The personal relationship between physician and patient has long been the cornerstone of medical practice. The bond that is created between a patient and his or her surgeon is often forged in times of crisis (eg, cancer or catastrophic illness), leading to a particularly powerful and special covenant. Because problems such as the development of a tumor, hemorrhage, or bowel perforation cannot be scheduled in an orderly manner during standardized hours, general surgery has never lent itself readily to a predictable work environment. A deep sense of duty and commitment to our patients, especially during critical times, makes the concept of work hour restrictions, or shift work, seem wholly unacceptable.