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Paradox

      Do aliens and extraterrestrial beings exist? Statistically speaking, considering the vastness of the universe, other intelligent beings ought to exist somewhere in the universe. Yet, following the classic Fermi’s paradox, we refute the existence of aliens.
      • Lohnes K.
      The Fermi paradox: where are all the aliens?.
      What is a paradox? It is a self-contradictory statement that seems absurd but, when carefully investigated, is found to be true. We are now living in the classic paradox: a pandemic of unimaginable misery, which despite the hardships, has a silver lining. Today, I want to explore the lessons of the past through the concept of paradox and examine how this shapes our vision for the American Society for Surgery of the Hand.
      It has been 2 years since we have been with each other at our annual gathering. I am so grateful to see all of you in person and virtually. The past 2 years seemed like a horrendous dream, or a classic paradox. To understand the roots of any crisis, we must consider what we know through the framework of the paradox. At one time, Europeans believed that swans were only white. In fact, they believed more in the existence of unicorns than in a swan that is black, until the black swan was discovered in Australia. This phenomenon led to the idea of the paradox of the black swan: an event that is so rare it is seemingly unfathomable.
      • Taleb N.N.
      The Black Swan: The Impact of the Highly Improbable.
      But coronavirus disease 2019 (COVID-19) is different; scientists have been saying for years that a pandemic is on the horizon, but we did little to mitigate the danger.
      There is an often-stated saying, “it was the best of times, it was the worst of times.”
      The Dickens Project. The Best of Times, the Worst of Times. June 29, 2020.
      On the one hand, we all lived through our first pandemic and experienced times of increased national tension and global destruction like we never saw before. On the other hand, there is a bright side to this, in that we got to spend more time with our families and maybe pick up a new hobby or finally catch up on our reading lists. However, our story has not yet reached a finale.
      In most stories, there is a hero, a villain, and a sidekick who helps the hero along the journey. A classic example of this is Star Wars, a story with which all of us are familiar. In this story, the hero, Luke Skywalker, aims to defeat the villain, Darth Vader. He needs help along the way, and he finds this from various friends, families, and allies, such as Obi Wan Kenobi. However, this pandemic is a reality and not a movie script. How is this story going to play out for us? It is easy to place blame on the virus—the villain—but who is the real villain?
      I would argue that we are the villains because we, human beings around the world, ignored all the signs of this pandemic, took minimal action to curb it, and, worse yet, disregarded its existence. We cannot blame the black swan for this unanticipated rare event. But who are the heroes? Herein lies the paradox—we are also the heroes: the brave health care workers around the globe who died caring for the sick. These heroes are our colleagues who made the ultimate sacrifice. We physicians are the heroes of this story. We achieved the most remarkable development of vaccines in record time using novel messenger RNA technology. It is humbling to witness the generosity of the heroes among us, you, who contributed to food banks and gave monetary assistance for those in need. In any great story, there are also helpers. Who are the helpers? How about the Federal Emergency Management Agency, which made an impressive vaccination effort throughout the country? They were vilified during the aftermath of Hurricane Katrina. My family received our vaccine at the Ford football stadium in Detroit. We are comforted that they are professional, efficient, and, just as importantly, delivering painless injections in their proud military uniforms. A paradox is at play here. We are also the helpers, recognizing that there is no “us versus them” in the divided world, but us, all human beings, who are the only ones who can get us out of this sorrow by collaborating among people and among nations and establishing the much-needed trust to overcome this pandemic. We need to have the resolve to anticipate the next disaster that will surely come again by helping and caring for each other.
      So, the question now becomes, how can we rise successfully from the depths of our current paradox? How should we deal with the paradox in the current pandemic? What good can come from this horrific event? Someone, I am not sure who, has said, “never waste a good crisis.” Many of these witty quotes can be traced to various people, but it is a safe bet that we can credit some of them to our sharp British colleagues, who are our international guest nation, and better yet, Winston Churchill.
      One way that we can recover is to look to history for lessons. One lesser-known story is the Siege of Leningrad.
      • Alexanyan S.M.
      • Krivchenko V.I.
      Vavilov Institute scientists heroically preserve world plant genetic resources collections during World War II Siege of Leningrad.
