The past is prologue: surgeons then and now.

About 10 years ago, the dean of student affairs at my medical school asked a group of senior members of the faculty to meet with some 30 of the first year students to talk about just what it was that we found so rewarding in being a clinician in our particular specialty. There were two representatives each from internal medicine, pediatrics and surgery—one from the fulltime faculty and one from the clinical faculty—with perhaps half a dozen others representing various subspecialties of medicine and surgery. I gathered with all the others in a large meeting room just above the library that Harvey Cushing founded. The room is sanctified to the memory of William Beaumont, and it’s a very serious place, befitting a topic that the dean took very seriously. Each of us had been asked to speak for no more than 2 minutes—just to hit the highlights—and then the students were to ask questions. My full-time academic colleague, who was the occupant of the oldest endowed chair in our department, spoke first, for surgery. He talked about the rewards of surgical science, the sense of satisfaction in solving complex problems as part of a team, the rapidity with which we can help people, and the appeal of working with one’s hands—all of those wondrous gifts we are given by virtue of having chosen this fascinating profession of ours. Of course, being a Yale professor he used up not only his 2 minutes but mine too. As I was about to get up, the dean leaned forward in his seat, caught my attention, tapped his wristwatch in that annoying way that petty bureaucrats have, and stagewhispered: “Keep it short, Shep.” And so, I said only what I thought was really important, and here’s what it was: “I love surgery (I said), because it’s fun. There are mornings when I wake up wondering how anyone can really be enjoying life, can really feel fulfilled, if he’s not a surgeon. Actually, I feel sorry for anyone who is not a surgeon.” And then I sat down. My academic colleague looked at me with a mixture of disappointment and disdain—it was as if I’d let the whole department down by talking like such an intellectual flyweight. I could tell what he was thinking. It was probably something like, “What do you expect from these mental midgets in private practice?” But the students understood, and I’ll bet virtually everyone in this room understands. No matter the specifics, the individual motivations and the dissectable details, surgery’s great attraction for young people is that it looks like fun and it is fun. And that remains the great attraction for all of us—10, 20, 30, 40 years later. I tell this little story for a purpose. There’s an analogy I’m aiming at, and the analogy is the study of medical history. I have read more essays than I care to think about, in which some clinician or researcher finds it necessary to answer the question “Why study medical history?” It’s as if one has to justify stealing time from reading the Annals of Surgery to go down to the stacks and turn the yellowed pages of some fragile 400-year-old tome by Ambroise Pare. The reason I became hooked on medical history 25 years ago is precisely the reason I became hooked on surgery. It looks like fun and it is fun. And, like surgery, the vast majority of nonparticipants somehow can’t see just how good a time the participants are having. And also like surgery, it takes a particular kind of world view to appreciate just how much fun it is. And there’s something else in relation to this Presented at the American College of Surgeons 83rd Annual Clinical Congress, American Urological Association Lecture, October 1997.