Where does the dwarf stand—And whom does he thank?

TRANSACTIONS OF THE TWENTY-SIXTH SCIENTIFIC MEETING OF THE SOCIETY OF GYNECOLOGIC SURGEONS

Where does the dwarf stand—And whom does he thank? Presidential address Donald G. Gallup, MD Savannah, Georgia

Please let me preface all my comments by thanking all of you for the privilege of serving you during this past year as your president of a growing and vibrant Society. It has been an honor. Dwarfs and giants, what is he talking about? Thank you to whom? As with all addresses similar to this, I had to seriously think and review—not about randomized prospective studies (now termed evidence-based medicine), not about some new surgical technique, but about a lifetime in academic medicine. I reviewed several presidential addresses, many of which I have heard. Most were presented at our Society. Some were presented at other societies. Older addresses have evaluated and alluded to manpower requirements for our specialty in general and the need for further gynecologic surgery training. More recent Society presidents have addressed such issues as who will fill our shoes as teachers or have reviewed our history and encouraged us to be active in shaping the future of our Society and the future of gynecologic surgery.1-3 Many of these same addresses noted the negative economic impact on us as gynecologic surgeons of changes during the past decade. As pointed out by past presidents Ray Lee and Bruce Drukker,4 we are truly privileged to be able to care for patients, but we need to continue to earn the trust of our patients. Our patients do teach us. Last year John Rock5 spoke to us about our role as From the Department of Obstetrics and Gynecology, Memorial Health–University Medical Center. Presented at the Twenty-sixth Scientific Meeting of the Society of Gynecologic Surgeons, New Orleans, Louisiana, February 28–March 1, 2000. Reprint requests: Donald G. Gallup, MD, Memorial Health–University Medical Center, 4700 Waters Ave, Savannah, GA 31404. Am J Obstet Gynecol 2000;183:1335-7. Copyright © 2000 by Mosby, Inc. 0002-9378/2000 $12.00 + 0 6/6/110907 doi:10.1067/mob.2000.110907

mentors. He provided us guidelines to enable us to serve as mentors and noted from his survey that “those mentored are more likely to serve as mentors.” With a background from the masters, I decided to focus on the following two major aspects of our careers, not necessarily in the order of importance: (1) our mentors and (2) our families. We owe them a debt. D. Stella coined the phrase in 65 CE: “A dwarf standing on the shoulders of the giant sees further than the giant himself.”6 I am not confident that any of us should take that particular wordage literally. But the phrase does give me the opportunity to reflect and honor those who taught me and continue to teach me. During my medical school training at Emory University I had the privileged opportunity to be a student of John D. Thompson. He was a newly appointed chair. He taught all of us to be humble and to respect our patients. He taught us discipline. And I do mean discipline. The volume of patients for medical students was extraordinary. The teaching was superb. I owe him. But I was determined to become an orthopedic surgeon. In that era we were all obligated to undertake military service or similar service. I eventually found myself in a small dispensary at a naval station in Mayport, Florida, after some overseas assignments. It was there I met CAPT Edward E. Hogan, MC, USN, a wise internist, at the tail end of a distinguished career. From Hogan, I learned the “four rules.” These are rules I have passed on to students and residents throughout my academic career. If followed, they lead to a moderately passive aggressive approach to work and life. These rules are best summarized by a tenet most of us live by: “Never take on battles that you cannot win.” Hogan, for some reason, took a shine to me. He told me that he would obtain for me a residency in obstetrics and gynecology in any program in the Navy. I chose San Diego. I owe him. 1335

