Legacy and Leadership Cutting Edge

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Legacy and Leadership- Class Edition of the Cutting Edge

Jump to Dr. Charles Lucas
Jump to Dr. Lewis Flint
Jump to Dr. Mark Malangoni
Jump to Dr. Thomas Scalea
Jump to Dr. Mark Indeck
Jump to Dr. L.D. Britt
Jump to Dr. David Livingston
Jump to Dr. Samir Fakhry
Jump to Dr. Christine Cocanour
Jump to Dr. David Jacobs
Jump to Dr. Patricia Byers

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The Class Edition 
Celebrating members with greater than 30 Anniversary years of AAST fellowship 

Cutting Edge Special Edition Editorial 

Written By: Shannon M. Foster, MD

Resilience. 
Commitment. 
Longevity. 
Perspective. 
Profound. 

A few of the many descriptors such distinguished leaders easily elicit. 

It is with humbleness and gratitude that we acknowledge those who have come before.  

They who have seen the changes, the challenges – and chosen to remain. 
They who have weathered, witnessed, and experienced vast shifts in technology, education, practice, and the very foundation of our specialty. 
And they who, rather than balk and depart, remained and guided, learned, and have chosen to stay involved, carve new paths, and paid it forward. 

Each of the participants in this edition were inducted to the AAST prior to 1995.  For emphasis — that equates to a minimum of 30 years of intentional and active engagement in our professional organization. Any who have chosen to stay with a group for that duration are its backbone, regardless of titles or positions held within it.  

As has often been said in these pages, membership is a choice. Each volunteer participant included here shared formative memories and bidirectional exchanges that enriched and advanced their careers and led to deep, long-lasting personal relationships stemming from AAST involvement. This collection is to inspire the rest of us to achieve the same. 

To all friends and colleagues in this community, a simple ask:  Please reach out to the mentors and champions in these lists – and thank them for years of continuity, years of advocacy, and years of supporting. Without them, where would we be?  

With deepest appreciation for each of you
Shannon Marie Foster 
shannonfostermd@gmail.com 

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Interview Piece:

Lewis Flint, MD

Class of 1977

Written by: Kaitlin A. Ritter, MD

Dr. Lewis Flint knows a thing or two about change. A trauma surgeon by trade, Dr. Flint completed his surgical training at Duke University and the Medical University of South Carolina. Prior to his chief resident year, he completed a trauma fellowship at the University of Texas Southwestern Medical Center. When he began his career, the field of trauma and acute care surgery was in its infancy—far from the structured specialty we recognize today. 

Reflecting on his early years in the profession, Dr. Flint recalled the challenges facing trauma surgeons at the time of his induction into the American Association for the Surgery of Trauma (AAST) in the late 1970s. “The big things we were dealing with were incorporating the talents of emergency physicians, figuring out how to educate ambulance personnel, and developing trauma systems,” he explained. Trauma surgery was still defining itself, and early leaders in the field worked to establish collaborative care models that integrated multiple disciplines.

“The AAST played a major role in the development of trauma systems alongside the ACS Committee on Trauma,” Dr. Flint noted. “We were working to expand ATLS training, bringing together surgeons, emergency medicine physicians, and pre-hospital providers to create a cohesive approach to trauma care.” These foundational efforts set the stage for the modern trauma system, which now ensures standardized, high-quality care for injured patients across the country.

 

The Changing Role of the Trauma Surgeon

Over the course of his 50-year career, Dr. Flint has witnessed a dramatic shift in trauma care—particularly in the volume and nature of surgical intervention. “As time went on, there were fewer and fewer operative cases in trauma,” he observed. “The widespread adoption of non-operative management significantly reduced the opportunities to perform surgery.”

This shift raised a critical question: how does a trauma surgeon maintain their surgical skills in an era of increasingly non-operative management? “Trauma surgery has two names—‘trauma’ and ‘surgery.’ You don’t want to be just a trauma specialist unless you are also a capable surgeon,” Dr. Flint emphasized.

