STRETCHED THIN Dr. Kelly will do whatever it takes when he overbooks his surgical schedule.

Sometimes, for a variety of reasons, I book more cases than I should. When I look at the next day's schedule and see that it has more entries than the Yellow Pages, I hearken the words of TV's Doctor Phil: "What in the world was I thinking?"

Instead of choosing the lame route and asking patients to reschedule, I take the high road and begin to strategize for the next day. My goal: to avoid the dreaded 5 o'clock witching hour. I have been warned on several occasions that if my cases extend beyond 5 p.m., all subsequent cases will be sent to a nebulous zone known as the big hospital, with starting times ranging from 5:30 p.m. to next week. Here are 4 things I do when I overbook.

Ask for an early start. The first step when I overbook is to ask for an early start. This tactic rarely works. Usually I am met with refusals citing the increased costs of bringing staff in early. On the rare occasion that I do get an early start, my incision time is generally close to my standard time anyway. Smell passive-aggressive behavior, anyone? Sadly, sometimes I sheepishly tell the resident that I will knock off the first couple of cases in order to meet the time deadline. In a matter of milliseconds, I have just downgraded my chief resident from nearly fully trained surgeon to innocent bystander. Yes, I do feel like a loser at these times, but I ease the resident's pain with promises of many good cases in the future and many a happy hour after work.

Ask for a second room. If I finish a case and expect the next one to be brief, I ask for a vacant, already cleaned room. Yeah, I know, this doesn't save that much time, and the same team has to accompany me, but I could save a few precious minutes. Seconds even matter when it comes to avoiding the 5 p.m. death knell. I always rejoice when I do get my clean room. It's the thought that counts.

Grab a mop. When I'm really in a crunch and as the witching hour approaches, I humbly submit myself to do whatever it takes the turn the rooms over. Push the gurney, empty the trash, mop the floor you name it. Anything, except empty the medical waste can. A man's got to know his limitations.

Stare down the block team. If the regional block is taking so long that the nurses' notes have 3 volumes, I employ a friendly version of the George Foreman pre-fight staredown. One simple engaging eye contact with the 'ologist' can say it all. No words are necessary. Let's hope the referee doesn't step in.

With a little help from my friends
Somehow, we get the job done on time. I truly am grateful for all the help of my team. They sense my feelings of urgency and respond. Thankfully, I have consistently avoided crossing the 5 o'clock Rubicon. I do know I will ultimately fail and my sentence awaits me. Until then, I will continue to transport patients, discard used instruments, clean floors and empty trash — so long as it's not tainted with bodily fluids!