PRESIDENTIAL ADDRESS

Advice, Remarks, and Observations to Young Head and Neck Surgeons

Oscar M. Guillamondegui, MD, Houston, Texas

M embers of the Society of Head and Neck Surgeons, friends. Throughout my years as an academic sur-

geon, teaching and training young physicians has been one of the most rewarding and enjoyable aspects of my professional life. I treasure the friendship of my former trainees as much as the love of my own children.

This is my unsolicited, perhaps impractical, but cer- tainly sincere advice to young head and neck surgeons. You have already passed through the difficult, soul- searching times of your medical school. You have sailed through the sometimes proud and rewarding moments, and the sometimes disappointing and emotional chal- lenges of the residency years. You have tested your fiber and ability to overcome failures and concealed deadfall traps and minefields of the spirit for a long time. Now you face a new struggle in your professional apprenticeship.

Your first major decision as a physician was to be- come a surgeon. Only then could you elect to become a head and neck surgeon. We must remember that a good surgeon can only evolve from a sound physician, and a good physician develops only from a morally and spiri- tually healthy man or woman.

To become a surgeon, you went through the many filters that ideally select those who have the infinite thirst

t o learn our art and those who have the physical and psychologic attributes needed to continue a constant and demanding lifetime apprenticeship.

In the world of high and pure ideals, only those with inquisitive souls, those who thrive on searching for an- swers to recurring questions would have made it to this point. Those of you who possess the rare mixture of spiri- tual strength and the physical gift of precise and tender hands will forge ahead.

Surgical technical ability is partially a genetic gift and partially a learned skill. Work to improve your manual dexterity by deliberately organizing your surgical proce- dures and planning every maneuver in your mind. Bril- liant improvisation may be the mark of a technical ge- nius, but most impressive operating technicians have labored long and hard to achieve their stature. Gentle f'Lrmness and purposeful manual gestures, careful han- dling of tissues and organs are the telltale sign of the experienced surgeon. Hands that are unable to offer the tender touch of a caress are hands that should not operate on a head and neck patient. Do not ever abandon the ideal of technical excellence. Some of us were born under a

From the Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.

Requests for reprints should be addressed to Oscar M. Guillamon- degui, MD, Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030.

Presented at the Third International Conference on Head and Neck Cancer, San Francisco, California, July 26-30, 1992.

happy conjunction of the stars and then worked unrelent- ingly to become good technical surgeons; most of us sim- ply worked very hard to that effect. No matter how knowledgeable you become about basic molecular mech- anisms of tumor invasion and metastases, your surgical colleagues will render you the supreme compliment of asking you to take care of their families, upon judging on your elementary common sense, and how skillfully you remove a parotid tumor.

Inside of every outstanding head and neck surgeon is an excellent anatomist. Nowhere in the human body do we find such a compressed, rich array of vital anatomic structures as in the head and neck regions. You must review the pertinent anatomy daily or as frequently as possible. This habit will help you forever in your surgical life.

You ponder the direction your surgical career will eventually take. How much control do you have? Will you become head and neck clinicians, researchers, teach- ers, or administrators? You may become successful and famous in any of these activities, perhaps in all. Neverthe- less, your solid base, the bedrock of your prestige and credibility, will always be the respect of your peers who admire you as a superb surgeon and clinician.

You expect to f'md in your mentor: a good person, the role model you can admire, a good physician who is scientifically informed and responsible, caring and hu- mane, and a skillful operator who will teach you the trade. In turn, you should be willing to pledge your com- plete dedication, your boundless enthusiasm, a solid basic knowledge, and a humble but driving wish to learn the most arcane details of our specialty. The time will come when you will be at the opposite side of the table, the circle will f'mally be closed, and you will have completed the process when you become the respected mentor of a promising young head and neck surgeon.

Surgical conscience is the surgeon's ability to impar- tially and methodically judge his or her own actions and thought processes. This must be deliberately cultivated and nurtured throughout our lives. Surgical conscience speaks of responsibility, feelings, and love, whereas surgi- cal judgment can be cold, detached, and calculating. Of- ten, our surgical judgment and our surgical conscience will disagree. The ultimate guideline could be to personal- ize the decisions in your mind. Would you choose this particular form of treatment for someone you love?

