Let's Bring the Magic Back

In 1995 Hal Urschel, MD, past president of the Society of Thoracic Surgeons, served as the Schuster Visiting Professor at The Brigham and Women's Hospital and Harvard Medical School. During that visit he delivered Surgical Grand Rounds, and his address was entitled "Let's Bring the Magic Back". His remarks were insightful and stimulating, and they are pertinent to many of the issues facing the profession of Cardiothoracic Surgery today. We are pleased to reproduce them on CTSNet.

-Dr. Walter Merrill

Let's Bring the Magic Back

By Harold C. Urschel, Jr. MD

TWO YEARS AGO ALLEN GREENSPAN WAS THE KEYNOTE SPEAKER
AT HARVARD’S COMMENCEMENT,

- WHETHER CONSIDERING GLOBALIZATION OR INDIVIDUAL
RELATIONSHIPS,

HE DEEMED THE MOST CRUCIAL CONDITION FOR SUCCESS WAS

- TRUST.

FOR THE PAST 8 YEARS IT HAS BEEN SORELY LACKING
NOT ONLY FROM ECONOMIC TREATIES,
    BUT WITHIN OUR FOREIGN POLICY

TRUST IS ALSO FUNDAMENTAL TO THE DOCTOR-PATIENT RELATIONSHIP
AND HAS BEEN ERODED SIGNIFICANTLY
    BY THE MULTIFACETED THIRD PARTY INTERFERENCE.

THE EROSION OF DOCTOR-PATIENT TRUST
HAS PROVOKED SEVERE DEPRESSION AND
    “CREPE HANGING” IN PROFESSIONS.

WHAT HAPPENED TO THE “JOY OF SURGERY” (CLEM HIEBERT)

“THE MAGIC STUFF,
THE GRAIL THAT ONCE MOVED EVERY DOCTOR IN THIS ROOM
TO BECOME A SURGEON
AND THAT EVEN NOW BECKONS
THROUGH THE JADING MIST
OF TEDIUM AND TIME.
STRIP AWAY THE CORRUPTING DULLNESS
AND LOOK AFRESH AT OUR PROFESSION.
I STILL CONTEND THAT IT IS THE MOST SPLENDIFEROUS OF ALL
PROFESSIONS.”

WHY DID WE GO INTO SURGERY?

WE WANTED TO HELP OTHER PEOPLE AND WE WANTED TO MAKE A
DIFFERENCE. 

CERTAINLY THE DECISION WAS NOT MADE BECAUSE OF DOLLARS AND CENTS.

SURGERY EMBODIES THE SCHOLARSHIP OF SCIENCE,

THE SKILL OF A FINE ATHLETE,
AND THE NECESSITY TO MAKE A PRECISE DECISION
– THE SURGEON IS THE “FIGHTER PILOT” SO TO SPEAK OF OUR
PROFESSION. 

WHEN I WAS IN SCHOOL HIPPOCRATES’ APHORISM, CHIZELED IN STONE
ON BLDG D,  PRECISELY CHARACTERIZED THE SURGEON’S DAILY
    DILEMA:

“LIFE IS SHORT.
THE ART LONG.
THE OCCASION INSTANT.
THE EXPERIMENT PERILOUS.
AND THE DECISION DIFFICULT.”

MY BOOT CAMP TRAINING WAS TOUGH – SACRIFICE WAS PRIMARY. 

AT THE HOSPITAL. 

MY PATIENTS ALWAYS CAME FIRST . 

MY WIFE, MY FAMILY, MY EMOTIONS ALWAYS REMAINED SECOND –
36 HOURS ON, 12 HOURS OFF, FOR $25.00 A MONTH.

ONCE WHEN I CAME HOME ON A RARE WEEKEND, TO MY TWO SONS
WHO HAD BEEN GIVEN TOY RAZORS FOR CHRISTMAS
    I SAID, “LET’S  SHAVE TOGETHER.” 

THEY IMMEDIATELY BEGAN TO SHAVE THEIR LEGS. 
THAT PRETTY MUCH SUMMARIZED MY INFLUENCE ON THE FAMILY AT
THAT TIME.

IN THOSE DAYS OUR POSITION WAS REVERED
“THERE ARE MEN AND CLASSES OF MEN
THAT STAND ABOVE THE COMMON HERD-
THE SOLDIER, THE SAILOR, THE SHEPHERD NOT
      INFREQUENTLY,
THE ARTIST RARELY, RARELIER STILL THE CLERGYMAN,
THE PHYSICIAN ALMOST AS A RULE.