To that end, he highlighted the importance of the Acute Care Surgery (ACS) model, which was pioneered by Dr. L.D. Britt. This approach broadened the trauma surgeon’s scope of practice to include emergency general surgery and critical care, ensuring that surgeons maintain their operative competency while remaining central figures in hospital-based emergency care. “This model created more opportunities for trauma surgeons and transformed how we train,” he said. He praised the AAST’s development of a detailed ACS fellowship curriculum, which he sees as a crucial step in preparing surgeons for long-term careers in trauma care.

 

Keys to Career Longevity: Collaboration and Adaptation

Beyond maintaining surgical skills, Dr. Flint identified collaboration as a key factor in career longevity. “Building strong professional relationships and friendships with surgeon colleagues, emergency physicians, hospitalists, and intensivists not only improves patient care but also creates professional opportunities for trauma surgeons beyond the trauma bay,” he said. Open communication and teamwork across specialties ensure that trauma surgeons remain actively engaged and valued members of the healthcare system.

He also stressed the importance of continuous adaptation, noting that trauma surgeons must be proactive in shaping their careers. The field will continue to evolve, and surgeons need to be prepared for those changes. Whether it’s embracing new technologies, expanding one’s clinical practice, or taking on leadership roles, surgeons must remain flexible and forward-thinking to sustain long-term success.

 

Protecting Surgeons: The Role of Physical Health in Career Longevity

Another pressing concern Dr. Flint highlighted is the physical toll of a surgical career. “It’s not good for surgeons to work for 35 years and wind up with spinal stenosis,” he warned. The physically demanding nature of surgery, combined with long hours and repetitive strain, puts many surgeons at risk for musculoskeletal injuries.

“Once you transition out of clinical trauma care, you should be able to get out and do things, spend time with your family—without being in pain all the time,” he said. To prevent long-term disability, surgeons must prioritize ergonomics and injury prevention throughout their careers. Organizations like the AAST are increasingly recognizing this issue, developing initiatives such as ROBO-TRACS, which incorporate robotic and minimally invasive techniques to reduce surgeon fatigue and strain.

 

Looking Ahead: Preparing for the Future

At the heart of Dr. Flint’s reflections is a simple but profound message: planning for the future starts now. Change is the only constant in life. Arming yourself with the resources and network to stay ahead of the curve is crucial for both career longevity and satisfaction.

For today’s trauma surgeons, this means embracing a mindset of lifelong learning, collaboration, and adaptability. Whether through expanding clinical skills, fostering interdisciplinary relationships, or prioritizing physical health, the key to a long and fulfilling career lies in being proactive, engaged, and prepared for change.

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Interview Piece:

David Jacobs, MD

Class of 1994 

Written by: Simin Golestani, MD and Jeremy Levin, MD​

At the end of his surgical training, Dr. Jacobs knew one thing for sure: He did NOT want to be a trauma surgeon. Instead, he flew a helicopter and spent time taking care of his newborn son. Slowly, he found his way to the field of acute care surgery. Decades later, he has left a mark on the world of trauma through the surgeons he’s mentored, the patients he's taken care of, and the people he's impacted through his advocacy and leadership.  

Change and adjustment have been the theme of Dr. Jacobs’ career. Having joined the trauma field just as trauma surgery was beginning to evolve into its modern form, he has witnessed and implemented changes both for patient management and in the culture of the field.  Dr. Jacobs credits AAST with exposing him to the field’s giants who played pivotal roles in shaping trauma surgery and playing a part in his professional development. When he took a new position in Carolinas Medical Center in the 90s, his trauma center was still finding its footing. Networking through AAST was instrumental in navigating those early challenges. Whether it was verification, residency training, or simply understanding best practices, having access to experienced mentors made all the difference.  Over time, those relationships through the AAST helped shape his career and grow trauma care in his region. 

