In 2019, it was said that he “hath impaired vision.” In 2020, I can finally say that he hath 20/20 vision. Whether that vision was always extended to unfinished dictations is another matter. Every chief resident leaves behind a record. Some leave records for operative cases, academic achievement, or leadership. My Resident may also have established a record for the most delayed dictation. It is important to be remembered for something.
The pandemic taught us many lessons about masks, vaccines, and creative explanations. Whenever masks were discussed, his position seemed to be that “the season is over.” That same philosophy may also have explained the timing of his vaccination. Still, he survived the pandemic, residency, and five years of my supervision — three conditions that demanded resilience, judgment, and occasionally selective hearing.
To the incoming chief residents, I offer reassurance: working with the younger residents will be no problem. There will be the same teething issues, the same notes to complete, the same dictations to chase, and the same delinquencies that somehow become urgent only after several reminders. The names will change, but residency has a remarkable ability to preserve its traditions and culture.
He is, of course, a millennial, so day trading came naturally to him. While others reviewed laboratory results, he may have been reviewing market results. Surgery teaches us to recognize risk, act decisively, and know when to cut our losses. Perhaps that is why he found the stock market so familiar.
His childhood ambition was to become a commercial airline pilot. He no longer needs to regret that decision. As a general surgeon, he has spent many hours in the cockpit, although his flight log has been somewhat unconventional. No other chief resident has shown such enthusiasm for scrubbing into a hemorrhoidectomy. Apparently, the case counted toward his flying time only when the patient was male. I did not write the rules; I merely observed the aviation curriculum.
In the operating room, he developed a particular fondness for the LigaSure. Why use monopolar cautery when one instrument can seal, divide, and make the resident feel technologically advanced? I suspect he was preparing himself for the inevitable arrival of robot-assisted laparoscopic surgery, when the surgeon will sit across the room and the robot will receive all the credit.
During a complex abdominal wall reconstruction with components separation, I repeatedly warned him about the possibility of bladder injury. I guarded the bladder, reminded him about the bladder, and then reminded him that I had already reminded him about the bladder. He listened — and did not injure the bladder. This was an important milestone, not only in surgical technique but also in proving that repetition can eventually produce results.
He learned surgery at the bedside. I used to tell him that, once married, he might find himself at the wrong bedside. It was a joke, but he sometimes took my jokes more seriously than my operative instructions. While considering fellowship opportunities, he described the broad farmland of rural Pennsylvania as though he had discovered Wuthering Heights. I told him that the landscape might seem less lonely if, after one of his frequent flights to Lahore, he returned with a band on the fourth finger of his left hand.
There are practical advantages to listening to one’s parents. Pakistani home cooking is one of them. Homemade keema is difficult to argue against. I know this from personal experience: I ate keema every morning for a month with my Pakistani roommate in Edinburgh, Scotland. So my advice was simple — be slightly less American, slightly more Pakistani, listen to your parents, and secure a lifetime supply of excellent food. This may be the most useful career advice I have ever given him.
Then there was the famous spleen. I admire residents who are enthusiastic, energetic, and always searching through CT scans for the next operative opportunity. My Resident could identify a patient, move toward the operating room, and tell the story afterward with such efficiency that the splenectomy became known as the “nine-minute spleen.” Doubting Thomases may add the word “allegedly.” I prefer to emphasize that, in surgery, outcome is usually more important than speed — although a good story benefits from both.
His hands could occasionally appear heavy. When he irrigated the left upper quadrant, I would say, “Let us not add a splenectomy to the planned procedure.” To his credit, we never did. He may have added gray hairs to my head and shortened my telomeres, but he also developed judgment, control, and technical maturity. During the gastrectomy for recurrent upper gastrointestinal bleeding, he separated the pancreas from the “duo,” as he called it, with a light and steady hand. That was the moment when the teacher worries a little less and begins to trust a little more.
Of course, training is never perfect. With My Resident, I once performed a right end colostomy when my plan had been a left diverting loop colostomy. These things teach humility. The motto of good surgical training is not “forgive and forget.” It is “forgive and remember” — forgive the mistake, remember the lesson, and make certain that neither the resident nor the attending repeats it.
After five long years, he learned the most difficult skill in surgery: listening. When I spoke, he became silent and reflective. At first, I wondered whether he was listening, day trading, or planning his next flight. Over time, it became clear that he was absorbing the lessons, developing his own judgment, and becoming the surgeon we hoped he would be.
He relates well to residents, patients, and every member of the health care team. He reminds us that patients are not diagnoses, operative opportunities, or, as he once put it, “slugs” or “poor protoplasm.” They are people who place their trust in us. He has earned that trust through hard work, loyalty, humor, resilience, and genuine concern for others.
So tonight, we roast the delayed dictations, the day trading, the model airplanes, the LigaSure, the allegedly nine-minute spleen, and the many shortened telomeres. But we toast the colleague, leader, and surgeon who emerged from it all: an exemplary Chief Resident, a valued member of our surgical family, and a man whose vision, at last, is truly 20/20.
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