HE IS THE FLOWER SUCH AS IT IS OF OUR CIVILIZATION AND
WHEN THAT STAGE OF MAN IS DONE WITH AND
ONLY TO BE MARVELED AT IN HISTORY,  
HE WILL BE THOUGHT TO HAVE SHARED
AS LITTLE AS ANY IN THE DEFECTS OF THE PERIOD
AND MOST NOTABLY EXHIBITED THE VIRTUES OF THE RACE.”

ROBERT LOUIS STEVENSON

  I WOULD HOPE THAT IS STILL TRUE

WHO ARE OUR HEROES?

I WILL GIVE YOU A FEW OF MINE – WHILE YOU THINK OF YOURS
WHAT LESSONS OF THEIRS WILL HELP?

DR. CHURCHILL ALWAYS FELT THAT
“WE STAND ON THE SHOULDERS OF GIANTS,
WE ARE CUSTODIANS OF A TRADITION. 
KNOWLEDGE IS HANDED TO US AND WE MUST PASS IT ON,
    SCRUBBED CLEAN, SO AS TO LEAVE THE PLACE BETTER
    AND BRIGHTER THAN WE FOUND IT. 
    THINK OF YOUR HEROES –
    HOW CAN THEY HELP US?”

CHURCHILL FELT THAT THE MAIN STRENGTH OF THE SURGEON
      RESTED IN HUMANISM.

EINSTEIN, ONE OF HIS HEROES, ARTICULATED
      MANY OF CHURCHILL’S PRINCIPLES.

“TIME DOES NOT EXIST
      - THE DISTICTION BETWEEN THE PAST & FUTURE IS AN ILLUSION.”

ONE OF OUR MAJOR SATISFACTIONS AND COMPLIMENTS IS THE TRUST
       THAT OUR PATIENTS COMMIT TO US BY PLACING THEIR LIVES
       IN OUR HANDS FOR CARE. 
THIS IS WHAT MAKES OURS A PROFESSION, AND NOT A TRADE. 

OUR BOND IS WITH OUR PATIENTS,
      SURGERY IS AN IRREVOCABLY INVASIVE REMEDY
      WHICH LINKS PATIENTS WITH US MORE CLEARLY
      THAN OTHER AREAS OF MEDICINE. 
DECADE’S LATER PATIENTS MAY RECALL THE VERY DATE OF THE EVENT,
      ESPECIALLY IF WE HAVE ADDED CARING TO THE CURING.

IN TRYING TO EXPLAIN WHY SOMEONE GETS THE NOBEL PRIZE
  JOE MURRAY – ANOTHER ONE OF MY HEROES TOLD ME THE LAST TIME I WAS
  HERE,

IT’S NOT JUST ONE GOOD IDEA CARRIED TO FRUITION – BUT RATHER A SERIES:
       THAT DEVELOPS A SYSTEM OF CARE

IN HIS CASE:  RENAL TRANSPLANT: IDENTICAL TWINS – (MY 3rd YR HMS)

        RELATED DONOR
 
        CADAVER

JOE IS A GREAT EXAMPLE OF EINSTEIN’S CONVICTION

“IMAGINATION IS STRONGER THAN KNOWLEDGE,
MYTH IS MORE IMPORTANT THAN HISTORY
DREAMS ARE MORE POWERFUL THAN FACTS
HOPE ALWAYS TRIUMPHS OVER EXPERIENCE
LAUGHTER IS THE ONLY CURE FOR GRIEF
LOVE IS STRONGER THAN DEATH.”
                                        - EINSTEIN

IN 1985 DICK BASS ASCENDED MT EVEREST AND BECAME THE FIRST PERSON
       TO CLIMB THE SEVEN SUMMITS
       - THE TALLEST MOUNTAIN ON EACH CONTINENT
       HE TOOK US TO MT. EVEREST IN 1987 TO PUT THE 1ST AMERICAN
       WOMEN ON THE SUMMIT AND AS ONE OF MY HEROES SAID:

“OUR DOUBTS ARE TRAITORS,
  AND MAKE US LOSE THE GOOD
  WE OFT MIGHT WIN,
  BY FEARING TO ATTEMPT.”