His storied career and professional accomplishments were not without being hard fought. When Dr. Jacobs first applied to be part of the AAST, he was rejected and felt as an outsider. "AAST was a good-old-boys club back then. Nobody got in on their first try—it was just understood". Not only was the organization exclusive, it lacked diversity. However, over time the AAST evolved into an inclusive organization, expanding its reach beyond traditional academic trauma surgery. "It has grown to reflect the diversity of its members and their interests, from injury prevention to geriatric trauma to military collaborations," Jacobs explained. He saw this as a necessary and positive shift, ensuring that the field remains relevant and continues to serve all populations effectively.

The changes in the AAST over time mirror the efforts Jacobs has made to address deficiencies in the field. At his home institution, he serves as the vice chair for diversity, equity and inclusivity. In discussing the role of surgeons in promoting the importance of this work, Dr. Jacobs shared: “.. by virtue of what we have pledged to do, you would think that we would all naturally feel that things such as equity and inclusion are important.” However, he laments that just by reading the comment section on the American College of Surgeons DEI initiative page, one can see that opinions are divided. He believes that the most important first step is to change the culture, not to try to change the hearts and minds of every individual. The next steps are to work on expanding the existing spaces in medicine where diversity is seen as essential, and inclusivity is deemed important.    

Advocacy for social justice issues has not only been at the forefront of Dr. Jacob’s work as a leader in his department, but also as a surgeon taking care of his community. From his early days of trauma surgery, Dr. Jacob’s noticed the racial inequality in his patients. Seeing young Black men who looked like his three sons be constant victims of gun violence made him realize that he had an obligation to the Black community to address this issue upstream.  His commitment began 35 years ago, and since then Dr. Jacobs has done significant work in starting hospital-based violence intervention programs and working with the community to find ways of preventing gun violence. He is hopeful about the momentum that violence prevention has gained. As a mentor to young surgeons and residents, his goal is to pass on the importance of advocacy. “We as surgeons have an obligation and a platform that we should not take for granted.” 

When Jacobs reflects on his most significant achievements, including the reception of a Lifetime Achievement Award as part of the Charleston Business Healthcare Heroes, his humility shines. Modestly, he reflects on his ability to build a coalition for better patient care with a growing and diverse membership on organizational and interpersonal levels as a point of pride. As a trauma medical director, he looks at how his trauma service has grown by being inclusive in practice formation and process improvement. “Probably for the first time, this allowed us to be able to put ourselves in the shoes of the group of people we were working with and to work cooperatively…instead of passing off responsibility.”

Throughout his career, the AAST has always been a source of professional support for Dr. Jacobs. But recently this membership paid priceless dividends on a deeply personal level. Dr. Jacobs’ son was traveling in Bogota, Colombia, when he developed abdominal pain and nausea. His son had abdominal surgery as a child, and Jacobs knew a small bowel obstruction was afoot. When his son’s phone stopped working, Jacob’s turned to the AAST members list. Within hours of contacting all three AAST members living in Bogota, he was able to find help for his son to navigate the local medical system. The AAST turned a parent’s nightmare into a reminder that the world of trauma is small, its members caring, and its mission to help unifying.

Dr. Jacobs is not without aspirations and interests outside of medicine. Decades later he still enjoys flying and as his surgical career winds down he’s looking forward to rekindling this passion. Having grown up listening to his father play Handel’s Messiah every weekend, vocal music has always been a source of joy for him. He was part of many choirs, however any attempt to find him on a social platform would unfortunately be unsuccessful. “That was pre-Youtube…and we burned all the tapes!.”

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Charles Lucas, MD

Class of 1972

To my fellow AAST members:

You have longevity in a challenging career!  Please explain how this organization has helped you in that path. 
Thank you for the invitation to comment regarding the AAST and the opportunity that the AAST has to foster a career in what is now called acute care surgery.  Like all things in life, decision making is often based upon one’s environment.  I am the youngest son of immigrant farmers, and the financial support was very limited as my father spent 40 years working in one of the Detroit factories.  Consequently, all of his sons, including myself, were educated within the city of Detroit, which meant that medical school for two of us was at Wayne State University which worked closely with the Detroit Receiving Hospital.  While rotating at the DRH as a medical school student, I absorbed the enormous challenges for the surgical residents in taking care of injured patients and patients with acute surgical problems not related to injury. 

