09:15 came and went and the first patient had not even been sent for. Then 9:30 and 10:00 passed. I walked out to the desk and spoke to the charge nurse.

“Mike, what’s going on?” I said.

“The first case hasn’t left the room yet,” he replied. I went back into the surgeon’s lounge. This can happen when you are following an earlier case. All you can do is to wait. Every surgeon has had cases go longer than expected.

At 10:45 I returned to the desk and, before I could ask, Mike said, “the patient is out of the room but we don’t have anesthesia staff to start yet. “ This is a perennial problem in nearly every hospital I have worked in.

My official cut time for the first case ultimately was 11:45. The case went well and we were done in an hour and two minutes. I went to recovery to post my orders and postoperative note on the computer. The hospital had just switched to a new system of electronic health records because the one preceding it was so awful and difficult to use it almost sparked a mutinous uprising in the medical staff. The new system was the same one I had been using at another hospital for years so I was confident that I could navigate this one with ease. I should have known better.

When I tried to place my postoperative orders and operative note, it became quickly evident that, although the screen looked familiar, this was not the same system at all. I guessed they purchased the discount version. I quickly reached a point where I could go no further and called for IT assistance. The hospital’s IT guy showed up and could not figure out the problem either, so he called the on site representative from the company that made the program. With the two of them hovering over my shoulder and the minutes ticking until I had to be in the room for the next case, we tried to get my orders and report done. It was futile. The company rep put in two work tickets to report the glitches holding me up, but these would not help now. I was getting antsy and champing at the bit to get to my next patient. I had wanted to have some time to focus on the upcoming surgery and mentally prepare myself. I also wanted to be there when she went into the operating room so I could help the staff prepare and drape her out. I wanted things to be done just so for this important case.

Instead, I was sitting here, in front of a computer, getting angrier and angrier that the EHT manufacturer had not produced a more user friendly and intuitive product and that the hospital administrators had not done a better job of launching this new system. As it became obvious that we weren’t going to solve the problems quickly, I think the IT guy and company rep sensed that I was about to have a meltdown; I wasn’t subtle about it. They told me to go on to my next case and they would work on the issues. I headed to my second case angry and frustrated, the first patient’s charting incomplete. This was not the frame of mind I had intended. I entered the OR to find my second patient already asleep, her breasts prepared and draped. I fought off my irritation, took a deep breath, let it out, and announced to the room in general, “I want this to be a happy room today.”

As I approached the scrub tech to be gowned and gloved, I saw that she was new. As she helped me on with the gown, she said, “Hi, I’m sunshine.”

My jaw must have dropped open. “What?” was all I could say as her name registered.

“My name is sunshine,” she said again.

“For real?” I said.

“Yes,” it’s on my birth certificate.

After my morning thus far, the improbability of this hit me like a ton of bricks. If I believed in signs or omens, this would definitely have been one. My sense of frustration and anger vanished in an instant and I started to laugh. It was perfect. From that moment the case went as smoothly as anything I have ever done and I left the room optimistic that my patient would get a good result. As I exited the operating room, I felt that, indeed, angels walk amongst us, sometimes in the most unexpected guises.

Richard T. Bosshardt, MD, FACS