Major surgery is underway for our town. The surgical plan is very complex, trying to answer present and future needs and trying to do it all in a single operation. 
In my participation in major operations that required coordination among diverse specialties, unexpected intraoperative challenges can so burden the outcome that everyone regrets acceding to the idea that all surgical goals be accomplished in a single trip to the OR. There are limits to how long you can safely keep an elderly patient under anesthesia. 
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Consider the bridge replacements and essential track repairs first. Then reconsider the needs of agencies that dream of tunnels and double-deck cars. It’s our town. Let’s walk before we run.
Patrick Stine, MD
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Whiting