My first Chairman as a student was Dr. Charlie Johnston who was a tremendous leader in trauma and acute care surgery and indeed was the first editor of the Journal of Trauma.  He and his teammates were very much involved in the academic aspects of trauma.  My next Chairman was Dr. Alan Thal who was one of the world’s leading experts in defining the physiologic changes of septic shock.  The combination of being exposed to these two giants totally captured my inner brain and challenged me to become knowledgeable in caring for injured patients and septic patients.  The Vice-Chairman of the department when I was a resident was Dr. Raymond Reed who reminded me of the beautiful rewards that one gets by putting the pen to paper.  I was mentally trapped into a situation where I had to accept the clinical challenges of these very, very ill patients and learn about, and then publish about, their altered physiology.  With that mental contamination, one had to include membership in the AAST as a means to help advance one’s career, identify new challenges, and allow for external publication of one’s works.

The AAST has provided a family for people of similar backgrounds and other backgrounds which provides great enjoyment as members of this family challenge each other in a constructive manner.  This relationship enhances the satisfaction related to working ridiculous hours every week at a time when the 80-hour work week was unheard of. 

As with all professional organizations, some of the greatest challenges faced by the AAST will be to maintain the open-mindedness so that members who believe that the only way to treat a specific injury is what they preach, will accept the fact that contrary views should be considered and lead to meaningful discussions and presentations at the annual meeting.

The greatest pleasure that I received at the AAST was to give the Fitt’s Oration in Hawaii where my good friend from high school lives and was in attendance.  One of my favorite teachers has been a long-term surgeon in Hawaii and was in attendance.  My Research Fellow was also in attendance, as was my long-term partner, Dr. Ledgerwood.  Following the oration, we all had the opportunity to spend the evening together at the home of my former surgical student who also lives in Hawaii.  It was a great reunion of all parts of my existence after a very rewarding lecture.

Please share a hobby/interest/activity outside of surgery that has given you peace, joy, revitalization
During my academic years when the joints were still healthy, I was a very active tennis player which provided a nice outlet from the long work hours each week, but the most exciting part of these years has been the re-study of physiology in response to patients not following what the book says should occur.  The greatest joy of taking care of these very ill patients is to see their recovery and to teach about the altered physiology which we continue to learn about every day when caring for these very ill patients. 

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?If the young surgical resident decides that he/she is interested in acute care surgery, the modern opportunities call for that person to become involved in a Trauma Fellowship at a place which sees many injured patients and to also become involved in surgical critical care.  During their early practice years, they should identify the individuals in their program who meet their ideals for leadership and emulate those individuals.  When making these lifelong decisions, the future academic trauma surgeon should ignore the salary and focus on the technical opportunities and research opportunities since the results of providing good care and publishing new work is far more rewarding than a large income. 

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Mark Malangoni, MD

Class of 1985

I was very fortunate to become involved with the AAST early in my career beginning with the Organ Injury Scaling committee, a Board of Managers at large member, and eventually vice president. These were rewarding experiences, and I worked with some of the icons of Trauma and Acute Care Surgery along the way.  Participating in the incorporation of Acute Care Surgery within the AAST was controversial initially but was clearly important in the evolution of the organization. Acute Care Surgery has grown from a handful of presentations at the annual meeting to a significant part of the program.

My advice to young faculty is get involved in the AAST and related professional organizations. You will make some lifelong friends and have rewarding experiences. Who knows, one day you may be president of the AAST!

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Thomas Scalea, MD

Class of 1988

The AAST has been my professional home for just short of 40 years. I have made innumerable friends and our relationships have spanned successes, failures, joy, and sadness. As I move in to the last part of my career, those relationships become even more important to me.

