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premeasured doses of resuscitation medications, the Hail Mary Meds. Hopefully they would not need to be given. That was all routine which went on as the doctor hurried through his own between case chores. That included speaking to the next child's parents after first talking to the last child's parents. There was dictation, a detailed account of what was just done, mask change, briefing the control desk of any new needs or changes in time estimates. The next youngster had a spastic arm which involuntarily poised the hand at shoulder level and flexed sharply at the wrist. This stemmed from an intrauterine stroke caused by a placental separation. Belatedly, at seven years, the hand was showing improved prospects of function, but limited by the ability of the forearm and elbow to deliver it away from the shoulder. Simple enough. Muscles were detached, rotated and moved back to alter leverage and constraint. Others were restrung to new locations to promote the desired wrist extension and thumb release. After the hand, wrist, forearm, and elbow procedures were finished and the long cast was split to allow for swelling, a trip to recovery was accompanied by a litany of questions from the anesthesiologist about the upcoming case. This was typical. Shannon had already arranged most of the follow up details and was reviewing the immediate post operative rehabilitation orders. There were six more children on the schedule waiting for surgery. That adrenaline which flows through a surgeons veins was kicking in as was the fifth cup of coffee. Macaluso was still at full speed. A long day passed in this manner. Only Macaluso and Kathy, a fee for service surgical nurse assistant, stayed the full span. For them, there were no pauses in the flow. Otherwise, nurses swapped in and out for their lunches and for their breaks. Anesthesiologists gave each other eating and bathroom spells. But for the surgeon and his assistant, Saltine crackers and coffee from the common area off