PALM BEACH, Fla.—In an address that ran the gamut of emotions—from success to tragedy and back again—W. Charles Sternbergh III, MD, may have delivered a salutary lesson in both life and work for posterity, one from which vascular surgeons of every vintage could draw.
He began by asking for his audience’s indulgence. This was to be a deeply personal address, a break from the purely scientific and the clinical.
It was, Sternbergh warned, primarily about his “personal quest for contentment, understanding and fulfilment.” Lessons learned, ah-ha moments, his journey of self- discovery—“all in the pursuit of happiness.”
As its 43rd president, Sternbergh was delivering the presidential address at the Southern Association for Vascular Surgery (SAVS) 2020 annual meeting (Jan. 8–11) in Palm Beach, Florida. And he quickly turned the mirror on himself.
Sternbergh started by relating the tale of his search for self-awareness in his early years. “I believe that the mastery of self-awareness is rare. Many people don’t have great self-awareness and the irony is glaring. Folks just don’t know what they don’t know.”
Personally, the professor and chief of vascular and endovascular surgery at Ochsner Health in New Orleans, admitted, he wasn’t blessed with great self-awareness.
“Here’s a great example,” Sternbergh said: “Convincing myself that my choice of college and medical school had nothing to do with the fact that my father had attended the same institutions: I really believed and would try to convince anybody who would listen there was no connection.”
The journey continued three years out of his fellowship training in New Orleans, at the time of the earliest minimally invasive endografts for aortic aneurysm repair. Given his junior status, he said, he “had no illusions about getting a piece of the clinical trial data for presentation.
“But I thought, hey, what about an economic paper about costs of this new technology. Well, cost papers are now omnipresent in healthcare delivery, though not a topic explored much 20 years ago. My working hypothesis was that EVAR [endovascular aneurysm repair] was going to be less costly than open repair given the radically reduced length of stay.”
As Sternbergh related, he took delivery of the summary data the afternoon before the Society for Vascular Surgery (SVS) deadline for abstracts.
“I was floored to find my hypothesis had been completely wrong. AAA [abdominal aortic aneurysm] management with EVAR was actually more costly, primarily because the endograft cost was going to be 50% of the total hospitalization cost.
“I knew immediately that these data were abstract gold and spent the rest of that evening writing. So now is where it gets interesting. The abstract was highly ranked by the program committee and initially placed as the second podium presentation at the opening session.
“But then we received word that at the direction of the SVS president our abstract had been removed entirely from the program. Notably, the SVS president also happened to be the national primary investigator for that trial.
“But this was before the age of conflict of interest disclosures. While we were successful in getting our abstract back on the program, the patient level data and cost methodology were suddenly no longer available.”
Who was the discussant for said paper? The aforementioned SVS president, Sternbergh said. Accusations of fabricated cost data were levelled, he went on, as well as attempts to block its publication. He was further “encouraged” to withdraw the manuscript. The accusations, Sternbergh said, “cut me to the bone. Integrity is everything to me. So, I took this very personally.”
Following this denouement, a self- explanatory epilogue, he said: The paper was published and reproduced down the years. And within a year of this episode, formal conflict of interest disclosures were mandated for the Journal of Vascular Surgery.
Personal growth—and tragedy
“Although I did not realize it at the time, this episode helped me along the path of self-awareness, providing a concrete example of understanding and conscious knowledge of one’s own character.”
So goes personal growth. For Sternbergh, unbearable personal trauma was just around the corner, laying bare for him the challenges of life. This period of his life helped him underscore what he described as a central part of self-awareness: “Being able to locate, access and process your feelings. As a head-directed person, that has frequently been a challenge.”
A couple of decades down the road, he said, “I feel more self-aware and perhaps a bit farther along that path in the pursuit of happiness.”
He then turned the lens on his gathered colleagues, challenging them to consider what pains, grief, loss or sadness they might be holding on to. “As vascular surgeons,” said Sternbergh, “we excel at cerebral, thought-directed activities but we are frequently challenged when it comes to accessing and processing our feelings, especially ones that are painful.
“I urge each of you to look inward and embrace the challenging emotional work of processing those hurts that many of us bear.”
Sternbergh recalled one other moment in his life, this time at the 2007 winter meeting of the Vascular & Endovascular Surgery Society (VESS) in Steamboat Springs, Colorado. He had fallen and suffered a tibia-fibula fracture. The attending surgeon informed him he would require emergency surgery and six-to-eight weeks laid-up. His response? To worry about his following week’s schedule.
“Did that response demonstrate great self-awareness? Not so much. But it did expose a classic Baby Boomer characteristic. A mantra of work ethic and duty above all else.”
Too often in the U.S., Sternbergh said, people live to work. “As vascular surgeons we are driven and ambitious, and too many of us—myself included—have fallen into this former category. We Boomers have plenty to learn from the Gen Xers and Millennials who in my opinion have a healthier approach to work-life balance.”
That said, Sternbergh highlighted the idiosyncratic nature of a discipline he loves. “As vascular surgeons, we are fortunate to be in a position to make a real difference in people’s lives. That satisfaction and the genuine gratitude of patients still puts a smile on my face. I’m quick to point out to medical students and trainees that vascular surgery is one of the very few surgical specialties which provides longitudinal care in connection with our patients.”