Identity

I have been thinking about the word “identity” for a while now. It is not, perhaps, the typical focus of a presidential address to an academic surgical society. You might expect something more along the lines of a history of our organization, a comment on a major advancement in our field, a remembrance of a glorious symbolic figure of our profession, or a call to action to address some grievance, or even ruminating on the field of medicine we have chosen. Surgery is the career path we have chosen. Like most of you, I have defined myself as a surgeon and, more specifically, as a trauma surgeon. We have chosen this identity, or it may have chosen us. In some way, along the way, nature, God, and karma brought us to this place of our identity. I have my identity. You have yours. And our organization, like any other professional organization, also has its identity. This address is about the importance of identity in defining who we are, why we do what we do, how it guides our decisions, and how it comforts us in times of stress and turmoil; but it is also about how it can hold us back from trying new things or even from achieving the potential of what we could be. Professional Identity My professional identity has been bred from a mix of Catholic priests and old time medical general practitioners, transplant surgical pioneers, and the original acute care surgeons of the county hospitals. My middle name, Jerome, is in honor of Monsignor Jerome Quinn (1927–1988), a Roman Catholic priest who baptized me and befriended my family for more than 30 years. He was a well-recognized biblical scholar of his time, as was his namesake, St. Jerome of the fourth century, the patron saint of librarians and encyclopedists. St. Jerome is perhaps best remembered for the medieval story of his befriending a lion after removing a thorn from its paw. It is a bit of a stretch, but this does remind me of the way some nights on call turn out. My nickname “Jerry” is from Jerome. Dr. Ben Owens was our “family doctor” for many years. He was the classic family general practitioner from Hibbing Minnesota and the cornerstone of that community’s healthcare. He undoubtedly influenced my decision to become a physician. I also have to acknowledge the Dean of Students at the University of Minnesota Medical School, Dr. Al Sullivan, who demonstrated a nurturing belief in me and my future, and of course the influence of my father, who I seem to be more and more like every day (Fig. 1).Figure 1.: Medical school graduation.I was not always going to be a physician and certainly not a surgeon. Although my identity was tied to the sciences and my academic performance in high school, I was desperate not to be too much of a nerd, failing miserably as President-elect Peitzman has so nicely pointed out in my introduction. I grew up, as it were, in the sixties and seventies, and they were the time of rebellion, free love, psychedelic drugs, and space travel. I did none of those. Either it did not fit or I just simply missed out. I was an engineering major in college, for reasons that escape me now, and decided late on a career change to medicine. In medical school, I thought I was going to be an internist, but the influence of the surgical service of Dr. John Najarian was too strong. In residency at the University of Colorado, the pull between the cutting edge transplant world of Dr. Tom Starzl, and the county hospital, free form, take no prisoners world of the senior leader Dr. Ben Eiseman, and the young attending Dr. Gene Moore were a dynamic that further shaped my identity. These were stimulating times, creative times, and identity shaping times. I present this brief litany of my legacy, in part, not only to thank these mentors and supporters but also to acknowledge that the formation of an identity takes some time for individuals, as it does for organizations. I suspect that many of you can similarly retrace the origin of your identity, but there is more to identity than our mentors and our site or style of practice. There is our heritage, as Dr. Fabian’s presidential address last year highlighted. Our heritage does shape us, but it can also trap us into believing that we cannot change: that we must remain as we are. But this is so untrue. If this were the case I, and I suspect most of you, would not be here. Personal Identity I was born and bred in Minnesota, in the heartland of the United States, the area known as the upper Midwest. Much of my identity (like our organizations identity) was derived from my early years. I spent the first 18 years of my life in Minnesota: land of 10,000 lakes and 10 gazillion mosquitoes; land of the loon and Paul Bunyan and the headwaters of the mighty Mississippi; land of farming and grain mills and General Mills and Little House on the Prairie; land of iron mines and timber and railroad barons; land of Garrison Keillor,1,2 and the fictional, but oh so real Lake Wobegon. The Lutheran Church Protestants and pastor Ingqvist, and the Catholics of Our Lady of Perpetual Responsibility. Where all the women are good looking, the men strong, and the children above average. A place