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face? 
The most rewarding change we have seen is the evolution of Acute Care Surgery. The maturation of a trauma surgeon into a more well rounded surgeon that cares for emergencies and those critically ill has been necessary for the survival of our specialty. Preserving the need to do elective surgery within the framework of Acute Care Surgery and being able to operate in any body cavity is in our DNA. I love being the person that gets called when no one else knows what to do. The greatest frustration has been that we remain our own worst enemy. We have failed to really believe and have stayed in our corners. For me, the most striking example has been our failure to embrace endovascular and other subspecialty care in Acute Care Surgery. The future of injury and emergency care is with catheters and minimally invasive modalities. We must own this, investigate and report results, and define the future or we will again g=face the challenge of extinction as we did 20-25 years ago.

What is an AAST memory that is special to you?
In 1986, I presented at the AAST for the first time. I was ecstatic when I received notification that my abstract was accepted. The letter was signed by P William Curreiri, the recorder and George Sheldon was the discussant. I still have a copy of the abstract and the letter inviting Dr Sheldon to discuss it framed on the wall of my office suite. It made me feel as though I had finally arrived.

What is a hobby/interest/activity outside of surgery that has given you peace, joy, or revitalization?
Though I was never really good at athletics when I was young, I was at least an enthusiastic athlete. In medical school, I became a pretty fait long distance runner. When I lived in NYC, I had my routes mapped out. I would run 10-12 miles early Sunday morning if I was not on call. I ran through lower Manhattan. It was eerie to run Wall Street among the skyscrapers and actually be alone, a rare feeling in NYC. Running became my outlet, the way I would work out the bad feelings when a patient did badly. This was in the late 1980’s when penetrating trauma was constant. Once I hit 7-8 miles, the endorphins kicked in and the bad feelings started to leave my body. My knees no longer allow me to run but I now bike. Same principle.

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?
I tell my young residents to do what they love. Only you can decide what that is but I advise them to not get put in to a box just because someone else says that is what to do. I tell my finishing fellows that during the first several years of their career, they should have a three word vocabulary, “Happy to help”. It is the best way to build a practice. I tell those who are finishing their careers to do it as long as it makes you happy and you are able. Knowing when to quit is tricky, I have that conversation with myself almost every day and every time I have a complication.

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Matt Indeck, MD

Class of 1989

You have longevity in a challenging career!  Please explain how AAST has helped you in that path. 
When I first joined AAST back in the late 80's I found it to be an excellent source of cutting edge trauma from around the country and some internationally. I was also able to establish long lasting friendships with colleagues across the country, that I could always discuss difficult cases or just STS about the future of trauma. Back then most trauma was blunt with rare operative cases except in the inner city Centers. Lots of discussion about keeping younger surgeons interested and engaged.

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face? 
There was no such thing as Acute Care Surgery when I started and for many years afterward.  I was a very lucky Trauma Surgeon at the time, because my Chairman allowed me to do as much general surgery as I wanted. This was such an advantage back then, because many of my peers were relegated to only doing Trauma and in essence very little surgery. Losing a very essential skill set. Back then the discussion was how to change that paradigm. Hence the development of Acute Care Surgery. This was a slow process starting with just an idea and defining what Acute Care Surgery meant. Here the names kept changing, Emergency General Surgery, Critical Care Surgery, Trauma and Emergency Surgery etc.  I was able to "sway" my Dept. Chair over time to change how our Trauma group was viewed within the institution.  None of this was easily done.

Many of my personal challenges were maintaining control of our patients in an ICU run by Pulmonary Medicine. This was an ongoing battle for many years. Part of the issue was there were originally only 2 of us taking every other night call and trying to cover everything. Then there were 3 of us for a good ten years or so. Still not ideal but we persevered. Many of my AAST colleagues and subsequently EAST (I was a charter member) were in similar situations.

I think Acute Care Surgery has set a standard in medicine overall in terms of data driven management for outcomes. Maintaining that path will be a challenge, because our organizations have splintered and I am not sure this is in the best interest of the Specialty overall. 

