Bernard M. Jaffe, MD Professor of Surgery Department of Surgery Tulane University School of Medicine New Orleans, LA

Life is definitely full of ups and downs. The pendulum swings constantly, and the only variant is the width of its oscillations. Just as the lows do not last, neither do the highs. But like the stock market, things tend to even out—as long as you are willing to wait long enough. As Heraclitus said, “the road up and the road down is the same.”*

Overall, the past year has been a ‘down’ period for New Orleans, with mas­sive destruction, mass displacement, and economic disruption. But even during that horrendous period, there were important glimpses of optimism. While many residents have left, New Orleans is being repopulated with new citizens, who are energized and committed to the rebuilding process. This movement exemplifies the adage “One person’s problem is another’s opportunity.” And there is certainly the opportunity to make money in a rebuilding environment.

In the face of such despair, one might expect Tulane to have difficulty recruiting medical students and residents. Amazingly, the opposite has occurred, with applications to the medical school at an all-time high. Last year, Tulane’s match for surgical residents was the best in a long time, with the list filled from the six top-ranked applicants. When asked about their choice, potential medical students and residents have expressed an overriding interest in being part of the solution rather than shying away from the problems. They choose to come to Tulane and New Orleans because of the recognized difficulties, not despite them. Remember, the glass can be half full or half empty.

Katrina had a profound impact on all of us in New Orleans, whether one’s  dwelling or business remained intact or whether it was destroyed. While some citizens were energized and strengthened, others have faltered. Still, regardless of circumstances, each of us has devel­oped mechanisms for coping, and let me assure you, the techniques vary widely. Some have turned a blind eye and lost themselves in work, while others have become activists, working with community organizations to bring back their neighborhoods. Unfortunately, some have needed professional guidance to steer them through the narrow channels.

I selected a relatively unusual response. Before Katrina, I ate whenever I was stressed; as you can tell from the photo above, my patient population and practice were never easy. With Katrina, I adopted the opposite response. Having eaten virtually nothing during the several days spent evacuating Tulane University Hospital after the hurricane (partly because there wasn’t much available and partly because we were too busy working), I saw this difficult period as an opportunity. Rather than choosing food as the mechanism for relieving anxiety, I embarked on a rigidly structured program of carbohydrate deprivation and mild semistarvation. As a surgeon who has performed a large number of gastric bypass procedures, I now became a member of the control group. The new photos, included here for the first time and to be used in subsequent issues of Surgical Rounds, attest to the results of eating 700 calories per day for 14 months.

Now, a brief explanation for presenting two photos, one with a smile and the other displaying a scowl. In reviewing last year’s editorials, I realized that they reflected the same ups and downs that I have described. In keeping with this theme, I thought it might be appropriate for me to signal the tenor of the editorial using my picture: the smile for a positive editorial and the scowl for one that is critical. There doesn’t seem to be much need for a neutral photo, since there are only ups and downs.

Reference
*Diogenes Laertius. Lives of Eminent Philosophers, Book IX, Section 8, p.69.