JOHN KNOWLES FELT

"HUMOR IS ESSENTIAL IN OVERCOMING MONUMENTAL CHALLANGES
MANKIND’S MOST ENDURING AVENUE TO EMPATHY
SHARED INSIGHT BINDING FAMILIES, FRIENDS
AND EVEN STRANGERS TOGETHER
STARK, PAINFUL TRUTH DELIVERED IN WORDS OF
AFFECTION AND ABIDING TRUST
SHUNS POMPOSITY, SHAM AND ALL FALSEHOOD
HE THINKS IT’S THE BROADEST EXPRESSION
OF HUMAN FAITH THAT WE HAVE"

“WHEN I DIE I WANT TO GO PEACEFULLY,
 LIKE MY GRANDFATHER DID,
IN HIS SLEEP,
NOT SCREAMING LIKE THE OTHER PASSENGERS
IN THE BACKSEAT OF HIS CAR.” (HCU)

DICK BASS LIKE RICHARD SWEET REMINDS US THAT:
        - THE MAJOR GOAL OF THE SURGEON AS THE MOUNTAINEER
        IS TO “OVERCOME DIFFICULTY.”

STANLEY MARCUS - FRIEND
                           PATIENT
                           WORLD TRAVELING COMPANION

HAS BEEN A CONSTANT INSPIRATION AND HIS

LEGENDARY BOOK:

– QUEST FOR THE BEST

 “- THE RIGHT TO BELIEVE FREELY.
  TO BE A SLAVE TO NO MAN’S AUTHORITY.
  IF THIS BE HERESY – SO BE IT.
  IT IS STILL THE TRUTH
  TO GO AGAINST CONSCIENCE IS NEITHER RIGHT NOR SAFE.
  I CANNOT – WILL NOT – RECANT.
  HERE I STAND –
  NO MAN CAN COMMAND MY CONSCIENCE.

MARTIN LUTHER

- MARTIN LUTHER’S FAMOUS CREDO
  IS ONE OF THE NOBLEST EVER MADE BY MAN.
  IT REPRESENTS MY PERSONAL PHILOSOPHY EXACTLY.
  IT IS BY MY SUBSCRIPTION TO IT
  THAT I HOPE TO BE REMEMBERED.”

      STANLEY MARCUS

REMINDS US THAT:
WE MUST INSIST ON “WHAT IS BEST” FOR OUR PATIENTS
        -AS THEIR PRIMARY ADVOCATE.

THE EDITOR OF THE DAYTON FLYER NEWSPAPER WAS CHAGRINED AT
        REPORTING ONLY MURDERS, TRAGEDY AND DEPRESSION
        - MUCH AS WE SEE TODAY.
IN THE LATE 1800’S HE STARTED PUBLISHING ON THE FRONT PAGE
        A STORY TWO OR THREE TIMES A WEEK OF A GREAT
        HERO, INVENTOR, OR SCIENTIST. 
THIS CONTINUED FOR FORTY YEARS – THE REST IS HISTORY. 
DAYTON HAS PRODUCED MANY MORE INVENTORS, LEADERS AND
        SCIENTISTS THAN ANY OTHER MAJOR CITY IN THE COUNTRY PER CAPITA. 

YOU’RE FAMILIAR WITH THE WRIGHT BROTHERS, AND THOMAS EDISON,
        BUT WHAT ABOUT CHARLES KETTERING?  HE DESIGNED A MOTOR
        TO OPEN THE CASH REGISTER DRAWER FOR NCR WITHOUT THE CRANK.
HOWEVER HIS MOST DRAMATIC ADAPTATION ELIMINATED THE
        CHAUFFEUR’S FRACTURE.
HOW MANY KNOW WHAT THAT IS?  THIS WAS A FRACTURE OF THE RADIUS
        STYLOID AFTER “CRANKING THE MODEL T TO START THE ENGINE”
        – THE SELF-STARTER.  HE USED THE SAME MOTOR OF THE CASH REGISTER
TO REVOLUTIONIZE AND
        POPULARIZE THE CAR INDUSTRY.

SOME OF YOU REMEMBER: TO START THE CAR YOU HAD TO
SET THE SPARK & THROTTLE – JUMP OUT, TURN THE CRANK –
        RUN BACK, RESET THE SPARK & THROTTLE BEFORE IT STALLED.
        THE SELF-STARTER DID MORE TO EMANCIPATE WOMEN’S LIBERATION
                 THAN SUSAN B. ANTHONY.

KETTERING SUBSEQUENTLY GAVE MUCH OF HIS FORTUNE TO SLOAN-
        KETTERING MEMORIAL CANCER HOSPITAL IN NEW YORK.

OFTEN A SOLUTION TO A SIMPLE PROBLEM
        MAY HAVE A MUCH WIDER APPLICATION
        ONE ESSENTIAL TO SUCCESSFUL SYSTEMS DEVELOPMENT.