What is a hobby/interest/activity outside of surgery that has given you peace, joy, or revitalization?
My things that keep me going 1. Family 2. Being outside and working on our property 3. Skiing 4. Mountain biking 5. Play music and being in a Rock 'n Roll band 6. Scuba diving (but no longer do this) 7. Reading.  All these give me a sense of joy, relaxation and peace in their own way. One special thing I did for several years was giving back, and doing humanitarian surgery in several African countries.

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?My advice:

1. Don't go into this unless you truly love what you do, because it is physically and mentally taxing no matter how strong you think you are. It will take a toll on every aspect of your life if you let it. However, I think the attention to hours of being on have been altered to minimize their effects, and are now more supportive of healthier lifestyles.
2. For the new Acute Care Surgeon, always stay true to who you are, and never lower your standards of patient care. I know this is easier said than done.
3. Transitioning out of active practice is not easy after 40 years of it defining who you are. I go back to finding things you love to do, keep your mind active/socially engaged, and if possible -stay physically active. Your whole being starts making it very difficult to maintain all of this during the last 2 decades of your life.  Stay ahead of it if at all possible!

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L.D. Britt, MD

Class of 1991

The American Association for the Surgery of Trauma (AAST) has unapologetically made our discipline ( now “Acute Care Surgery”) evidence based (note: in my opinion ,there is no other surgical specialty more immersed in evidence-based “science)

The “greatest and best” change that I “weathered” was the change(s) that resulted in  the AAST officially endorsing and embracing (and welcoming my advice) to change the moniker of the annual meeting ( the year that I was the President of AAST) to add Clinical Congress of Acute Care Surgery-that was pivotal “branding”! I remain appreciative.

For me, the most frustrating aspect of our transitioning to a now highly respected and sought -after specialty fellowship -“Acute Care Surgery” is the reluctance and hesitancy of some of my most respected colleagues to embrace the brand! Note: the trauma discipline will always be the cornerstone of “Acute Care Surgery” (and that will NEVER change), but it is confusing, perplexing, and counterproductive to be redundant by addressing this new and exciting specialty, as “ Trauma and Acute Care Surgery “- such an unfortunate reference does nothing to engrave (and have embedded) our specialty into the tapestry of American surgery/medicine. Even our publication organ is misguided in the journal’s name

There are so many iconic moments/memories. However, witnessing the transition of the AAST to becoming a more inclusive organization is my best aggregate memory!

Reading biographies and autobiographies is not only relaxing but informative. You learn and reinforce the fact that EVERY luminary and major organization/company/industry has formidable “headwinds & “tailwinds“  to navigate throughout his/her/its existence.

My one piece of “advice “ to the surgery residents and young aspiring surgeons is that there is ABSOLUTELY, UNEQUIVOCALLY NO shortcut to EXCELLENCE!

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David Livingston, MD

Class of 1991

You have longevity in a challenging career!  Please explain how AAST has helped you in that path. 
Getting into the AAST was important and a “big deal” then and still is now when I was allowed join.  Back then EAST was still in its infancy, Western Trauma was still small and insular (especially coming from the east coast), the critical care exam had just come into being and Acute Care Surgery was not even a glimmer on the horizon. The AAST was IT for those involved in trauma care. What is the hallmark of our specialty is the openness and warmth of the members, especially the senior members to those of us starting out. This was truly “pay it forward” long before that was a catchphrase. It is the connections, deep friendships and collegiality that has enabled my career to be what it is.

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face?
The greatest things are the increasingly smart, talented and dedicated trainees who have come after us and taken leadership positions in the AAST as well our other organizations. This is our legacy. The most frustrating challenge has been the increased corporatization of medicine that has attempted (and too often succeeded) in getting between ourselves and our patients. I have fought this my entire career and, I am happy to say, I have more or less succeeded.

What is an AAST memory that is special to you?
There are so many memories that span my AAST career. From my first meeting in Montreal with bad weather on a white knuckle puddle jumper plane with Dr. Richardson (who I did not know hated small planes), to my first program committee meeting (and having to score 450-500 abstracts) under the guidance of Dr. Shackford, to finding out from Dr. Rozycki that I would be president (I think I said really about 4 times) to having to give Dr. Richardson’s Fitts Oration after his death. To the countless, lunches, dinners, drinks and more with the most wonderful friends people could ask for.  

