Scrum, the most popular agile method and project management framework, is widely reported to be used, adapted, misused, and abused in practice. However, not much is known about how Scrum actually works in practice, and critically, where, when, how and why it diverges from Scrum by the book. Through a Grounded Theory study involving semi-structured interviews of 45 participants from 30 companies and observations of five teams, we present our findings on how Scrum works in practice as compared to how it is presented in its formative books. We identify significant variations in these practices such as work breakdown, estimation, prioritization, assignment, the associated roles and artefacts, and discuss the underlying rationales driving the variations. Critically, we claim that not all variations are process misuse/abuse and propose a nuanced classification approach to understanding variations as standard, necessary, contextual, and clear deviations for successful Scrum use and adaptation.