is funny later. I'm almost ready to laugh about this recent incident.

Hurry up and wait
The surgeon is 15 minutes late. OK, we'll roll with it. Nurses and techs always shoulder the blame for turnover times, so documenting that it was someone else's fault is a welcome occurrence.

When the surgeon arrives, though, we discover that the vendor's rep hasn't. A phone call is made. The rep's schedule says the case was supposed to begin an hour later than we'd booked it. Really? Now our schedule is taking its marching orders from the vendor? Whatever. The CRNA is sent to lunch. In fact, the OR manager sends everyone to lunch. See you in 30.

After lunch we return to the OR and, happily, the rep has shown up. Great, let's go. Wait, where's the radiology tech? The department that's in charge of imaging often seems like it can't visualize the schedule. We call them and it's a surprise. It'll be another 20 minutes before the tech gets to surgery, changes into scrubs and sets up the C-arm.

We notify anesthesia that we're just about ready. The CRNA didn't get to leave for lunch until 15 minutes ago. So we dog the anesthesiologist supervising our OR until, exasperated, he agrees to cover for the CRNA till he gets back.

At this point we're going on 2 hours late. Things are looking up, though. We have the patient in the room, on the table, and connected to all the bells and whistles.

Is it legal to pull hair?
As it turns out, the delays were the easy part. The CRNA starts the sedation and the surgeon starts the local, but the patient's still moving. I see his arm break free of the tuck job I did and jump on it like it's a fumble on the 10-yard line, trying to secure it.

It's around this time that the scrub at the field requests more local. I'd like to get it for you, I tell him, but I'm a little restrained here, seeing as how the patient's got me by the hair. Then the surgeon's pager goes off. When you get a chance, he asks, could you get that for me? An intercom voice from outside the OR even chimes in: Could someone please pick up? Again, nothing doing until the patient has unhanded me and my blue bouffant hat.

I work myself free, but freedom is relative: The patient is still in his underwear. Two pair, and they aren't clean. Why? Forget why, the answers I want are from the pre-op nurses. This case is a cysto. Did you think the surgeon was going in through the fly?

I must have blocked out the rest of that case, because the next thing I remember, I'm staffing another room. I'm still in good spirits because it's a hernia case, the paperwork's done, everything the surgeon needs is already on the field. I'll be out of here in no time. But I'm growing more uneasy as the surgeon repeatedly tempts fate, messing around something red and squishy with his pointy instrument. Leave that red thing alone, I'm thinking, you're too close. Then: Now you've done it.

Sometimes I'm convinced that medicine's not a science, not even an art, but controlled chaos that often works out for the best, despite our best efforts to foul it up. All in a day's work, I guess.