You must be the change you wish to see in the world

I would like to thank the Society for the privilege of serving as your president (Fig. 1). For me, this is but a point on a journey, as I hand the presidential reins to Dr. Melvin. SAGES itself remains a journey I hope to continue with many of you for years to come; there is no actual destination. In partnership with other groups, this journey will help to define gastrointestinal (GI) surgery and surgical endoscopy for the future—a future that YOU will live in. If you have been in practice for a while, you can see the path that led you to where you are today complete with the potholes and wrong turns. I am sure that there were times you could not quite see your way. If you are now just starting out, I am sorry to say that there are no maps; the best you can hope for is a compass. My compass led me on a journey past three particular mentors: two cardiac and one trauma surgeon. Michael DeBakey was legendary. He was a relentless taskmaster who pursued perfection in surgery for more than 70 of his 99 years (Fig. 2). Most of the stories associated with him, such as residents living in the hospital for two to three months at a time, are true. He lived and pursued excellence for himself and those around him. Those who did not measure up were shredded and fired. Kinder and gentler had yet to arrive in Houston in the early 1980s. The surgical residency pyramid was very steep for the seven chief resident slots. There were many casualties, but if you survived, you were reasonably fearless (for better or worse) in the operating room. He did not converse much with residents, but he loved to talk to the medical students about the early days of vascular surgery and making vascular grafts on his wife’s sewing machine (Fig. 3). He told our second-year medical school class, ‘‘You cannot learn to play the violin by reading the sheet music.’’ He participated in more than 60,000 surgeries. It was awe-inspiring. I stayed at Baylor for my surgical residency. Although he worked us into the ground, it should be no surprise that the vast majority of residents went into cardiovascular surgery. In fact, all of my fellow chiefs became cardiovascular surgeons, except me. I guess someone has to be the black sheep. My compass pointed to general surgery. I had seen an angioplasty in 1983 and decided that cardiologists would someday overrun coronary artery disease. It took awhile, but this year there are only 55 applicants for the 110 nonintegrated cardiothoracic residency positions. With this in mind, I went to the program director and asked to do an endoscopy rotation. He chuckled and told me I would have to talk to Dr. DeBakey if I wanted to do something like that. Dr. DeBakey sat behind his desk and looked up at the terrified third-year resident. I asked about endoscopy. He said nothing—he just went back to his work. I stood there speechless. The interview was over, but the next day I received a page from the Chief of Gastroenterology at the Houston Veterans Administration Hospital and spent the next few months learning how to ‘‘scope.’’ Years later, I ran into Dr. DeBakey in a bookstore in Houston. We talked about endoscopy. He described training and working with Alton Ochshner and doing rigid endoscopy. That day one of the world’s greatest cardiovascular surgeons told me that general surgeons were foolish for ceding the majority of endoscopies. He said we would need to relearn those skills someday. Thank you, Dr. DeBakey for your prescience. We’ll get back to him later. A few months after that endoscopy rotation, I was called to the operating room one day by the GYN chief resident who was peering down a laparoscope. He was bent over S. D. Schwaitzberg (&) Department of Surgery, Cambridge Health Alliance Harvard Medical School, Cambridge, MA 02139, USA e-mail: sschwaitzberg@challiance.org