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CAPT William E. Lucas, MC, USN, the chair and a gynecologic oncologist, was underwhelmed by my arrival. Lucas made Thompson’s disciplinary approach look like grade school. Ramrod straight in appearance, he did have compassion for his patients and, although certainly somewhat hidden, for his residents. He was a master surgeon, and his meticulous technique and compulsive care pushed me to consider a career in performing radical surgery for what our trauma surgeons call the “organs of darkness.” He also took a shine to me, after a few years. He carefully advised me and wrote strong letters of recommendation for my fellowship. I owe him. After interviews with the usual programs in gynecologic oncology, such as Miami and MD Anderson, I found myself in A2—Ann Arbor, Michigan. The details are long, but briefly, George Morley, a past president of our Society, accepted me as a fellow, having never met me. He was a superb surgeon but, more important, was a kind, compassionate, patient leader. Since those very eventful 2 years, he has become a true friend. As I have traveled around the country and became more involved in academics, I have never heard one person say anything negative about Morley. He taught us to operate and to stay out of harm’s way. He pushed us to write, and he introduced us to the new catchphrase “quality of life.” He sponsored me and encouraged me (along with Bob Park) to join prestigious societies, such as the Society of Gynecologic Surgeons. We taught him about “happy hour” on occasional Friday afternoons. I quote from his book,6 “You know you are getting old when Happy Hour is a nap.” That phrase must have been coined long after my departure from A2. (Marcheta, now you know where he was.) When I left Ann Arbor, I was sent to the Naval Hospital, Portsmouth, Virginia. Marco Labudovich, a former attending physician in San Diego, California, eventually became our chair. From this physical bear of a truly compassionate leader, I learned about “Marco’s markers,” the old leadership rules that many of us take a career to learn: Listen, hold your cards, and play them at the right time. Marco’s leadership, teaching, and friendship have paid off. From that Portsmouth program we find many of our teachers and leaders firmly entrenched in teaching in the new millennium—Ralph Chesson, program director at Louisiana State University in New Orleans, Louisiana; Brian Cowan, Director of Reproductive Endocrinology and program director at the University of Mississippi; Dean Cromartie, who was given the 1999 Council on Resident Education in Obstetrics and Gynecology Award for resident teaching at the University of Mississippi; Tom Elkins, our esteemed Society member who died 2 years ago, when on the faculty at Johns Hopkins; Keith Hansen, a reproductive endocrinologist at the University of South Dakota; Wayne Hess, chair at the University of Missouri, Columbia; John Lurain, John I. Brewer Professor at Northwestern; Ramon Meguiar, vice

December 2000 Am J Obstet Gynecol

chair at Memorial Health–University Medical Center in Savannah, Georgia; our own Tom Nolan, vice chair at Louisiana State University, here in New Orleans; Jeff Phelan, maternal-fetal medicine specialist, attorney, and editor of OBG Management; and Carl V. Smith, chair at University of Arkansas; to name a few. For all the presidents who have expressed concern about our future in supplying teachers, rest a little easier. Just one program of many is an example. Dwarfs are still standing, and some have vision. We owe Marco. As my payback time to the Navy approached, I interviewed several southeastern schools to continue my academic career. Largely because of the surgical reputation and bearing of O. Eduardo Talledo, I chose the Medical College of Georgia. Ed easily measured up to his reputation as a superb surgeon and teacher. My friend and partner for several years, he is also a member of our Society. I had the opportunity to learn further leadership skills and people skills from the firm but visionary chair at the Medical College of Georgia, Don Sherline. Discipline, intelligence, and compassion were his gifts to us. I continue to marvel at how consistently he had his faculty and residents in their seats 1 minute early for Grand Rounds. He and Marco must have played a few poker hands together. I learned a little about his technique when he sent me a valuable book7 on winning important battles, the 2500year-old Sun Tzu approach, to deal with our current problems in medicine. However, he also reintroduced me to another old philosophy: “Be nice to the people you pass on the way up the ladder—they’re the same people you pass on the way down.”5 I owe him. Finally, I would be truly delinquent if I failed to mention two of my older contemporaries. These two and I have worked together in gynecologic oncology since the late 1970s. In those days at meetings the three of us often shared one hotel room because of our financial status. The cot went to the younger of those two. Our most memorable room was probably in the Morocco in Las Vegas, Nevada. These two pushed me hard to become more involved in the Gynecologic Oncology Group. Their insistence has taught me the best way to be involved in managing cancer, through a cooperative group that promotes clinical trials. The first of these is Bob Park, who was given our prestigious Distinguished Surgeon Award. The second, who just completed his term as president of the Society of Gynecologic Oncologists, is Bill Hoskins. I owe both of these long-term friends. To my other friends and associates in our Society, thank you. I have learned many valuable pearls at our meetings and through my 8 years on the executive committee. The past presidents during these 8 years, Easterday, Tancer, Lee, Addison, Kohorn, Blythe, Drukker, and Rock, have individually enhanced the quality of our meetings and the appropriate growth of our Society. We all owe them.

