Just when I thought I'd seen it all, another hard-to-believe moment manifests in the OR. The wisdom of experience merely means that I have personally encountered nearly everything that can go wrong in surgery. Here's just a sampling of the memory menu of the last 24 years of surgical bliss, all based on true events I wouldn't believe unless I'd been there to witness them.

• Sterility maelstrom. Years ago I was doing a shoulder arthroscopy when halfway through the procedure the nurse informed me that my instruments were not sterile. Turns out that somebody "misinterpreted" the autoclave indicator — the scope set was washed but never sterilized. Ow!!! I promptly stopped the case, irrigated the shoulder thoroughly, lit 3 candles at church and placed the patient on antibiotics for several days. Thankfully no infection manifested and I was able to convince the patient to return to the OR to have her procedure completed. My gastric secretions (and coronaries) have never been the same.
• Graft trouble. Once during an ACL reconstruction, after carefully preparing my graft, I neatly tucked it into a sponge to rest on the back table. I returned to the knee to drill my tunnels. Minutes later, when I went to retrieve the graft for placement into the knee, I learned that the nurse threw it out since she thought the sponge was trash.

Code Blue, Room 3!

Three nitrates and 4 Ativans later, I explained to the nurse that the Raytec sponge on the back table was not expendable. So much for sponge counts! Thank God it was an allograft. We merely requested another, let it thaw and re-prepared it. The hospital (and again, my coronaries) took the hit.

• No suture retriever in the house. In the midst of a complex shoulder procedure, after inserting my suture anchors, I matter-of-factly requested the suture retriever, a lobster-claw-like device that elegantly and smoothly grasps suture threads in tight places. My scrub nurse replied: "Ahhhhhhh, Dr. Kelly, we simply don't have one!" Yes, the ever-present inventory issue was to blame. There were simply no more retrievers to be found.

Five Hail Marys, 3 sublingual nitrates and 3 Libriums later, I asked if a crotchet hook was available. No, I was not about to start an afghan. They used crotchet hooks in the pioneer days of shoulder arthroscopy to retrieve sutures. Thank heavens there was one in the set — undoubtedly purchased before the scrub nurse was born. I then proceeded to repair a rotator cuff, glenoid labrum and fill in a bone defect all without the aid of a suture retriever. Thank God I took a course in mindfulness. My Zen state prevented me from sojourning to the material supply office and throttling the manager.

Captain of the ship
Stuff does indeed happen and I ultimately take responsibility. I have since learned to be more proactive in my pre-surgical planning, including a pre-flight check of sterile instruments as well as communication of the steps of the procedure so that events such as errant graft disposal don't occur. In the meantime, I have yet to receive my first coronary stent. Thank you, Lipitor!