Being Part of a Department

Departments of Surgery are important for an Institution, for the members of the department and for the patients they serve. They are a mixture of personalities, egos, philosophies, interests, and of work ethic. The tone of the department is set by its leader, who is responsible for the way the department runs and who largely determines the mix of parts that makes up the whole. When you join a surgical department, you have the opportunity to see where you are going to fit in the mix; in the mix of everything I have listed above. How will your personality mesh, where will your interests fit, who do you respect? The way you fit into a department will determine your happiness and to a large extent will make or break your career.

When I joined the Cleveland Clinic, our department of Colorectal Surgery was small. I had the distinct advantage of having worked there as a fellow and a clinical associate and so I knew the answer to the key questions: I knew what the Chairman was like, and I liked and respected him. I knew who my partners were and that I would get on well with them. I had a role in the department. And I wanted to be there. At the beginning my Chairman was Vic Fazio, one of the doyens of Colorectal Surgery, truly inspirational, intensely loyal, and a great mentor for a young surgeon. He pushed my career forward as much as possible. The Vice Chair was Ian Lavery, an amazing surgeon who scared me when I was a resident but was a great partner when I was Staff. Fazio and Lavery were good friends, very hard working and set a department philosophy that always put patients first. Frank Weakley was the senior member of the department and was slowing down on the way to retirement. He was a jovial man who loved to chat, but who knew a lot about colorectal surgery. He ran an anorectal clinic for the first few years I was in the Department, but he didn’t operate and so was always calling me in to see the various conditions he felt needed surgery. My fourth partner was another Australian, John Oakley. John had been a fellow with me and he was a confirmed bachelor. John was a good surgeon, hard-working, but he loved a party. He had a fund of questionable jokes, was very easy to talk to, and was the life and soul of any gathering. This was the department I joined in March of 1989; four surgeons, famous for inflammatory bowel disease and colorectal cancer, and acclaimed for the expertise of Fazio and Lavery. It was my job to contribute to the group, to add something unique, to add to the ethos. While all four of us operating surgeons accepted all patients and operated on all diseases, my interests developed in the areas of colonoscopy, polyps, hereditary colorectal cancer, anorectal physiology, anorectal disease and functional diseases of the large bowel. In this I had minimal conflicts with my partners, and anyway there was plenty of work to go around. My interest in colonoscopy allowed me to build bridges to Gastroenterology while helped when interdepartmental relationships became strained.

A series of new staff joined the department, including Jeff Milson, Peter Marcello, Scott Strong, Tracy Hull. Under the leadership of Vic Fazio the department prospered, and the careers of all its members prospered too. The “Cleveland Clinic way” was taught to generations of fellows, a few of whom were hired as staff. Research was always given a high priority, and researchers were supported with funds and time. The reputation of the department grew and this was reinforced by the numerous studies and the regular speaking activities of the staff and fellows. Within the department the staff got on well with the secretaries, the nurses, and other support people. This led to a happy atmosphere. The most important thing to me however, was that we all liked each other. We saw each other regularly in social situations, we had dinners at the “Clinic Inn”, and our wives would also hang out from time to time.

Since the loss of Vic Fazio as a Chair the department has struggled, showing the true worth of his leadership. Throughout my career I have sought to serve my partners in every way that I could.