THE ACS CLINICAL CONGRESS
IN THE CRESCENT CITY-THE BIG EASY
OCT. 8-10, 2001
The multi-ring circus that is the ACS Clinical Congress is familiar to me from about thirty years' attendance at this event but I am probably getting quite beyond it-at least as a holiday out-of-pocket solo entertainment for me in the wining and dining of the Crescent City. Apparently the membership of the ACS felt the same way since the attendance is officially 5,200 surgeons, a decrease by more than a half from the last ACS Congress held in New Orleans and about a third of what it would be if the Clinical Congress is held in San Francisco, as it is every three years. That means that the exhibitors at the big convention center standing in front of several billions of dollars worth of high technology, and preparing their major launch of everything from textbooks to product innovations and designs at this "Launch Meeting"-the world's largest medical meeting perennially, ---are finding out the that new era has arrived, with the expenses of getting here being over a thousand dollars for every traveler and the hassles mounting up past the previous road warrior tolerance, and the simple stay in my no frills room at the Holiday Inn costing another thousand dollars-without any food or drink factored in-all on diminishing clinical receipts-and in my cases-negative ones-will dampen the enthusiasm for the attendance from now into the foreseeable future. Higher tech communication and smaller meetings with more directed personal attention may replace this extravaganza meeting as surely as the "World's Fairs" have become obsolete-as surely as my expense account is a thing of the long-distant past.
Having said that, it is still some enjoyment to meet and re-meet my aging colleagues and learn of changes with them, as I am myself no longer doing what they all were on the fast track, some of whom having slipped still further off the track than I have.
AN ENTHUSIASTIC INITIATIVE BY THE ACS LEADERSHIP
AND THE NEW "GO TO GUY" ON THE THEME OF
VOLUNTEER SURGICAL SERVICE IN THE DEVELOPING WORLD
I may have stepped off the treadmill of the academic surgeon's fast track to the leadership elite of the College, and I may even have done so deliberately, with modified ambitions about being one of the surgical founding fathers-after a nearly conscious decision that it was worth the foregoing of an all-pervading absorption of all energies to get to a not-very-rewarding yield of the professional perpetuation. But, what I have found rewarding is the dedication to service to those underserved in the developing world, and for whatever reason, the College leadership no longer considers this a rather interesting diversion from the real world of surgery which I pursued on holiday in lieu of my not playing golf. For reasons that they may need an antidote to the public image tarnishing that has come from cardiac surgeons buying condominia in the Bahamas, or profiteering entrepreneurs cashing in on the rapidly evolving high tech woofers and tweeters of modern surgical "medibusiness", the College is now interested in focusing some attention on the efforts at least some of the Fellows of the ACS have been donating in the third world. This time it seems to be going on for reasons other than the poster child window dressing of a few do-gooders, but with a theme of making all surgeons aware that surgical care for disease is not-or should not be-- limited to our borders or reimbursement schemes.
So, the ACS has been coming to me, rather than the former direction of my going to them. They have actually asked for articles for the Bulletin of the ACS, just last week published the proceedings of our panel that we had done in last year's ACS in Chicago, and have paid attention to the books just now coming out---my "Surgery and healing in the Developing World" (Landes Bioscience, January 2002), and "Tropical Surgery" of the Current Problems in General Surgery" the following month, and a number of the regents-my former colleagues in the race for the then-coveted, now-regretted chairs in big surgical departments-academic leaders like Ron Merrill, Keith Kelly, Andrew Warshaw have come to me to ask for a registry of places and opportunities available and a data base of the pro bono surgical experiences by fellows of the College. "Medical Missionary" has come around again as a term, not of withdrawal from the competitive "real world" of American surgery, but an honorable special interest the ACS wishes to acknowledge and support. And I seem to be their "Go To Guy"-perhaps the current "poster child" of this new movement of the not-yet-retired fellow who might still be doing what everyone else has been trying to do to scramble to make a living in the shrinking contractures of the medical marketplace. I am getting increasing direct referrals from the ACS of "wannabes"
AN INSTANT PANELIST IS DRAWN FROM THE AUDIENCE
Almost by accident, I stumbled into a plenary session on "Acute Abdomen-Management Around the World" which Keith Kelly was assigned to lead. Two of his speakers did not show up at all due to the events related to September 11, and one of the remaining two sent a substitute to use his own slides wired forward from the University of Hong Kong which John Wong used to present his colleague's talk for him. Keith Kelly spotted me in the audience and asked me to join the panel. He had also buttonholed Cedric Bremer whom I had known well in South Africa who also gave a "pinch hitting" discussion with many apologies. I was the fellow to whom most of the questions were referred, on such subjects as imaging without the use of electricity, management of typhoid perforations and tuberculous peritonitis.
