Seven years ago, I entered the OR as a patient needing the first of six subsequent shoulder surgeries. After my third trip through those ominously swinging doors, I realized that while I was getting pretty experienced at moving through the paces of prepping and recovering from surgeries, I still had zero understanding at what was happening during the procedures themselves. It dawned on me that it might be quite fascinating for me to watch firsthand how a surgeon actually repairs problematic shoulders like mine.
At this point it would be prudent for me to offer a disclaimer. There are a number of excellent reasons to ask for permission to enter an operating room (as an observer) and some not nearly so noble. As a writer, columnist and book author, I viewed this opportunity as part professional research, part personal enrichment. To my great delight, it turned out to be both of the above (and then some). Though observing surgeries greatly exceeded my expectations, let’s be clear about what actually unfolds in a real operating room bears little resemblance to television’s glamorized fictional accounts. Here is the real deal, and believe me, it’s way better (for your health and mine) than any screenwriter can muster up.
Revisiting this list and what I learned while in the OR, put the bug in me to observe again. It’s the one place I know where there is never a dull moment. Thanks to my surgeon, Dr. Foetisch, for allowing me this cool opportunity to observe firsthand how these professionals do their fine work. 
1.Anesthesiologists may divide their time – Depending on the size of the hospital, the anesthesiologist assigned to your case may not be in the operating room with you during your entire procedure. Contrary to what I previously thought, the person administering the anesthesia doesn’t necessarily stay at your side for the duration. In line with each particular hospital’s protocol, an anesthesiologist may start the anesthetic and then turn it over to a nurse anesthetist who cares for the patient during the operation. Some anesthesiologists move from one operating room to room to another overseeing multiple procedures (and patients) at a time.
2.Instrument trays are often pre-made – Surgical tech nurses whose job it is to hand the instruments to the surgeon during the operation do not go to a stock room prior to a procedure and put together a list of needed instruments piece by piece. Basic instruments are in sets owned by the hospital. These instruments are grouped in sets specific to the procedure. For operations such as joint replacements, however, an independent company does provide the instruments used for this type of procedure but does not provide the basic instruments such as; retractors, forceps, scissors, etc.
3.Closing up the wound site – Even though your surgeon makes the first incision, he may or may not be the one stitching you up after the procedure is complete. Depending upon your surgeon’s practices and preferences, his surgical technician may do the final closing up of your wound because the surgeon might already be out debriefing your family on how the operation went.
4.Why surgery start times are elastic – Surgery schedules are flexible, sort of. Even though you might be scheduled for a 10:30am operation (and you have to arrive at the hospital two hours earlier for surgery preps), your procedure could be delayed for several reasons. The previous patient’s operation might have taken longer than the surgeon expected (you never know what you’re going to find until you’ve been opened up). Or, an emergency add-on might have been scheduled in between yours and another patient’s procedure.
5.Order is everything – There’s a place for everything and everything in its place and this goes for timing too. Each OR staff member has a specific role to play which falls perfectly in place with the other medical personnel. Liken the OR to a finely tuned symphony where every musician knows when and how to use his instrument in harmony with his colleagues to execute an intricate musical performance. Same skill, different dance.
6.Safety, first, last and every step in between – There are many safety protocols carried out in the OR to protect every patient from possible error. Every nurse, technician, and physician, will repeatedly require a patient to state their name, spelling, birth date, and more just to be sure “you know” and “they know” who’s getting what done. The final “check” is having your surgeon place his autograph on your body so once you’re under the sway of an anesthetic there’s no question about it, you’ve given permission and the evidence is written in black and white.
7.Sales representatives know more than you think – If you’re having any type of replacement surgery done, the sales representative whose joint replacement hardware is being used will also be in the OR. Interesting fact, these sales reps understand the surgical procedures step by step just like the other surgical staff members. Prior to placing the replacement part into the patient’s body, the rep and the surgeon will call out the model type/number/size of the hardware multiple times so there’s no chance of error.
8.Surgeons invest hours, patients invest months – Though a patient begins the process of gaining better health by undergoing a medical procedure that may take several hours, this operation is but the first step in a long process of healing for which the patient must take primary responsibility. The surgeon and his staff work for a couple of hours in the OR (after having invested years in education and training), and then the patient works for several months to regain his health.
9.Fitter prior to surgery makes recover faster – The physical state of a patient’s health upon entering the OR matters more than most people realize. A patient’s weight and overall fitness level makes a huge difference on how smoothly a procedure will go. The fitter a patient is before surgery, in general, the faster and less stressful the recovery.
10.OR staffers take their jobs seriously – There is an underlying level of tension in the room because no matter how smoothly a procedure goes, everyone in the room is keenly aware that they’re handling a person’s life in their hands. Though naturally accepted as part of their job description as medical professionals, it was obvious to me as an outside observer (and as a patient) that they take this responsibility seriously (and that’s good to know).
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When I opened my inbox there was a terrifically insightful selection of brief essays written by four medical professionals on the art (and importance) of listening well. 
