We returned to the VA today. I arrived 45 minutes early, expecting another hassle over scrubs – especially since earlier this week I talked to some students who said they really had been forced to scrub, even in joint cases, in paper scrubs. I guess Thanksgiving had a good effect on the desk lady.

Me (with my best smile): Good morning. Could you help me get some scrubs?
Lady (skeptically): And you would be?
Me: Er, medical student, with Dr. Ashley. . .
Lady (big smile): Oh, that’s right, you were here last week, weren’t you? I thought you looked familiar. Did you have a good Thanksgiving?
Me (in shock): Oh yes; and how was yours?

And she got up and came round to unlock the store-room, smiling and chatting the whole way.
I’m fairly certain it’s the same lady. I guess we should have Thanksgiving more often.

That was the easy part of the day. When Dr. Ashley finally got the shoulder open, things became much more complicated. The resident had shared with me the articles he’d printed in preparation for the case – a very difficult bone grafting procedure, with only a few reports in the literature, for a rare defect. The place to be repaired was on the posterior surface of the humeral head. Accessing it required dislocating the shoulder and holding it at a tremendous and unnatural degree of external rotation and posterior adduction. Did I mention that the guy was a wrestler? His arms were so chiseled they looked like the illustration of muscle anatomy in Netter’s come to life. Guess who got to wrestle with those muscles during the entirety of the three-hour case?

There was one point at which the bone graft had been cut and cut again to fit, painstakingly tamped into place, and screwed down, and then Dr. Ashley tried to relocate the shoulder, and the graft came off. I thought he showed admirable restraint in not throwing anything around the OR. He tried again with a new piece of the graft, and it fit much better, and stayed screwed. I gave up looking at the clock, and tried to pretend that it was my

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