Fellow pays tribute to ACS and citizen surgeons

Editor’s note: At the request of Carlos A. Pellegrini, MD, FACS, FRCS(I)(Hon), President of the American College of Surgeons (ACS), Dr. Stojadinovic delivered a tribute to the American College of Surgeons and all citizen surgeons at the President’s Dinner during the 2013 Clinical Congress in Washington, DC. The following is an edited version of that presentation.

Distinguished guests, given the magnitude of these ceremonies and the celebration of the ACS’ 100th anniversary, I am honored and humbled to speak with you tonight.

I would like to take a quick moment to thank my fellow servicemen and women for their dedication and sacrifice to our nation.

On Memorial Day, I wrote this tribute. Perhaps I was overwhelmed with the spirit of that solemn day of remembrance for all of the blessings that have been bestowed upon me and my gratitude to be an American.

Nation of immigrants

I reflected upon a common thread that brings us together, binding us all into one, with the reality that we are a nation of immigrants.1 We or our forbearers ventured to this land often with little or nothing, hoping for a better life and to establish a legacy to pass on to the next generation and generations to come.

Tonight, I dedicate this tribute to the late Peter Fiore, MD, FACS. Like many of us and our predecessors, Dr. Fiore and my mentor’s father, Sam Paletta, MD, served together during World War II. (Personal communication with Christian Paletta, MD, FACS, May 27, 2013.)

Dr. Fiore was a Brooklyn, NY, surgeon, a son of Italian immigrants.  He, like so many citizen surgeons of his generation, left private practice to serve his country in time of war. After he returned to the U.S. from the front lines, Dr. Fiore continued to serve as a battalion surgeon, and when he returned to Brooklyn, he applied the knowledge gained in wartime service in his civilian practice.2

As a son of immigrants, Dr. Fiore understood and lived the American dream—a dream that comes with the understanding that this gift of freedom is not free, that many before us laid down their lives to protect our freedoms, and that the American dream is truly realized when one is dedicated to improving the lives of others. Dr. Fiore personified dignity, compassion, and high moral principles throughout his life of service.

We are honored to have with us tonight Dr. Fiore’s son, Andy Fiore, MD, FACS, a distinguished pediatric cardiothoracic surgeon at Saint Louis University, MO, and Fellow of the College. Andy, my humble thanks to you and your family for the gift of service you have given our nation.

As in Dr. Andy Fiore’s case, many present tonight have family members who have served in uniform, even as fewer of America’s citizens serve in the all-volunteer military.

Notwithstanding, the very fact that I was invited to attend this momentous occasion by ACS President-Elect Carlos A. Pellegrini—himself a son of immigrants, a leader, and citizen surgeon who served in uniform—that I was asked to present to our College, and that I am standing before you this evening to share a message of gratitude, of dedicated service to our fellow man, of solemn tribute to our College, clearly shows that “we are one.”

Called to serve

We gather at times like these to honor a long and distinguished history of service and leadership. Tonight, the American College of Surgeons celebrates 100 years of service, particularly the dedicated service to our nation in time of war.

Surgeons of the College have answered the call to duty throughout the organization’s history. These citizen surgeons have rendered excellent care to our service members who have borne the visible and invisible wounds of war.

One among them was the late C. Rollins Hanlon, MD, FACS, a former Director of the College and protector of its history, who served in the U.S. Navy during World War II.3

I dedicate the following tribute to these surgeons, to all men and women—past, present, and future—who have and will shed their civilian roles and don a uniform to serve our country to, as Abraham Lincoln so aptly articulated in his second inaugural address, “…bind up the nation’s wounds…to care for him who shall have borne the battle, and for his widow, and his orphan….”4

I am blessed to stand before this distinguished audience in the uniform of a U.S. Army soldier. I am here, however, representing all citizen surgeons who have worn the uniform for their respective nation.

These citizen surgeons ventured bravely into battle to care for soldiers and innocent civilians alike. Citizen surgeons went into harm’s way not by choice, but rather because of an obligation greater than themselves, bearing witness to events that would forever change them.