ROSS PEROT OFFERED TO HELP IN 1994 AGAINST CLINTON’S SOCIALIZATION OF
        MEDICINE.
BETSEY & I  BROUGHT HIM TO THE KENNEDY SCHOOL OF GOVERNMENT (KSG) AT
        HARVARD FOR A 2 DAY ORIENTATION - MEDICAL - PUBLIC HEALTH – LAW – BUSINESS
        – TO BRING HIM UP TO SPEED.

ROSS PEROT CHALLENGED US DURING THE CLINTON HEALTH CARE
        SCARE TO “PUT OUR PATIENTS FIRST ” AND PROVIDE LEADERSHIP
        FOR HEALTH CARE REFORM.  FEW OF US COMPLIED.
WE ARE VICTIMS OF OUR PERSONALITIES AND OUR TRAINING. 
WE DON’T FOLLOW ANYONE. 
IT WAS THE RESTAURANT OWNER AND WORKERS’ UNION WHO
        SUCCESSFULLY LOBBIED AND DEFEATED THE CLINTON HEALTH
        REFORM CHALLENGE.
LEADING SURGEONS IS LIKE HERDING CATS. – ONE OF OUR MAJOR HURDLES TO
        DEVELOP SYSTEMS
GIVING OUR PATIENTS PREMIERE BILLING IS CARDINAL TO FUTURE SUCCESS.

BASED ON THE SUCCESS OF PEROT’S ORIENTATION AT THE KSG, BETSEY AND I
        ARRANGED A HEALTH POLICY COURSE THERE TWO TIMES A YEAR FOR CARDIOVASCULAR
        LEADERSHIP AND INDUSTRY.

PEROT POINTED OUT:
“THERE ARE AT LEAST THREE AREAS IN WHICH AMERICA EXCELS IN THE
       WORLD.”
“OUR FARMER IS THE BEST
      -ONLY 6% OF OUR POPULATION IS REQUIRED TO FEED ALL OF US
      -IT TAKES 65% OF RUSSIANS AND 75% OF CHINESE FARMING –
WE BUILT THE FIRST, AND BEST AIRPLANES, IN THE WORLD.
OUR MEDICINE AND RESEARCH ARE WORLD-CLASS.  PEOPLE COME FROM
      ALL CORNERS OF THE EARTH FOR OUR HEALTH CARE. 
ALL THREE OF THESE SHINING STARS ARE BEING CRIPPLED
      BY THE SAME FORCE – THE PARASITIC MIDDLEMAN .”

WE MUST REDUCE THE POWER OF THE MIDDLEMAN.
      -THE INSURANCE COMPANY. 
WHO HAS THE TALLEST BUILDING IN EVERY CITY?
      – HE WHO CONTROLS THE DATA AND INFORMATION
      CONTROLS THE SYSTEM.

HENRY CISNEROS DESCRIBED THE INEVITABILITY OF CHANGE,
“IF NO ONE LIFTS A FINGER OR NO ONE CARES, THINGS CHANGE
THE HUMAN BODY GROWS OLDER, MACHINES GROW RUSTY,
FRIENDSHIPS FALL APART, FOUNDATIONS BEGIN TO SETTLE.
LEFT UNATTENDED, THE DYNAMIC OF CHANGE IS ‘DECLINE’ ”.
THE TRICK IS TO CONVERT CHANGE INTO A POSITIVE FORCE AND THAT TAKES POSITIVE ACTION. 

GENERAL DOUGLAS MACARTHUR MADE IT VERY CLEAR:

“THE HISTORY OF THE FAILURE OF WAR CAN BE SUMMED UP IN
TWO WORDS: TOO LATE
TOO LATE IN COMPREHENDING THE DEADLY PURPOSE OF A
POTENTIAL ENEMY;
TOO LATE IN REALIZING THE MORTAL DANGER;
TOO LATE IN PREPAREDNESS;
TOO LATE IN UNITING ALL POSSIBLE FORCES FOR RESISTANCE;
TOO LATE IN STANDING WITH ONE’S FRIENDS”.

WE MUST RECAPTURE THE:

“THE JOY OF SURGERY
 THE MAGIC STUFF, THE GRAIL
 THAT ONCE MOVED EVERY DOCTOR IN THIS ROOM
 TO BECOME A SURGEON,
 AND THAT EVEN NOW BECKONS
 THROUGH THE JADING MIST OF TEDIUM AND TIME.
 STRIP AWAY THE CORRUPTING DULLNESS
 AND LOOK AFRESH AT OUR PROFESSION.
 IT IS THE MOST SPLENDIFEROUS OF ALL PROFESSIONS.”

IT’S TIME TO TAKE THE MAGIC BACK .