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To My Fellow Thoracic Surgeon

Wednesday, December 6, 2000

Years ago I used to write. Usually late at night. Usually focused on the college student's search for meaning, for purpose. Usually struggling with the reconciliation of idealism with reality. I still have a small package of those writings. One of those musings poses an unfinished task:

Must I grow up?

How it hurts to see the world as it is.

For years I've known

That men are less than they should be.

Now I fear I only begin

To see how much.

Is there not one honest man

Who dares to face

All of the truth?

I cannot, I will not

Accept this state.

I throw the gauntlet out,

Hopeless as the joust may be!

Rather I would face all the rest at once

Than this one I must first subdue.

But I know there's no one else,

I must begin with me.

Thirty-five years later I'm still working on me. Like you, the path I chose was very focused. We worked. We studied. We worked. By day and by night. Week after week. Month after month. College contemporaries of ours became millionaire businessmen, engineers and lawyers. The path was not without self-doubt, expressed by my comment to myself during medical school:

Ambition, you gravest curse of man,

Where, where are you taking me?

Your faint and flickering star

Has teased me, lured me, trapped me.

Up and up I build and climb

Tearing away from what I had

To reach new heights, dizzy heights,

But closer to what? Closer to what?

I can't stay here.

It's hard to breathe,

And I ache for the joys that once were mine.

But there's nothing up there but thinner air

And nothing below but the void I've left behind.

Was it worth it? Am I better off than Joe Johnson with his lodge in Vail and his compound in the Caymans? DAMN RIGHT I AM! You see, I called 21 ICU an hour ago and Mr. Malone has an index of 3.5 and moves all fours to command. Mr. Malone, you see, was just in Atlanta on business from Charlotte. Then his chest hurt and he couldn't breathe. He hit the emergency room cold and sweating after 24 hours. His LVEDP was 38 and his EF was 20. His baggy heart was cursed with diabetic strings for vessels. Worst of all was the pain. Over and over, the pain. V-fib after induction. No blood pressure except from compression until the internal paddles kissed his departing soul. Eight of us, a team working together almost wordlessly, held Mr. Malone's heart in our hands yesterday. Today his index is 3.5 and all four move to command.

Do we share this, you and I? Do you feel the intensity that I feel with every operation? It is the Grand Joust in the Tournament, and each time the opponent, the one I must subdue, is myself. I must defeat my self-doubt with preparation. I must battle my ignorance with knowledge gleaned from others. I must overcome inattention to detail with focus and commitment. I must fight the unexpected with tenacity. I must overcome progressive limitations of physical skill with experience. I must subdue my pride with the understanding that the squire and the armorer and the horse are often more critical than I. Mostly I win. Sometimes I'm knocked on my rear end! But every time there is the rush, the feeling of a unique and personal contribution to the interdependency of human souls. Yes, we share Mr. Malone, you and I.

We are fortunate, you and I. We are fortunate to taste this aphrodisiac almost daily. But the Operating Room is a treacherous mistress. The operation is a great and singular event, but it is a problem, this intermittent total immersion into responsibility for another's life. Tasks of daily living and daily work seem less vital, almost trivial sometimes by comparison. Importantly, the activities that we must undertake to preserve the environment in which we work, to preserve the opportunity to help our patients, present very delayed gratification compared to Mr. Malone.

Thoracic Surgery is threatened today. We must reinvent ourselves not only to adapt to changing technology, but also to be the initiators of progressive change. We must work together to defeat the forces that would reduce us to operating room technicians. We must become the champions of quality and value in medicine. We must be tenacious advocates of patient education and empowerment. There are mountains to move. I believe that great mountains are moved by great faith. But mountains are moved stone by stone. The faith that moves mountains is the faith that you will carry your stone and I will carry mine. And we carry these stones, not for you, not for me, but for Mr. Malone.

References

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Mineo TC, Pompeo E, Ambrogi V, Sabato AF, Bernardi G, Casciani CU. Adjuvant pneumomediastinum in thoracoscopic thymectomy for myasthenia gravis. Ann Thorac Surg 1996;62:1210-2.

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Mineo TC, Pompeo E, Lerut T, et al. Thoracoscopic thymectomy in autoimmune myasthenia: results of the left-sided approach. Ann Thorac Surg 2000;69:1537-41.

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Calhoun RF, Ritter JH, Guthrie TJ, et al. Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 1999;230:555-561.

DeFilippi VJ, Richman DP, Ferguson MK. Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 1994;57:194-7.

Hatton PD, Diehl JT, Daly BD, et al. Transsternal radical thymectomy for myasthenia gravis. Ann Thorac Surg 1989;47:838-40.

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