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Before I proceed to the briefer second part of this talk, let me remind you that this is not the first tribute to our mentors given at our Society. In 1995 Al Addison addressed this group with his presidential address, entitled “Paying Debts That Cannot Be Repaid.”8 Also in 1998, at the Pacific Coast Obstetrical and Gynecological Society meeting, the presidential address by Caillouette was “Mentors I Have Known.”9 However, we cannot say, think, or write these tributes enough. I want to initiate part two of this talk by thanking my partner in life, Pam, sometimes known as Pamela or the Pamster. As a companion she is patient, understanding, and full of humor. She tolerates the sometimes long days that I spend in the hospital and the periodic educational meetings that I attend. When I need to work at home, she allows me “protected home time.” She is a superb physician. But most important, she is the mother of the twins. She is the glue that holds the family together. She consistently initiates laughter in all of us. We owe her. The twins, which many of you have heard about, aged 21⁄2 years, will be a new challenge for Pam and me. I will need to modify. What is the message? I believe that this part of my message is for those with younger families. Some of us older folks, in the pursuit of our careers, may not have put in the time we should have during the younger years of our children. We need to reflect. To Kelly, my older son, I hope that I was there enough for those soccer matches, basketball games, and baseball games. Please remember that playing pepper with you in the backyard was not to harass you—just a method to help you keep your eye on that tricky ground ball. For Daverin, my older daughter, I really did try and teach you to execute a layup without flattening your opponent. I do hope you remember that it was your dad who took you for your first ear piercing, and I hope you remember when your dad took you to your first “Nutcracker” show. I do. I owe both my older children. As the Michigan Boss has said, “It is not the duration of life, but the donation to life that is important.”6 We need to donate more time to our families. “Medicine, with all its gratification, should not consume one’s life completely.”6 As Waller has stated, “We come, we do, we go, and the doing can be a rather grand voyage if we don’t panic.”10 Most of us rarely panic about events in our professional lives. Some of us subconsciously panic when dealing with our children or avoid closeness with our children, particularly as they grow a little. Let’s not. Regarding our young daughters, regrets as they become older are often expressed. “I wish I had walked

more in the woods with her.”10 Or, as was said by Arthur Hetzler, “It is given to a man but briefly to walk hand in hand with his daughter through a field of daisies.”6 Surely, we can make time for either. “The language of caring is a language of imprecision.”10 How can we more precisely express our love for our families, and particularly for our children? In addition to spending quality time, we must strive to be less judgmental. It has been said, “The more you judge, the less you love.”6 Older children, as we all know, are particularly sensitive to criticism. We need to be firm disciplinarians, but we need to be fair. Regarding our sons, reminisce with me about the old song “Cat’s in the Cradle.”* You remember the gist of it— the little boy who was always asking when his dad was coming home, the dad who didn’t have time to teach his son to throw. And the little boy saying “That’s okay,” and reflecting that he was “gonna be” just like his dad. Years later the grown boy moves away and has a family. His now older, retired father calls to see whether he can visit his son. His son is too busy with work and his own family. Remember the last stanza: “And as I hung up the phone, it occurred to me/He’d grown up just like me/My boy was just like me.” Let’s not go there. In summary, honor your mentors but not just in thought. Thank them personally. Call them. Fax them. E-mail them. Let them know about the positive difference that they made in your life and career. You can tell them that dwarf Gallup suggested it. Second, honor your family and friends. Save time for who is really important. Regarding our careers, as it has been said, “In 200 years, no one will know the difference.” In the short run, however, our families will. *Copyright © 1974 by Harry Chapin and Sandy Chapin. REFERENCES

1. Drukker BH. Shoes. Am J Obstet Gynecol 1995;172:1661-5. 2. Kohorn EI. For what we stand. Am J Obstet Gynecol 1996;175:1414-7. 3. Blythe JG. Back to the future: values and consequences in gynecologic surgery training. Am J Obstet Gynecol 1997;177:1293-7. 4. Drukker BH. Envelopes. Am J Obstet Gynecol 1998;179:1400-4. 5. Rock JA. Mentoring in gynecology. Am J Obstet Gynecol 1999;181:1293-5. 6. Morley GW. Book of Sayings (Morleyisms). Ann Arbor (MI): Univ. of Michigan; 1994. p. 1-26. 7. Krause DG. The art of war for executives. New York: Berkely Publishing; 1995. p. 1-116. 8. Addison WA. Paying debts that cannot be repaid. Am J Obstet Gynecol 1995;175:1661-3. 9. Caillouette JC. Mentors I have known. Am J Obstet Gynecol 1998:178:1111-5. 10. Waller RJ. Old songs in a new cafe. New York: Warner Books; 1994. p. 1-172.