Dr. Peter Fiore, a son of immigrants, was one of those citizen surgeons. Like so many of his generation, he is no longer with us. But he answered the call to duty and served honorably as a citizen surgeon, having spent 11 months in General George Patton’s Third Army, providing lifesaving care to American and German soldiers, as well as countless civilians caught in this terrible strife.

The calling of citizen surgeons, even in war, is unquestionably focused on preserving life and human dignity. Swiss businessman and social activist Jean Henri Dunant understood this calling. He witnessed the carnage at the Battle of Solferino in 1859, which changed his life forever. The lasting memory of “chaotic disorder, [unspeakable] despair and misery of every kind” inspired Mr. Dunant to envision the establishment of the Geneva Convention, for which he was a co-recipient of the first Nobel Peace Prize.5

In the Declaration of the Geneva Convention there is a solemn pledge to devote one’s life to serving humanity—to do all that one can possibly do to honor the traditions of our profession. This is precisely what the citizen surgeons of the American College of Surgeons have done during their 100 years of service and leadership, which has been an object example for surgeons the world over.

Wartime advances in surgery

Indeed, notable progress has been made during wartime, and our College’s century of service has led to transformational advances in military and civilian surgical practice. Truly, “the only victor in war is medicine.”6 George Crile, MD, FACS, a founder of the ACS, extended this concept, stating that more progress has been made in surgery from lessons learned during armed conflict than has been achieved by an entire generation.7

Time does not allow me to cover all advances in surgery over that century, and the multitude of individuals and institutions that have earned the credit for this progress. I would be remiss, however, if I didn’t recognize a few visionary leaders whose wartime surgical advances make possible tributes such as this to citizen surgeons of the College.

Since World War II, we have seen advances in antibiotics, surgical staplers, the development of battlefield blood banks, and the deployment of skilled citizen surgeons to front lines close to point of wounding. During the Korean War, helicopter evacuation significantly reduced time from wounding to definitive care and enabled transformational advances in the treatment of vascular injuries. In 1958, Carl Hughes, MD, FACS, reported incredible limb salvage rates, historically unattainable with treatment of wartime arterial injuries.8

As a medical student I was inspired by a 1970 report that Norman Rich, MD, FACS, wrote on using data from his Vietnam Vascular Registry on 1,000 casualties treated for combat arterial injuries.9 During Vietnam, significant advancements emerged in surgery, including helicopter evacuation and improvements in burn care and treatment of related infections at the Burn Unit at Brooke Army Medical Center, Fort Sam Houston, TX, under the leadership of Basil Pruitt, MD, FACS.

The ACS played leading roles in communicating lessons learned on the battlefield broadly and implementing systematic programs to improve the education, organization, and delivery of civilian and military trauma care through such efforts as the Advanced Trauma Life Support® course and the Committee on Trauma’s civilian trauma center training programs to ready surgeons for combat surgery.

The wars in Iraq and Afghanistan represent the longest continuous commitment of military medicine in our nation’s history. During these wars, significant advances in the integrated, coordinated, and multidisciplinary care of our wounded troops produced the lowest combat case fatality rates in the history of warfare.

Proven advances in civilian trauma system care have translated to the modern-day battlefield. Examples include the following:

  • Rapid control of traumatic hemorrhage through damage control resuscitation and damage control surgery
  • Rapid external fracture fixation, advanced wound care, and limb salvage across the continuum of care made possible through such advances as Critical Care in the Air
  • Health information technology
  • Trauma registry across echelons of care
  • Remarkable advances in computer and robotic technology evident in lower-extremity prosthetics.

And as citizen surgeons have answered the call with ingenuity and solutions to complex problems, their family members have stepped up to the challenge as well. One telling recent example is Maribeth Russell Hoyt, the spouse of ACS Executive Director David B. Hoyt, MD, FACS. Beth has dedicated her life to improving the lives of others through leadership, advocacy, and innovation to support our veterans suffering the invisible wounds of war.

TIME magazine recently published a special article on the healing power of community public service for our wounded warriors and veterans. The article, “Can service save us?” by Joe Klein, suggests that service changes people.10 Reaching beyond self in service to others is personally enriching and therapeutic.