Make the therapeutic decisions calmly and deliberate- ly, but, once the decision is reached, act swiftly, without hesitation. Do not look back.

Our professional pride will always be playing a back- ground music to our medical activities. It will rise to symphonic levels at the tune of our accomplishments and successes, and it will retreat in anguish during our rnis-

5 5 4 THE AMERICAN JOURNAL OF SURGERY VOLUME 164 DECEMBER 1992

PRESIDENTIAL ADDRESS

takes and failures. We should not allow professional pride to overshadow serene judgment in our decisions. Pride is one of the pillars supporting our integrity, but intellectual pride is a poor advisor for our medical conscience. Like the northern lights and the sirens, professional pride tends to mesmerize, distract, and confuse.

In 1956, archaeologists from the University of Penn- sylvania uncovered the Mayan pyramids in the Yucatan, and they found out that the temples were built as layer upon layer of architectural surprises. They built temples on top of temples. Build on the accomplishments of your predecessors. Remember that the accumulation of expe- rience in any subject began long before you. "Re-invent- ing the wheel," sometimes a mass phenomenon by entire groups or generations, only delays progress and stifles growth. Do not limit your study of the literature to the last few years. This problem is clearly demonstrated by the repetitive and superfluous character of most publica- tions. Relatively little published material is truly original.

What about uncharted waters and the welfare of our patients? Our explorations, trials, apprenticeship mis- takes, and false starts tread on patients. Without surgical exploration, there would be no progress. However, we should not sacrifice accomplishments and succ~sful forms of therapy, no matter how meager, for the sake of potential gains.

My generation questioned every surgical dogma from the past. We doubted, we probed, and we changed. I believe that we accomplished our portion of a long mis- sion that perhaps will never be completed. I challenge you to correct our mistakes and to perfect our successes. I hope head and neck surgery in your hands rises to levels of brightness never reached before.

Experience has shown us how difficult it is to predict the clinical course of head and neck cancer. We can accurately predict the behavior of only some tumors. The remaining tumors are still an unknown entity. Avoid making recommendations for treatment or against treat- ment following dogmatic statements of surgical Cassan- dras. Humility and acceptance of our own ignorance will not temper the fire to search for new and better answers.

In legendary times, the Sphinx imposed a question, a riddle, to the weary travelers who happened to pass through the Theban countryside. The true answer was both disarmingly simple and amazingly complex. I ask you to look around and to see who your professional brothers and sisters are. How could you recognize them? I propose a simple answer: Your surgical brothers and sisters are those who do the same type of work you do, those who are as competent as you are, those who try to understand the perverse behavior of head and neck can, cer as much as you do, those who often fall asleep think- ing about the next day's impossible case, and those who suffer the same anxieties and disappointments you do. Those arc your surgical brothers and sisters and true fellow travelers. Forget the specialty camp where they started their journey, forget under what flags their cam- paign began, and forget who their original campfh'e com- panions were. Concentrate on only two things: mutual respect and a common cause. Join forces only with those who hold the same high ideals of perfection and responsi- bility we all share. Do not limit yourself to conversing only with angels like Emanuel Swedenborg.

You should understand that the successful surgeon and scientist needs not to live a vapid and colorless life. I hope you will be able to stretch your hours and your dreams into the world of the arts, sports, and many other endeavors and to live rich and fulfilling lives. I hope, also, that you will someday be able to say to yourselves: Dear God, the sun has shone brightly in my face, and I thank you for I have walked many different and enjoyable paths; I am at peace.

Finally, some advice with a missionary flavor: Live your professional lives as if you were to die tomorrow, and practice your medicine as if you were to live forever. If you do, your thoughts and ideas will remain alive in your disciples after your days are over.

My friends, becoming the President of The Society of Head and Neck Surgeons has been the zenith of my professional career and, indeed, one of the brightest and more significant moments in my entire life. I thank you for this honor. I will treasure these moments forever.

THE AMERICAN JOURNAL OF SURGERY VOLUME 164 DECEMBER 1992 555