I'd like to commend the performance of Nurse Pam Karakusis yesterday in the cardiac OR. She is not an OR nurse, but my understanding is she brings a lot of experience from the Med-Surge wing. I was managing the toughest of all cardiac cases yesterday - a Thoraco-abdominal aneurysm - and not to mince words, it felt like I was under attack in a war zone for several hours after coming off bypass. The patient was bleeding heavily and trying to die at least a dozen times - no exaggeration. During the worst of it, Pam was recruited to come to the OR to help with auto-transfusion which we were all unfamiliar with. Her situational awareness, focus, attention to detail were uncanny - almost freakish. She read the situation for what it was, got the patient the desperately needed blood and coagulation products. It freed up my hands which I desperately needed to keep the patient alive pharmacologically. Pam's concentration rivals that of the finest surgeons I've worked with, and I've seen my share. To do it in a venue which she is not accustomed to makes it all the more impressive. Furthermore, the few times I have dropped patients off in the ICU with her present, I've noticed that while others banter or relax, she's always laser-focused on expediting care. No distraction. Never saw anything like it yesterday. I didn't have to say a word. She just knew. Last I heard, the patient is still alive which is some feat after a 16 hours slog.