of European immigrants, farmers, and mine workers. My paternal grandparents immigrated to the United States shortly after the turn of the 20th century from Croatia of the old Yugoslavia. My maternal ancestors came to America even earlier, before the turn of the century, from German-Russian border towns. Driven by the quest for a better life, they left their homes, their comfort zones, their families, and began a new life. They chose a new identity, and they were not alone. Approximately 15 million people entered the United States from 1900 to 1920, the largest percent of population legally admitted during any 20-year period, and a population that contained my father’s soon to be parents (Fig. 2). Before 1890, 82% of immigrants came from north and Western Europe, like my German great grandparents of my mother. By 1920, that number decreased to 25%, with a dramatic increase in immigrants from East, Central, and Southern Europe. Although immigration has increased over the last century to current levels of about 1 million legal immigrants per year, the foreign born share of the population was still higher in 1900 (∼20%) than it is today (∼10%).3Figure 2.: US Immigration, 1820–1970 (from United States, 2009 No. 71).The lesson of the great immigration to the United States is one of a realization of new identity. My grandparents referred to the past life as “the old country.” These immigrants kept much of the “old country” life they valued deeply: a sense of family and community, the food and the recipes, the work ethic, and the love of their children. But the drive and the desire for a better life, for the opportunity to be something more, unsettling though it was, that drive was strong, and for many it was a drive to survive. Here in lies the crux of the paradox of identity. Identity defines who we are. It runs heart deep and bone true within us. I believe our identity, along with our progeny, and our need to be loved are uniquely defining human elements. Identity is crucial to happiness. And yet, although identity can, and does, define you, it can limit you from becoming who you are meant to be. A corporation that is wedded to its identity may not have the adaptability to survive. Blacksmiths, cowboys, Pony Express and telegraph operators, lumberjacks, miners, and even fisherman have found in their tools of identity an essential need so constrained as to not adapt, and hence, not survive. Adaptability, accepting change, and allowing the possibility of another identity are the individual’s equivalent of corporate survival, human society adaptation, and Darwinian species adaptation. Certainly, biological evidence of adaptation for survival should be an unmistakable message as to how to accept the necessary tension or even conflict between having a strong sense of identity, yet harnessing the power derived from allowing a change. That power to change allows survival. It allows regeneration, rebirth, continuity, and in secular terms, immortality. Bloom,4 writing in her novella “Away,” tells a unique American story of a young Russian Jewish immigrant in 1924 New York and her quest to find her identity. The book is replete with lines that beautifully depict the struggle her characters have with their own identity. Describing the relationship the main character has with Yakov, an older man, a kind, yet sad benefactor: “She does not bring him back to the man Yaakov knew thirty years ago; she brings the man he is now closer to who he might have been.” Closer to the possibility of a different, alternative identity. This line is reminiscent to me of one of the great quotes from Hank Devereaux, Jr., author Richard Russo’s central character in the book “Straight Man.”4 Hank is the 50-year-old head of an academic department in financial difficulty and full of departmental squabbling. He is under tremendous stress with his fledgling academic career, a prominent academic father coming for a visit, and impossible management choices he must make in the midst of severe budget cut backs (sound familiar?). Too add to his stress, Hank is also accused of killing a campus icon, a goose. Hank’s wife, increasingly frustrated with his behavior, his poor choices, his moping, and the general struggles of his mid-life crisis, one day demands of him: “Hank, be the man you are. Be the man I married” to which he replies: “Which one? Make up your mind.” Struggles with identity and solutions to this age-old question line the shelves of airport bookstores and self-help sections of the mega booksellers. A search term “identity” on Amazon.com book section Website garners 535,637 results. Adoptees have a particularly difficult time with personal identity and have been pushing to open adoption records in many states, with Maine being the most recent to grant adoptees total access to their original birth certificates (Maine LD 1084/Public Law 409). As quoted by a legislator who was an adoptee herself: “this is about identity and the truth of a human beings existence.”5,6 Our social identity may be tied to our pursuit of happiness more than any other single factor. The Canadian Institute for Advanced Research (http://www2.cifar.ca/) has an entire program dedicated to the study of identity and well being. A key finding of their work is that the key to happiness is belonging—to families, clubs, sports teams, churches, the American Association for the Surgery of Trauma (AAST), whatever. Belonging, or social connectedness, predicts happiness far better than wealth, health, or intelligence.7 It even predicts how well one from an The Canadian are not the largest or but with the sense of and the most as a with on to something and identity from I this to the importance of our the in our professional and personal happiness. It is in many an of our identity, and the social of that identity is necessary for happiness. is our Where is the is the identity of our as some of our have for or If that is can we There is a new that this In an for the one of the key in a of stress and high love this I do love my but we we to acknowledge the identity we were, the identity we are, and to the identity we might Identity and of the The of of the have with Research and to the identity and of the and identity can be defined as a of and and that people have in their about a or that of one from things seem to best define the most of the past and (Fig. The of this of the is to who we are as a professional and how we can best our society to adapt, and in this time of in of may have been the first corporate and 1890, it has with the of like and their in the with and to of at every was in the and the for family was the of for a and the of the and it management has to a of professional and and the an is certainly not the as a We are not but we are we have an identity, and we are trying to and our as a A professional is a of identity, and that has the power to influence decision to become a and to our organization, in our our our and our and work If the things that define the most are and how are we Our performance might be by the of a and a valued do from this it to their it the and the in and the unique and and something we in our and we have a Our and the of our all influence our identity, but the key to is the message we are that we have one of on the of and The of the first that of or current identity, can be in on the site The and of the is in with the central being a trauma surgical We believe that the the of the are the of the and of surgeons and to take and the and of trauma Although there is strong of the and the of Trauma and their is there may be an opportunity to better and for an of the to the and Although is as a leader in the field of trauma with for new in the area of But although the is as the of thought in academic trauma there is some about the and the the should or identity of the American Association for the Surgery of Trauma by and of this our identity. 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The that with this is that although we are to acknowledge a we are an opportunity to with a of we are and who we might And I do from some personal but I also from so much of the of human that these of are one of even to the the too much to and we we from the potential of back to our place of and only to the with the of a new The or simply the or the is a cornerstone of This writing is to have been by the in the century was an older of but his life is that of It is that the into of or have been more than all the the most is the Paul from but there have been of other at all some on their to the As a and and a practitioner of the I myself with even the and I the of well and in the way, but the of or is to one of the of this This paradox is to the Western by by and It in the world is as as as can the the strong, and remain strong. the This paradox can be into a on identity, and although not from any of the the is also to I of what I I become what I might be. You cannot become who you are meant to be of who you are. I that identity, love, and are to me the of human Although I have at some of identity, the are key to our identity and It is the and the yet to be of this that must our identity and have the to accept the to up, and become what we might I this a good place to and you can to the of identity as a of the and in your own In I to acknowledge the tremendous and opportunity so many have me along my surgical I the of Tom Starzl, John and Ben I must add who me my first at the University of The academic career I there by with and was a I Gene Moore and have been more than and they have been my and along with so many of you, have me find my and my identity in academic medicine. And my academic career much to the of and our with the University of and Medical I to thank and for and and for not me at any number of along this 20-year I could not work for a better I all of you could be so to work and a and of surgeons and as I have been to do so for that past at It is a I that my wife, and my and and my and father, and are with me in the I was of even to or about and my earlier, the that is a of the of a presidential Although the is my professional identity, they are also my personal identity. They are my and They are all to and I love and

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