Farewell #2 (I got another chance to address my
Department, June 1996)

     Last year I gave a lot of thought to what I was
going to say on this ceremonial occasion. 
Unfortunately, I forgot that the head resident
graduation dinner should always be an "upper"; while I
was on a free-fall "downer."  It seemed to me that the
intrusion of alien entrepreneurship into what I have
always believed to be a covenant between the physician
or surgeon and his or her patient (and, for that
matter, into the sanctuary of covenants between
teaching hospitals and their students) was intolerable
and insurmountable.  I have had a year to recover my
sense of well-being.  

     Cynics say that we are all motivated by sex,
power, and money.  I have given up power and money, and
I am happier than I have ever been in my life (and not
just because I have more time for sex).  I have gotten
back to being motivated by what I believe to be the
primary engine of self-esteem - namely to be engaging
in activities that will someday leave the world a
better place.  I know lots of people who are driven by
motivations for power and money, perhaps because they
fundamentally lack self-esteem.  For me, self-esteem
springs from contributing a legacy of new scientific
knowledge that will improve the lot of those born with
genetic susceptibility to aneurysms, and a cadre of
dedicated students who will carry on and amplify my own
efforts.  What does this mean for graduating head
residents? 

     It is really pretty simple.  You young surgeons
are among the most highly motivated and idealistic
people on the planet.  In the cases of hundreds of
human beings already (and eventually thousands over the
course of your careers) who have the misfortune of
requiring surgical attention, you can do something with
your hands and minds of inestimable value to people on
earth.  Your self-esteem is assured.

     Whenever a reversal of fortune overtakes a
profession, there will be some inevitable hardships. 
But because your professional activity inherently
generates self-esteem as I have described, you are in a
lot better shape than Baroque architects were at the
end of the Renaissance.  Do good for your fellow man,
and your happiness will take care of itself.  So long
again, but this time with a stronger affirmation for
the future of surgery - and for you highly competent,
talented, and compassionate young surgeons.  Your
parent hospital will bask in your reflected luster as
your careers mature.  I'm very proud of you.