At the outset, let me dispense with the obligatory thanks to the membership of the Western Surgical Association for the very great honor of allowing me to serve as your president during the past year. I am still not sure why this occurred, but I cannot help but marvel at the wisdom of the nominating committee. However, the reality of putting together several coherent thoughts that, at most, might be remembered beyond this day, but at least might prevent me from being summarily lynched by the membership at the meeting's conclusion, proved to be a daunting one, but as ever, I was guided by my one constant and unwavering source of support. As many of you know, my wife, Brenda, is a professional actress and, in this capacity, she has served me well. On one particular evening, I was ruminating about this effort; as I recall, she was midway through her nightly aliquot of Chivas Regal and in all candor, a bit higher up on the dose-response curve than usual. She turned to me and said, "Jack, who really gives a damn?" With that brief reality check, this talk became far easier to prepare, and so I decided once again to write a letter to the president of the United States.