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induction, mildly irritated at Stevenson for not telling me about this earlier. With the right preparation I look forward to cases like this—calming a challenging patient in my preoperative interview. I’m playing psychiatrist as well as medicinal artist, a chemical hypnotist beckoning the frightened and the uninitiated into a secure and painless realm of trust. It’s a private world I build with my patient, a world the surgeon never sees, a secret pact that never makes it into the hospital record or onto an insurance billing form. I like to think it is where I can make the most difference—spinning the first layer of the anesthetic cocoon with language instead of drugs.
    “OK. I might need a little extra time then, to get some sedation going before we bring her into the room,” I tell Alicia.
    “You’re the boss. I go home at three no matter how much time you take.”
     
    My first patient today is a forty-six-year-old woman who will lose her right breast to cancer. I greet her in the surgical holding area, smiling, cheerful, deflecting her anxiety with rapid-fire questions and explanations, reassuring her that she wins the lowest risk classification for undergoing anesthesia—ASA 1 on a scale of 5. She is sitting up in her bed, slender and tanned, wearing light pink lipstick and tasteful eye makeup (for whom, I wonder). It gives the morning a patina of normality, as if she were headed to the tennis club instead of cleaving this invasive parasite from her body.
    I feel like I’ve met this woman before, dozens of times. She is the Junior League volunteer, the poised hostess, the sorority alumna usually referenced by her husband’s full name prefixed with a Mrs ., polished enough to be mistaken for pampered. She is the woman who does not wince when I start her IV, who asks me about my work and my family and defies me to pity her. She will beat this and move on.
    Wrapped warmly on the narrow operating table, I lean next to her ear as she slips beyond knowing, and whisper, “I am right here with you. I will take care of you. You will wake up safe and comfortable. You will recover and be fine.” The faintest rise in her heart rate is the only fear she ever shows.
    The case goes well. The steady high pitch of the pulse monitor tells me her red blood cells are richly saturated with oxygen. The slight valleys and peaks of her blood pressure and heart rate guide my mix of anesthetic gas flows, narcotics and fluids. We are in an unspoken physiologic communion, my patient and I. I stand like a sentry at the gate of surgical trespass.
    Stevenson is in a good mood this morning, thank God. His kid has just been chosen first-string quarterback in tenth grade, so maybe he is hoping college tuition will be covered. He teases Alicia about setting them up together, the “things” she could teach him. When the patient’s lymph nodes come back from pathology free of cancer the mood lifts for all of us and Stevenson asks for closing music—he likes to suture the skin to Led Zeppelin.
    I can almost quantify how well a case is going by the volume of the background music and conversation. People on the outside seem shocked at the irreverence of listening to a hard-rock band while latexed hands split or sew the tissues of living flesh. But I reassure them—that is a good sign. That is the sign your surgeon is walking straight down the center of known territory, so at ease with this procedure his hands are driven by comforting familiarity. That is the sign your anesthesiologist hears the steady high tone of the oxygen and heart monitor and knows, intuits, exactly where in the operation the extra touch of narcotic or the lightened breath of gas will foment the precise balance of chemicals to keep you sleeping, unaware and senseless, until the last bandage is taped, the fresh sheet is pulled over your chest, and you hear the reassuring whisper in your ear, “Wake up, wake up, your surgery is over, and all went well.” We have honed