FAREWELL TO MY DEPARTMENT - June 5, 1995


[slide] "When a man knows he will be hanged in a fortnight, it
concentrates the mind wonderfully."  Samuel Johnson

     This is my last chance to address you as your Chairman on
a ceremonial occasion.  I have been reading famous gallows and
farewell speeches to put myself in the right frame of mind:
Socrates (when he drank the hemlock), George Washington (when
he decided not to seek a third term), Lou Gehrig (when he
retired from baseball)...  These have all been collected in a
marvelous book by William Safire named "Lend Me Your Ears."

This picture of Nelson Rockefeller has been in my scrapbook
for almost 20 years.  Many of you will remember that he was
Governor of NY, and I'm going to take a lesson from him when
I say goodbye to the administration.  

[Slide: shows Rocky giving the finger]

With you, however, I would like to speak from my heart.

[Slide: "It would be useful..."]

There are 4 legs on the stool of academic medical practice:
clinical work, education, research, and administration.  I
sometimes regret that I came to the conclusion that I could
save more lives from aneurysms by thinking about them and doing
research, than by operating on them one at a time.  But anyway, 
I have been reflecting on teaching, research and administration; 
with the hope of distilling my experience into something that 
I can put into a nutshell for you.  We'll start with education....

[Slide: "Old soldiers never die..."]

When General Douglas MacArthur gave his farewell to a Joint
Session of Congress, he delivered a punch line that has
launched a thousand jokes (I might tell some of them).  But,
old teachers never die either; their influence can go on
forever.  

[Slide: The solid blocks of marble in front of the Cathedral
of St. John the Divine, when I moved to New York from Yale in
1989]

This was my first class of interns here in 1990.

[Slide: Finished sculptures of the apostles, 1995]

Look at them today.  From my Yale years I have former students
who are now professors at Harvard, Yale, Hopkins, Wash U
St Louis, Univ of Michigan, Medical College of Georgia -- and
there are quite a few others that I taught surgery (but not
research) who are teaching in other medical schools all over the
country.  And there are more in the pipeline now from my years
in New York.  

Does an old teacher have any secrets?  Make time for your
students and respect the dignity  of their persons and their
ideas.  There's a covenant between a teacher and a student;
never take advantage.  Attendings teaching residents,
senior residents teaching junior residents - strive for
excellence.  Having students in an institution promotes
integrity and gives the whole organization a fountain of moral
energy.

Research

As my students know, my pulse picks up every morning when I go
over to the lab and look for God through the mist of Coomasie
Blue in the destaining polyacrylamide gels.  How many of you
know that the poet Keats went to medical school in London
and was apprenticed as a surgeon?  Fortunately, he did not
persist in that career, but concentrated on his poetry, so
that when he died at 25, he left what some have felt to be the
greatest legacy of lyric poetry in our language.  When he
came to describing the thrill of first reading Chapman's
translation of Homer, he turned to the metaphor of scientific
discovery:  

     Then felt I like some watcher of the skies
     When a new planet swims into his ken;
     Or like stout Cortez when with eagle eyes
     He stared at the Pacific - and all his men
     Looked at each other with a wild surmise -
     Silent, on a peak in Darien.

Most of you are meant to be surgeons, but some of you will be
both surgeons and scientists.  In children, the best predictor
for a successful career in science is how they respond to: "Do you
like questions with one correct answer or with several correct
answers."

If you enjoy problems with only one correct answer, you should
make the most of every opportunity to see over the top of a
mountain.  It will add immeasurable richness and joy to your career.

Administration

If it comes your way, you will find that administration
requires a major adaptation from the characteristics that made
you successful in the first place.  Your intensity in pursuing
excellence in surgery, teaching and research brought you to
your position.  But now you must re-orient from concentration 
on your personal objectives to improving the environment 
for everyone.  

There are astonishing parallels of my present situation to
that of the Magister Ludi in Hermann Hesse's *Das
Glasperlenspiel*, which I read almost 30 years ago.  It is
arguably Hesse's greatest masterpiece, for which he received
a Nobel Prize.  Details of the glass bead game were left
somewhat vague, but the game was the pinnacle of human
intellectual achievement.  It was something like a combination
of chess and playing on an organ with multiple stops,
registers, and keyboards, and it was played with the whole sum
of human knowledge: music, mathematics, literature, science. 

      The Magister was the *Master* of the game, and he was
responsible for organizing the Annual Game, which became
a spectator sport, with meditation and spiritual
renewal for the whole community.  The Magister realized that
the real world was changing, that the Ivory Tower Game
was getting out of touch, so he decided to say goodbye, at
least to his official function as an administrator.

       I wish I had thought of the parallels sooner, as I
might have composed a more eloquent letter of resignation. 
The best that I could do last summer was to stand up at the
Medical Board, tell a joke, and give a year's notice to seek
my successor.  If I had it to do over again, I would send the 
following to the Board of Trustees.  I have made a few minor 
changes, but it is very close to the original Hesse.  The Magister 
becomes the Director; the Academy becomes the Teaching
Hospital; the Game becomes the Academic Medical Center;
the Department of Mathematics becomes the Division of Cardiac
Surgery (with a modified phrase).

To the Board:

     Although I have endeavored to serve with all my strength,
the conduct of my office is (or seems to me to be) threatened. 
At any rate, I see my suitability to serve as Director is
imperiled, and this by circumstances beyond my control.  To
put it briefly: I have begun to doubt my ability to officiate
satisfactorily because I consider the Teaching
Hospital itself in a state of crisis.  My awareness of it
demands that I seek a position other than the one I now hold. 

     We depend on the condition of our country and the will
of the people.  We practice, use our libraries, teach and do 
research - but if the nation no longer wants to authorize this, then
our life and studying could be over in a minute.  Some day our
country might decide that its Academic Medical Centers are a
luxury it can no longer afford.  Instead of being proud of us,
it may come round to regarding us as parasites, tricksters,
and enemies.  ....

     The road leads downhill.  Historically, we are,
I believe, ripe for dismantling.  I draw this conclusion from
the movements which I see already in the outside world. 
Critical times are approaching; the omens can be sensed
everywhere; the world is about to shift its center of gravity. 
... In spite of the government's benevolent disposition toward
us, much of the economizing will strike us directly.... When
the time comes to save the country every needless expenditure,
the elite schools will be contracted, the funds for the
maintenance ... of the libraries will be eliminated...  

     All of the principal divisions of our department
will be allowed to continue except for the office of the
Director.  Cardiac surgery, for example, is needed to fill
beds; but the Office of the Director is the most outlying and
most vulnerable part of our structure.  Perhaps this explains
why the Director, head of the unworldliest office, should be
the first to sense the coming calamity.

[slide: St Luke's LOGO]      

Well, what have I been talking about?  The future is going to
be more difficult for your generation in medicine than it was
for mine.  But the values I have discussed are changeless in
a changing world.  Teaching holds great rewards.  Do not
neglect this privilege of your profession.  Contributing to
new knowledge can thrill you, the way Balboa and his men must have 
been moved, when they grasped the significance of the Pacific Ocean. 
Be vigilant for opportunities to figure out how nature works. 
And even administration can be a source of satisfaction, when
after all the battles (some won, some lost), the place has become 
a better environment for each and every one of you - 
to strive, to seek, to find, and  *to be*  your personal best.

Goodbye, and good luck.