"How then shall we live?".

This address did not originate in my neocortex, but in a deeper region of my brain, the one responsible for signaling a sense of warning. The sense I have is that a subtle, distinct change is occurring around me that is not quite right. This sense eventually grew into the perception that society, in general, and medicine, in particular, are devaluing the ideals of service and sacrifice. I did not intend to share this perception, however, until three seemingly unrelated events occurred. The first event occurred when I saw Saving Private Ryan for the first time. To me the most memorable part occurred when Tom Hanks, playing the dying Lieutenant Miller, whispers, “earn this” to Private Ryan. “This,” of course, is the ultimate and supreme sacrifice that he and others have made for Ryan. Over the ensuing weeks as I reflected more on the “earn this” phrase, it occurred to me that all physicians have been given an incredible gift, the science and the art of healing. No matter how many personal sacrifices the individual physician made in preparing to become a doctor, those sacrifices pale in comparison to those made by the thousands of physicians, nurses, patients, and scientists who have made medicine and surgery what it is today. In addition to the numerous diagnostic and therapeutic tools that have been given to us, we have been given trust, admiration, and respect simply because we are physicians and not because we specifically earned it. It also occurred to me that physicians of the future will rely on each of us to maintain and increase that respect and admiration by the way we practice and by the way we live. The Saving Private Ryan epiphany would probably have come to naught were it not for the second, more profound, event. This occurred in August of 1999, when our family took my oldest daughter Kate to college. She had chosen to attend the College of the Holy Cross in Worcester, Massachusetts. Holy Cross is a Jesuit school with a strong tradition of integrating service and spirituality with social issues. As part of that tradition, all freshmen are introduced to the first year program, which poses the fundamental question, “How then shall we live?” This question, first proposed by Leo Tolstoy, forces one to come to terms with his or her own role in society. The question exactly posed to Kate’s entering class was, “In the culture of the here and now, how then shall we live?” Like a thunderbolt, the question struck a chord in me and resonated. I realized this had relevance, not only for my daughter, a freshman at Holy Cross, but also for me, an academic surgeon in Vermont. At first, it seemed almost rhetorical to ask this question because conventional thought would suggest that how an individual lives has no real consequence in terms of societal or cultural change. Then the third event occurred. I read Albert Schweitzer’s autobiography. Schweitzer, a philosopher, theologian, musician, teacher, author, husband, father, and physician wrote: It’s not enough merely to exist. It’s not enough to say, “I’m earning enough to live and support my family. I do my work well. I’m a good father. I’m a good husband. I’m a good churchgoer.” That is all very well, but you must do something more. Seek always to do some good somewhere. Every man has to seek his own way to make himself more noble. . .you must give someSubmitted for publication March 26, 2001. Accepted for publication March 26, 2001. Copyright © 2001 by Lippincott Williams & Wilkins, Inc. From the Department of Surgery, College of Medicine, University of Vermont, and the Fletcher Allen Health Care Center, Burlington, Vermont. Presidential address presented at the 31st Annual Meeting of the Western Trauma Association, March 1, 2001, Big Sky, Montana. Address for reprints: Steven R. Shackford, MD, FACS, Department of Surgery, Medical Center Hospital-Vermont, Fletcher House 301, FAHC, 111 Colchester Avenue, Burlington, VT 05401; email: [email protected]. Steven R. Shackford, MD, FACS President, Western Trauma Association The Journal of TRAUMA Injury, Infection, and Critical Care