Think about the last time you were at home, relaxed on the sofa, completely immersed in a film. The lights are low, you feel the tension building—you’re trying to figure out what will happen next. Then one of your roommates bursts into the room and turns all the lights on. She is upset, she failed an exam. You feel for her, stop the film and spend the next 10 minutes consoling her. You’re grateful when she leaves and allows you to go back to the film. A few minutes later, your phone rings—you reject the call, but it rings again. One of your medical schoolmates wants to talk to you; he’s in trouble with his girlfriend (again…). As a Good Samaritan, you lend him a sympathetic ear for a few minutes. When he is calmer, he gets off the phone and you’re once again free to enjoy the film. But a few minutes later your other roommates arrive home—will you help to carry the groceries from the car? asks one. Of course you will. As you bring the last bag to the kitchen they ask you to join them for dinner—after all, you haven’t seen them much lately. You accept, as you don’t want to be the only one not joining in, but by now you’re in a rather foul mood—and the rest of the movie will have to wait.

Now, let’s put this scenario aside—and let’s think of being in the operating room (OR), repairing a right inguinal hernia of a 77-year-old overweight male patient with medically controlled angina and diabetes. Your attending is assisting you actively because you’re early on in your learning curve, not having done many of these. You’re a junior resident; you’re keen to get your numbers up and impress the seniors. Unfortunately, you can’t quite focus. Since the beginning of the procedure there have been problems with the OR list—there has been an error, apparently, as the first patient should have been last on the list (she has latex allergy) but no one seemed to know about it. The OR chief nurse is very irritated and so is the attending anesthesiologist—the start of the list has been delayed and now you’re running late. Various people, many of whom you have never seen before, have been in and out of the OR to confer with the team, and your attending manages most of this while you’re trying to focus on the case. There is a radio playing in the background, and someone has left their pager on a stool on the side of the room; the pager goes off every few minutes. At the point when you’re trying to cut the mesh to the right size, a rather angry OR suite manager walks into the room to say that the next case will now have to be cancelled and put on the next available slot. Now your attending gets angry, as he is about to go on holiday and this will clearly mess things up. A heated conversation ensues—you’re keeping your head down and trying to take the case forward, but your boss eventually takes over to speed things up. The next patient is brought into the OR suite shortly after this case is completed. The patient is rolled onto the operating table as you’re writing up the notes for the previous case and the next thing you hear is the senior OR nurse yelling at the anesthesiologist that this patient is the one with the latex allergy, who somehow was brought forward on the list. You sigh. The chaos will clearly continue throughout the day (Figure 16.1).