What is a hobby/interest/activity outside of surgery that has given you peace, joy, or revitalization?
Debbie and I split our time between the Jersey Shore and Colorado at this point. Being on the boat or a kayak in the summer and the slopes in the winter simply cant be beat. Spending time with and taking care of our grandson Hollis is simply the best.  Last year I went to guitar school and built and acoustic guitar that actually sounds pretty good and learning about the engineering to get to that point was pretty fascinating.  

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?
Be curious, challenge dogma and learn as much as possible. Early in training (residency, fellowship, and junior attendinghood is simply a spectrum) be the best clinical surgeon you can be. Scrub on everything you can. Even if you are “not the surgeon” and not even scrubbed in you will learn. And if you are at the table, you probably will get a chance to do something. Floor work and notes will always be there (an endless and Sisyphean task) but the cases will come and go. So unless someone is dying in front of you…get to the OR. This is what drives me crazy about some trainees. Once you get that down, you can start to figure out what, if anything, you want to study and research. Lastly, stay off of any and all committees (except for trauma PIPS stuff). This is where good work goes to die, and nothing often gets done. You will never get those hours back.

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Samir Fakhry, MD

Class of 1993

You have longevity in a challenging career!  Please explain how AAST has helped you in that path. 
AAST is a great organization that allows us to share experiences and knowledge and also provides a peer-group of people who live the same opportunities and challenges. We are a small part of the House of Surgery but our impact is greater than our size and AAST helps us work together and make connections we would not otherwise make.

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face?
I regard change as a necessary and unavoidable part of our lives. As a recent Medicare card holder, I experienced the transition from the previous "plantation system" of surgical training to the current "shift-worker" system of 80 hours/week. Neither of those labels is entirely fair or objective but the transition reflected our ability to adapt to a new way. I learned a lot from that transition and I hope I provided useful lessons to my younger colleagues from my experiences in the previous system.  I have also experienced the transition to more and more specialization and minimally-invasive procedures and that was and remains challenging since it’s not easy to keep learning new things all the time at an ever increasing pace. I suspect this happens to all of us, you will look around one day they will be doing things in newer ways as well.

What is an AAST memory that is special to you?
I will always remember the first time I was preparing for a podium presentation at the AAST. It was a mix of anxiety and anticipation. Afterwards, I recall thinking how big a deal it was to present at the AAST. And it still is....

What is a hobby/interest/activity outside of surgery that has given you peace, joy, or revitalization?
I have spent many hours in recent years hiking and climbing and enjoying the vastness of some of the world's less spoiled places. Sometimes, its just nice to get away from the commotion and walk through the beauty of our natural world (or sail through it too!)

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?To today's surgical residents: I am jealous that you are just starting your incredible journey into surgery. Its hard sometimes but take full advantage of the opportunities to learn and experience our profession.  Teach your juniors and look out for our patients.

To my younger colleagues in their first job:  Your first task is to earn the respect of your fellow surgeons, the OR nurses, the ward teams and everyone else and convince them that you are a safe, competent and thoughtful surgeon who can be trusted to take care of patients and of  your team. I think its really hard to succeed otherwise no matter how many RVUs you generate, how many manuscripts you publish or how many awards you get. Also, don't buy a house right away. Buy a nice new car since its easier to drive a car to the next job than unload a house if the first job doesn't work out.

To those ready to transition from practice: Call me, we have a lot to talk about!

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Christine Cocanour

Class of 1993 

You have longevity in a challenging career!  Please explain how AAST has helped you in that path. 
AAST has provided a framework for bringing together those with interests in trauma and now emergency general surgery. This has led to lifelong friendships and the venue provided a time when we could get together. AAST also provided a place where the best of new information regarding trauma and EGS could be presented and discussed.  It has also taken on becoming a great resource for information and studies (ex multi-institutional trials and now the support of WITS).

