Looking Back, Moving Forward

Walter H. Merrill, MD, EditorDecember 2013

ALMANAC

Consider these notable events that occurred in the year this Presidential Address took place.

2012

In February, Queen Elizabeth II celebrated the 60th anniversary of her accession to the thrones of the United Kingdom, Canada, Australia and New Zealand.

The 2012 Summer Olympics were held from July 27 to August 12 in London. The United States topped the medal count with 104 total, including 46 gold.

On November 6, President Barack Obama was elected to a second term in office, beating Republican presidential candidate Mitt Romney.

“The past is malleable and flexible, changing as our recollection interprets and re-explains what has happened.” – Peter Berger

Dr. Michael J. Mack’s Presidential Address (Ann Thorac Surg 2012;94:1044-54), “If This Were My Last Speech, What Would I Say?”, contains much good advice for today’s practicing cardiothoracic surgeon. He began by saying “how proud I am to be one of you, a thoracic surgeon!” He said that “we as thoracic surgeons have the unparalleled privilege of standing at an even more important place: at the intersection of science and humanity.” He went on to say that “you have the ability and responsibility in your actions and your decisions to save a life, to change a life. Who else can say that?”

He challenged us to innovate, saying “innovation is not an option—it is mandatory.” He then gave three examples of “thinking outside the box”: new apps for thoracic surgery education, new medical devices, and new radiologic techniques.  While all of us may not be gifted innovators, Dr. Mack challenged each of us “to find your own way to lead, to give back, to think outside the box.”

He then imagined if he were to leave a letter to the next STS President, what would it tell that person about unfinished business? His letter would say we should expand “the focus on improving surgical outcomes.” He would make it a national goal “to make CABG mortality under 1% over the next 5 years” and “to make the stroke rate less than 0.5% during the next 5 years.” Likewise, we should lower the mortality rate for aortic valve replacement to 2% by 2017 and “do whatever it takes during the next 5 years to double the mitral valve repair rate to 80%.”

Dr. Mack then went on to tell us “we can accomplish much more by reaching out, joining hands, and working together.” We need to get away from our silo mentality and “throw away our union mentality, to divest ourselves of self-interest, and to work together.” He mentioned recent successes in partnering with the American College of Cardiology, the SYNTAX trial, new guidelines that call for a heart team approach in the PARTNER trial, close collaboration between the ACC, AATS, and STS, and the STS/ACC TVT Registry. He challenged us—the individual practitioners—“to reach out in your own institutions: take the first step, extend your hand, and break down the walls that divide us.”  By doing so, we can “speed the process of medical device innovation in a safe and effective manner.” Through partnering and joining with governmental agencies, “we are now part of the process and not just the subject of decisions beyond our control.”

The last thing he would say in his letter to the next STS President would be about “the real everyday, tangible, palpable, emotional investment in another person’s life that thoracic surgeons make.” He stated that “one of the great gifts of working in medicine is not what you learn about working but what you learn about living.” Finally, he advised us to “take every opportunity of the unique privilege that society has bequeathed us to make a difference, to think outside the box, to reach out a hand, to hold a hand, to break down a wall, to destroy a silo, to partner-up.”

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As we close out our “Looking Back, Moving Forward” series, there are just a few remaining things to accomplish in this final column. Most importantly, let me say thank you. It has been a pleasure to read again and reflect on what our Presidents have had to say in their Presidential Addresses. They have given us good advice to follow as we go forward into the future. While the future is uncertain, we should approach it with hopeful aspirations about making it better for our patients and ourselves. Let us remember the advice of Howard Zinn:

“To be hopeful in bad times is not just foolishly romantic. It is based on the fact that human history is a history not only of cruelty, but also of compassion, sacrifice, courage, kindness. What we choose to emphasize in this complex history will determine our lives… if we see only the worst, it destroys our capacity to do something. If we remember those times and places—and there are so many—where people have behaved magnificently, this gives us the energy to act, and at least the possibility of sending this spinning top of a world in a different direction. And if we do act, in however small a way, we… don’t have to wait for some grand Utopian future. The future is an infinite succession of presents, and to live now as we think human beings should live, in defiance of all that is bad around us, is itself a marvelous victory.”

With the above review of Dr. Mack’s address, we have now completed our task, set out in September 2011, which was “to begin to reflect on the origins of The Society of Thoracic Surgeons, the progress made by the Society and the field of cardiothoracic surgery since that time, and possible future endeavors and successes.” I can only hope that this effort has been successful and enjoyable for the readers. It is, perhaps, worthwhile to see how the past informs and affects not only the present, but also our future. We have attempted to infuse these postings with the wisdom expressed by Winston Churchill: “History with its flickering lamp stumbles along the trail of the past, trying to reconstruct its scenes, to revive its echoes, and kindle with pale gleams the passion of former days.” By all means possible within our powers, let us go forward with passion.

And so we end where we started, with the first President of The Society of Thoracic Surgeons, Dr. Paul C. Samson. Let me remind you what he stated in his editorial, “A New Specialty Surgical Society: La Raison d’Etre” (Ann Thorac Surg 1965;1:1-2). He said, “We believe that The Society of Thoracic Surgeons has a well-defined place in the schema of surgical organizations. We believe that the Society is not competitive, but additive. We believe that the Society will attract gifted young practitioners of our specialty, and benefit from their contributions. We believe that the scope and opportunities of thoracic and cardiovascular surgery as a specialty will unquestionably be enhanced because The Society of Thoracic Surgeons exists.” May it always be true.

And finally, let us think once again why a consideration of history is important. William Welch said it best: “Nothing adds more to the interest and fascination of our profession than the study of the historical and cultural background of medicine and the natural sciences through the ages, and I venture to add that such study helps to make better teachers and better doctors.”

Thank you.

--Walter H. Merrill, MD, Editor



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