I went from this "pick-up" panel to the one that John Woods had assembled, which was essentially a group of friends of long-standing who had been in service for World medical Missions or even full-time theology graduates who had come secondarily into medical practice when their mission boards recognized the need and asked them to do e.g. ophthalmology residencies. Several of the speakers ran overtime, and Doug had somehow erased his presentation and sat at the front table assembling a new talk on his MAC laptop. But, each of the presentations got the usual collection of the "wannabes" who came up to me afterwards asking for my card (which ran out quickly) or giving me theirs, asking to join the next expedition. They are either residents looking of r a few months between residency and a practice job, or a few folk asking what they can do with an early retirement. A number of participants came forward and said they were very interested in the surgical service but had been turned off by the evangelical requirements of a few of the presenters, and John Woods had to give an official disclaimer at the end to say that a number of the presenters may have expressed views beyond the surgical topic as was their right, but that one did not have to share their religious perspective to participate. One Indian fellow named Das came to see me, and said he wanted to talk to me an not one of the others, since he was not a Christian, and had been turned off by the exclusive protestant fervor of several of the participants-and I told him that the Hindu and Buddhist leaders of the Himalayan Health Exchange might be the ideal resolution of what he sought. I would not want anyone to be excluded from the interest in serving others, whatever their motivations, and try to be very tolerant of others who may differ, some of them fundamentally. We have already seen what intolerance of extremists can do to disrupt the world, let alone programs struggling against overwhelming economic and cultural odds against so natural a common human problem as disease and want.
I saw both Dick and Lowell Fuhrman who came up afterwards, and we even arranged to meet for dinner, but I gave them my phone number and had not heard from them further. I also referred people to them since they are officers of World Medical Mission in Boone, North Carolina. I also tried to arrange a rendezvous with Harold Adolph in Ethiopia-a far better expenditure of an investment about the size of my Holiday Inn Convention Center bill-in accompanying my three medical student seniors-Elizabeth Yellen, John Sutter and a third as yet unconfirmed, who may go with me to Mindanao Philippines and continue on around the Southern Hemisphere to Malawi and/or Ethiopia.
I had made several forays into the Exhibit Hall-a place to go to meet those people whom I could never see if I tried to pin them down in any other place. I rendezvoused on Monday night with Phil and Gayanne Burns, on Tuesday night with Parvis Sadighi and the Berkshire Medical Center crew-learning to my surprise that the University of Massachusetts has a new and capable chief Dana Anderson. We met at Pat O'Briens' and had the real item of Dixieland Jazz played at rather heavy decibels in our ears there, whereas on Monday night I made one brief "trolling run" down the "anything goes" sin strip of Bourbon Street before stopping for a bit of dancing and beer swilling with Gayannne and Phil, who-as many of my friends, asked that I come on down for an overdue visit. I may have to make the rounds all over again, and had promised the BMC crew that I would be happy to come on up around the first of December, for what will now be the 25th visit as Visiting Professor. Not only did I start this program for them and remain their most consistent participant, I believe the next most regular visitor they have had has been there twice!
So, another ACS Clinical Congress is now history, and I have participated in each of them for now the forty years of this surgery business (I heard from Tom Krizek that the average practicing surgeon's career is 22 years. So, I have almost doubled that number, and rather than still talking about some rapidly obsolete little technical or gimmicky innovation, or some minor scientific application wit a future utility that is unknown or perhaps irrelevant, at least I have been shifted into a niche of advocacy-trying to represent the voiceless majority of the world's suffering population. It is a better side to be on than that of the surgical Mega-Business.
I got up at 2:20 AM to be shuttled to the Airport MSY at 3:20 to be early for the security check-arriving at both the ticketing counter and the security check-in about a half hour before each opened. AT one I was surcharged $75 US for the "extra bag" represented by my rifle case, and at the security check in I was stripped of my tweezers and manicure scissors---no big deal, they simply confiscated it out of my carryon bag and snipped it off my keychain. In the basket they tossed it into, I saw a tidy pile of hardware-iris scissors, eyelash curlers, and finger nail clippers and files. A High Security intrusive policy has run amuck---I need to replace that little useful device for the more rational parts of the world where I intend to use its identical replacement!
Next stop---Colorado-and this one IS a holiday stop!