Friends and Colleagues,
As I stand before you this morning to present the 114th Presidential Address to the American Society of Colon Rectal Surgery, I find myself both humbled and honored. The privilege of serving as your president for the past year has been the pinnacle of my surgical career. I thank you for that trust and I promise to cherish this experience always.

As I sat in my office pondering the subject of today’s Presidential Address, my eyes scanned the walls and bounced between the diplomas, plaques, and pictures that represent some of the important milestones in my career. Seeing them, I felt a false sense of security. The topic of my speech, I thought, will be the complete picture of the colon and rectal surgeon in 2015, sort of a complete blueprint for younger colleagues to follow. After all, I have been an academic surgeon for more than three decades and I have seen it all. How hard could this project be? I thought that the picture of a colon and rectal surgeon in 2015 is just like a giant jigsaw puzzle and since I have mastered all the pieces, all I will need to do is to put the puzzle together for my colleagues to see.

As I started to put pen to paper, however, I was jolted by a strong dose of reality. I had not mastered all of the pieces, and after I had put together the puzzle, there was a problem with the picture—a big problem. Three large pieces were missing. It is the problem with these three missing pieces that I want to discuss with you this morning. Now the golden rule for resolving problems with any jigsaw puzzle is to start with the pieces we do understand, so let’s begin with the first piece: How did I become a part of this puzzle in the first place?