Considerable attention has been paid in the CA literature to the glossing practices through which participants in conversation formulate who they are, what they are talking about, where the things they are talking about are located, and so forth. There are, of course, gestural glossing practices as well. For any concept or category presented gesturally, however, there is a range of possibilities from which a particular formulation may be adopted on any actual occasion of use. Identifying alternative formulations serves as a useful analytic exercise for exploring the pragmatic consequences of a produced gesture. In our own research, we have been studying the practices through which surgeons provide instruction while performing surgeries in a teaching hospital. We describe here a particular anatomy lesson produced during a surgery. The attending surgeon uses his hands and arms to gesturally construct a representation of a specific anatomic region (“the Triangle of Doom”) for the benefit of two medical students viewing and participating in the surgery. Employing the structure of Schegloff’s analysis of place formulations, we conduct an analysis of the attending’s gestural formulation. We will show how analyzing a particular gesture in this way illuminates both the intricate ways in which the gesture is tied to its context of production and the exquisite specificity of the gesture itself.