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face? 
One of the greatest changes that I have seen in my lifetime as a surgeon has been the acceptance of first trauma, then surgical critical care and now emergency general surgery as a specialty.  

The biggest challenge that I have noticed over the years is that although we are a "wanted" specialty---elective general surgeons have no interest in doing what we do—other surgeons, hospital administrators, surgical chairs do not appreciate what we do and this can lead to burnout and toxicity in the workplace.  At times it is at the point of being considered second class citizens because we take care of patients that do not have insurance---and in some places are seen as a drag on the organization although without trauma, the institution would not need many of the services that other specialties depend on.  As more and more research and literature suggest that the sleep disruption that occurs with overnight call and irregular sleep schedules are very detrimental to our health—especially as we get older.  This is a challenge that we need to face and find a way to continue to provide 24/7 coverage yet in a way that has the least detrimental effect on our health.  Another challenge will be to add robotics to ACS. For example in our institution, the chair has refused to allow any of the ACS surgeons access to the robot.  As residents come out of residency having trained on the robot, they will not want to go into ACS if they have expertise in robotic surgery but have no access to robots.

What is an AAST memory that is special to you?
My first AAST meeting in Montreal, Canada in 1987 and meeting a friend from my medical student days (Dan Johnson) who was doing a trauma fellowship in Houston and told me to go talk to Ron Fischer. I ended up in Houston a year later.

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?Advice for the surgical resident: keep your mind open to experiences and don't sit down and calculate how many years it will take until you start a "real job".  JUST DO IT!

Advice for the ACS first job: Make sure that the job you take has partners that will provide support both in patient care and personal life (ie are willing to work with you on being able to attend family events, etc). These are important to help keep you sane!

Advice for those ready to transition from practice: This is very close to me as I am currently going through this transition. This starts before you even begin to think about retirement.  Make sure that you find something that speaks to you that you can continue to do as you age and do not let yourself make being a surgeon your only identity. If possible, find another area that you can use as a transition whether it is in administration or something else completely out of medicine. I have found that learning a new position is invigorating.

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Patricia Byers, MD

Class of 1995

You have longevity in a challenging career!  Please explain how AAST has helped you in that path. 
It has kept me young by energizing me daily.  However, as I was told when I was younger – that it’s a ‘young-person’s sport.’ The long hours, lack of sleep, and multi-tasking get more difficult as you get older.

What are some of the greatest and best changes you have weathered in our profession as Acute Care Surgeons?  What are some of the greatest and most frustrating challenges we still face?
The development of a mature trauma system has been amazing and brought resources for these patients.  The preventable death rate was 25-50% in South Florida before the trauma system.  Preventative measures that could save so many lives are politically difficult to achieve and are at the voluntary cost of the individual trauma center, unlike is Australia where they attribute $ saved to the prevention programs.  The fee for service environment pushes against these measures.

What is an AAST memory that is special to you?
I remember when it was my greatest goal to get into the ACS so I could apply to get into the AAST asap.  Another -  I couldn’t get off call for long and flew to Hawaii essentially overnight to discuss a paper.

What is a hobby/interest/activity outside of surgery that has given you peace, joy, or revitalization?
Besides my grandchildren, golf - as it requires me to be present and to focus on the moment.

What advice do you have for a surgical resident just beginning?  What advice for an Acute Care Surgeon on the first job?  And to those ready to retire or transition from clinical medicine?
What advice do you have for a surgical resident just beginning?  Learn as much as you can every day.  Remember that these are loved ones who are suffering.  Do not be afraid to cry with families when you are hurting due to a loss.  What advice for an Acute Care Surgeon on the first job?  Get a senior surgeon to be your mentor and advisor – someone on speed dial for the crazy cases than cannot wait.  Remember that we are tasked with fixing things – be brave and fix them.  Advice for those ready to transition away from practice?  Hopefully during your career you have found something that has given you passion that you can get more involved with as you transition away from clinical care. Try to remember who you really are when separated from being the ‘md’ or the ‘surgeon.’  Try to find your way back to that.