Surgeons are well-known for precision and protocols. There is often a ritual nature to our actions when preparing for surgical interventions, an orderliness and discipline: checklists, time-outs, pauses, consensus.

Two submissions in the Fall 2021 issue of Intima focus on a particular aspect of surgery—those distinct moments that come before the start of an operative case. In her succinct Field Notes essay “Lauds,” pediatric surgeon Kristen Zeller presents a surgeon’s morning leading up to the first surgery of the day. Each step is identified: the surgeon’s approach to the operating room, the bustle of activity as preparations are made, the synergy of the partners who make up the care team itself—nurses, anesthetists, medical students, assistants—all going through their individual checklists for the procedure, as the surgeon mentally checks off each contribution to the whole. It is a communal activity, as the team prepares for the work ahead of them.

The surgeon then finds their own individual, private moment of centering and focus, a solitary litany in preparation for the procedure, a personal checklist more detailed than the one shared with the team. What is needed to physically proceed and what is needed mentally as well.

It is a grounding of oneself, a settling, the hand-washing itself a ritual of cleansing the mind and body to center on the ultimate focus of all this preparation—the patient.

My poem “7:30 Start” takes place in the moments after Zeller’s piece ends. All the team activities have been completed, the items checked off; all that remains is the intimate communion between the surgeon and the patient. This is the deep breath before the plunge, this moment before contact, before the knife touches skin.

It is a moment of concentration, of self-reflection, of awe at the trust placed in our hands. A moment of solitary stillness before the work begins.

It is the moment where we are reminded of the sanctity and enormity of what we do.

Photine Liakos has spent her career as an orthopaedic surgeon. She received both her undergraduate degree in Comparative Arts and her medical degree from Washington University in St. Louis. Writing makes her feel like she is more than a small cog in a big machine. Baking is her love language. She is endlessly fascinated by all things related to J.R.R. Tolkien and The Beatles.