The lessons citizen surgeons learn on the battlefield extend beyond medicine itself. Lewis Flint, MD, FACS, recently reported on his survey of surgeons serving in conflicts since World War II. Almost all surgeons who participated in the study reported that wartime service had a profound effect on them, making them better people, improving their surgical skills, and expanding their understanding of teamwork.7

Dr. Flint said that the “experience of caring for the injured soldier gave the [citizen surgeons] a new perspective on what a ‘call to duty’ really means.”7

This is a compelling reminder of how service to others is a rich source of inner growth and healing. Many of us can relate to life experiences that provided us with keen insights into how life-changing “real service” truly is.

One of the best-known poems of World War I was “In Flanders Fields,” written by the Canadian physician Major John M. McCrae. He was inspired to write this poem after presiding over the funeral of fallen friend and fellow soldier, Lieutenant Alexis Helmer.11,12 Mr. Helmer had, as President Lincoln put it, “borne the battle” and paid the ultimate price at the Second Battle of Ypres.5,11,12

From this poem, I share with you this charge from a fallen citizen surgeon who left us timeless words of wisdom and inspiration:11,12

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders Fields.

We owe a debt of gratitude to all the men and women who have answered the call to duty and have borne the visible and invisible enduring wounds of war.

All of us who proudly wear and have worn the uniform have learned from those who have walked and fought before us that we are sworn to defend our nation’s pledge for our citizens and allies—a pledge to protect what Thomas Jefferson called the inalienable rights of life, liberty, and the pursuit of happiness.

Military strategists have often said “no plan survives contact with the enemy.”

Much of this is based upon knowledge from our nation’s battlefields.

I salute the American College of Surgeons on this day of tribute and celebration of its century of service and leadership.

With appreciation for my blessings, and
In the spirit of St. Luke,
The patron saint of physicians
Knowing that
“to whom much is given, much is expected”

I proudly, and humbly, thank you for your attention and the privilege of the podium.


References

  1. Pellegrini C. 2012 Annual Business Meeting of Members. 2012 ACS Clinical Congress, October 3, 2012. Acceptance speech. Available at: http://uwsurgery.org/675-home/featured-videos/667-dr-carlos-a-pellegrini-acceptance-speech-for-being-named-president-elect-of-the-acs. Accessed November 18, 2013.
  2. Paid notice: Deaths. Fiore, Peter P., MD. New York Times. December 11, 2005. Available at: http://query.nytimes.com/gst/fullpage.html?res=9B07E3DE1E31F932A25751C1A9639C8B63. Accessed October 25, 2013.
  3. Nahrwold DL. In memoriam: C. Rollins Hanlon, MD, FACS, remembered. Bull Am Coll Surg. 2011;96(9):47-52. Available at: www.facs.org/fellows_info/bulletin/2011/hanlon0911.pdf. Accessed October 25, 2013.
  4. National Archives and Records Administration, President Abraham Lincoln’s Second Inaugural Address. 1865. Available at: www.ourdocuments.gov/doc.php?flash=true&doc=38. Accessed October 25, 2013.
  5. Nobel Media AB 2013. Henry Dunant. Biographical. Nobelprize.org. Available at: www.nobelprize.org/nobel_prizes/peace/laureates/1901/dunant-bio.html. Accessed October 25, 2013.
  6. Clapesattle H. The Doctors Mayo. 2nd ed. Rochester, MN: Mayo Foundation for Medical Education and Research; 1969.
  7. Flint L. The surgical legacies of Hawkeye Pierce. J Am Coll Surg. 2013;216(4):515-524.
  8. Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147(4):555-561.
  9. Rich NM, Baugh JW, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359-369.
  10. Klein J. Can service save us? TIME. June 20, 2013. Available at: http://nation.time.com/2013/06/20/can-service-save-us/. Accessed October 25, 2013.
  11. Memmott M. We pause on Veterans Day to reread ‘In Flanders Fields’. National Public Radio. November 2011. Available at: www.npr.org/blogs/thetwo-way/2011/11/11/142235639/we-pause-for-veterans-day-to-reread-in-flanders-fields. Accessed October 25, 2013.
  12. The Great War: 1914–1918. In Flanders Fields. Available at: www.greatwar.co.uk/poems/john-mccrae-in-flanders-fields.htm. Accessed October 25, 2013.

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