I have graduated into adulthood... And it only took 28 years.

My job is not for the weak minded. Some days it's not even for the strong minded. Surgery is an area ignored by most labor laws of the civilized world. It's a place where if you make the business (a lot of) money, you are allowed to treat the employees who are hired to help you like pig shit. No, not cow or horse or chicken shit, like stank ass, you can smell it 10 miles away with a good strong wind, pig shit. It's a place where anything goes. Sometimes working in a place where you're not professionally hindered by silly things like sexual harassment laws, well, that can just make the day go a lot faster. But then there's those other days.

The thing about doctors is that they're psychologically changed by 20 years of schooling. This can be for the better, or for the worse. Some keep their sense of humor, and they stay human beings, and they're genuinely a blast to work with. You are able to use your knowledge and work with them, for the better of the patient.

Surgeons in general are different than other doctors, in that they are an extreme of their specialties. They just don't just make decisions, prescribe drugs, or give advice, they actually screw with people's insides, and make immediate physical changes with their hands for the better, instead of indirectly with drugs, therapy or advice. That changes things.

Then there's orthopods. Orthopaedic surgery is the main moneymaker for hospitals. Without them, there is no money. The personality difference between them and other specialties is a mystery to me. Maybe it's the ability to break a human femur with your bare hands that makes you different. Maybe it's the empowerment that they get from hospitals being scared to lose their business, and letting them get away with murder (not literally). I don't know.

One doc, in particular, is the epitome of nasty high school football captain all grown up. Picture the one jock you remember that beat up all the squirrelly smart kids just cause they could. He was very smart but mean, and generally speaking, better than you. Well, he grew up and became a doctor. A very very good doctor.

Most people in surgery are scared of him, because if you don't anticipate his every need, you get verbally mutilated. Sometimes, if you do anticipate him, that pisses him off too, and you get verbally mutilated. By default, if he's had a bad day, which you don't know because he doesn't talk on his best or worst of days, just stay away from him.

You have to be a personality chameleon to work in surgery. Of course you have to have skill- you have to know each case, but be flexible to change with moods, with events, with doctors. You have to know your anatomy, your instruments, and most importantly, your surgeon. You have to know the right time to do or say anything. If you're good, you can work with anyone on any case. The bonus level is defeating the "boss" without losing your dignity. Wednesday, I defeated the "boss", although I'm not done with the game. (There will be many more bosses to defeat.)

A week before, I worked with him on a case which uses 2 scrub nurses. One (the first scrub) runs the table, and hands off instruments, and the other (second scrub) just stands there and holds the leg, bending it into uncanny positions by order of the surgeon to facilitate access to the joint. Mostly, that person stands there and looks pretty. If they're nice, they backup the first scrub person while she is busy putting together instruments. This case is very difficult. Especially with a difficult surgeon. And he had already done 3 total replacements at another hospital, and he was on-call. So he was in a bad mood.

The first scrub I was working with had her back to the surgeon excessively. It's necessary sometimes to prepare your stuff, but that day almost every time he needed something, she was there, back turned, and, as I was second scrubbing, I had to hand him whatever he needed. He had to ask for things twice, sometimes three times. Which is never good in any case, for any doc. I had her back, to an extent, but I was doing my own job. There wasn't a lot of room to give, and really, I was going above and beyond, since it was not my job. But I'm just nice like that.

By the time it was my turn to take orders, he was pissed. Mega, ultra, uber pissed. And instead of raising his voice, he was mumbling. Behind a mask. He wanted external rotation and abduction. But did he say abduct or adduct? Did he want the neck exposed or was it time to pop the hip back into its socket? He had to trial another cup so I wasn't sure. I cringed as I asked him to repeat himself. At that time everyone in the room could feel the intensity, so everyone spoke simultaneously. The assisting orthopod, the PA, the first scrub, the circulating nurse, and the rep all answered. At the same time. "A-duct!" Was it a "b" or a "d"?! Fuck. I knew I was dogfood if I asked again, so I just externally rotated and stood there, neither ab nor adducting.

That was when the first scrub adducted the leg for me. That was apparently the wrong direction, because the surgeon blew a gasket. An industrial sized orthopedic gasket. Curse words flew, insults; it was an attempt to make me feel 2 inches tall.

And, yes, I was humiliated, mostly because the first scrub set me up. But I refused to let him see me defeated. Most times when this happens in the OR, people get all stirred up, nervous, start apologizing, and sucking up. I stood there, silent. Pissed. I didn't talk back- I knew better (he'd have my job) but I didn't break. He finished up, and as he was suturing, it was tense. He was silent. I forced an indifferent, pissed look onto my mug as well, as I cut his knots.

Unwavering. He finished his first layer, and looked to the first scrub for his second layer of suture. Her back to him was like a knife into the suffocating intense air. Instead of asking for more suture like any other doctor would, defiantly, he stood there- silent. As a second scrub, if you're nice, you help the first scrub by alerting them to situations like that. But furious, I, too, stood there silent, refusing to facilitate things any further. 3 days later, she turned around to find us both standing around the patient's pelvis, our arms crossed, having a silent showdown.

He finished closing the wound. After the case, he left the room, his black aura following him out the door. The broken people in the room bore him farewell, feigning unbroken voices. He said nothing. I said nothing.

After cases like that, the surgeon bans you from his room. (If you're lucky.) But he can't really do that realistically because of the limited number of staff who actually know those cases. Some of them now refuse to work with him. So that leaves maybe 2 people for him to do his cases. Unrealistic.

I'll be honest. I wanted to not work with him again. He doesn't forget and he never forgives. So normally when you do continue to work with him after cases like that, he just gets more and more pissed, treats you worse, and you get more and more nervous and naturally screw up more.

I saw him in the hallway the beginning of the next week. He rounded the corner and accidentally began to apologize for running into me, till he realized it was me. His apology stopped short. I checked the schedule that day and found myself scheduled to be in his room the following Wednesday. 3 staff members are needed for those cases. One to be unsterile, one to second scrub, and one to first scrub.

Instead of worrying about it, I decided I would take the bull by the horns, and chose to first scrub that total knee replacement. He was not going to scare me out of his room. It had been several weeks since I had the opportunity to first scrub his style knee replacement, and the last time was with another doctor who does it a little differently. But that was no matter. Wednesday was D-day.

It takes me about 40 minutes to set up my tables for those cases, and you usually have 20 minutes between cases. There is tons of room for error, and since I just learned totals a couple months ago, and had only scrubbed one or two with him, it was slightly nerve wracking. My chances of failure were worth betting a lot of money on. But luckily, the case ahead of his moved to a different OR, so I had more time than usual to set up.

He came into the room and saw me setting up the table. I could feel the tension instantly. I kept my cool, not letting him see me nervous. When you are 100% sure you are in for a terrible case, it can make you a little nervous, even me. I fumbled at first, but then fell right into the case. He picked up speed to catch me slipping, and held his hand out silently to make me anticipate incorrectly his next instrument. I was all over it. It wasn't flawless, but it worked. At the end of the case, he broke scrub, said my name, held my eye and said, "Thank you."

This is absolutely unheard of. Especially in this case. I won! Things are back to normal. Not better, mind you, but we're back to square one. All that for square one. Jesus.