2008 to 2009
In the book The Black Swan by Nassim Taleb, the author introduces the concept of an ovine miracle that had previously been deemed an unassailable European belief, the existence of a living “black swan.” The living evidence of these Australian phenomena was a concept whose very existence was thought to be not only improbable but also completely impossible, an unknown unknown. This finding caused great excitement within ornithological circles. These fantastic occurrences are very different from the known unknowns, which represent phenomena that occur with a predictable frequency, whose mechanism is understood, and are recognizable and quantifiable. The response is easy to craft and the downstream impact is rarely dramatic and unique. We understand these phenomena: a patient with a fever on postoperative day 5 may have atelectasis, a urinary tract infection, pneumonia, an intra-abdominal abscess, or an anastomotic leak. We can sort these dilemmas out.
To qualify as a true black swan, the event must be dramatic in and of itself. The magnitude of the event, however, is defined not by the occurrence itself but predominantly by the response and sequelae of the phenomena. Although it would be presumptuous to claim clairvoyance in selection of a theme for this talk, my term as president of the American Society of Colon and Rectal Surgeons (ASCRS) has been bracketed by 2 dramatic and unexpected events: the international monetary crisis last Fall and now the potential impact of influenza A(the politically correct term to avoid offending the porcine contingent). As a result, I would like to put this metaphor of the black swan in context for the things I have experienced thus far in my career and what this may mean to our specialty and professional medical association, the ASCRS.