      This is a unique paradox of protecting the future generation by sacrificing the current population. The city of Leningrad, now called St. Petersburg, underwent a siege lasting 872 days during World War II. It caused an extreme famine, where the main food source was a daily ration of 125 grams of bread a day (for context, one slice of bread is 38 grams; so, 3.3 slices of bread per day). They mixed it with sawdust to keep people full. This siege led to the deaths of 1.5 million people, a number that is hard to imagine. The paradox of this situation is that just down the road from where people were receiving their sawdust bread was enough food to feed the whole population of Leningrad for the duration of the siege. Have you heard of the Vavilov Institute of Plant Industry? Not many have. Nicolai Vavilov, the person in charge of this institute during World War II, kept the world’s largest collection of plant seeds largely a secret from the starving population. The intent of this institute is to safeguard the biodiversity of the earth to weather future calamities. This institute has survived many attempts to disband it and currently contains over 345,000 varieties of seeds from around the globe, some of which are extinct.
      Did the scientists make the right decision? Several members of the scientific team died protecting the seed repository, not to mention the millions in the city who perished. Are the scientists the heroes or the villains? Or both? The paradox is this: the scientists are the heroes who sacrificed their lives for future generations, but they are also the villains who permitted over 1.5 million people to die. They are also the helpers in this story. Their mission to safeguard the seeds prevented the starvation of future populations. This institute is still standing and is carrying out its goal of protecting the biodiversity today. For example, a particular wheat species from Ethiopia became extinct during their civil war in the 1970s.
      • Koreneva M.
      Russia’s Vavilov institute guardian of world's lost plants.
      The Ethiopian government asked the institute for the extinct wheat’s seeds, which were subsequently reintroduced back to Ethiopia; they now provide a much-needed food source for the population. We, as a species, have the opportunity to choose whether we want to be the hero, the helper, or the villain depending on whether we use our wisdom and resources or are consumed by our ignorance and individualism.
      How were the Russians feeling in the midst of the famine, and how can we be certain that this pandemic is going to end? I have been thinking a lot about Admiral Stockdale, who was a Navy admiral during the Vietnam War. The well-known Stockdale paradox illustrates the unspeakable personal tragedy and personal triumph that mirrored our individual reflection of this pandemic.
      • Pratibha A.
      The Stockdale paradox.
      The admiral, along with many other members of the Navy, was captured and held hostage as a prisoner of war for 8 years, 8 years of suffering from starvation and daily torture. The admiral survived this ordeal, with his mental fortitude intact; yet, many of his fellow prisoners died. Admiral Stockdale is remembered for maintaining hope despite being held as a prisoner not knowing when he would be released. Some of his powerful quotes from this paradox of tragedy and personal triumph form the Stockdale paradox: “I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which in retrospect, I would not trade,” in addition to “you must never confuse faith that you will prevail in the end—faith you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.” The admiral continues: “those who did not get out—the optimists … the ones who would say ‘we’re going to be out by Christmas’ and Christmas would go. Then they’d say, ‘we’re going to be out by Easter,’ and Easter would come, and Easter would go … And they died of a broken heart.”
      • Pratibha A.
      The Stockdale paradox.
      We are smack in the midst of the Stockdale paradox. How many times have we heard our kids, loved ones, or news anchors say that in 1 month, COVID-19 will go away, then in 6 months, then in 1 year? Do not confuse optimism with the resolve to overcome our current challenges. Yes, we must have hope because without hope, we will not have the will to survive this pandemic. But we must face the reality of this enormous obstacle. We have to do what we can to protect ourselves and each other. Be kind to our fellow people and help each other recover, together. “Share our vaccines to the world.” America is the most generous nation in the world, with the largest contribution of foreign aid. We have bought and donated 500 million doses of vaccine for the world, and most of the vaccines have been delivered.
      • Pager T.
      • Rauhala E.
      Biden administration to buy 500 million Pfizer coronavirus vaccine doses to donate to the world. The Washington Post. June 9, 2021.
      But more needs to be done by all countries with the means to do so; 90% of people from 67 low-income countries still stand little chance of getting vaccinated against COVID-19 in 2021.
      • Dyer O.
      Covid-19: many poor countries will see almost no vaccine next year, aid groups warn.
      This pandemic has illuminated the gross inequality among nations. Rich countries with just 14% of the population have bought over 50% of the 8 most effective vaccines.
      • Pager T.
      • Rauhala E.
      Biden administration to buy 500 million Pfizer coronavirus vaccine doses to donate to the world. The Washington Post. June 9, 2021.
      This pandemic does not discriminate among people. It is not helpful to lay blame and find a villain, for if we do marginalize anyone or any group, we will remain the villain of this story. We are in this together.
      You just saw the magnificent 75th anniversary video of a great society, the American Society for Surgery of the Hand. In 1939, the Surgeon General, Dr Norman Kirk, promoted Dr Sterling Bunnell from here in San Francisco to teach hand surgery around America.
      • Dunn J.C.
      • Lenhart M.K.
      • Higgins J.P.
      • Nesti L.J.
      How the US army forged hand surgery.
      The iconic quote of our specialty is “it falls to a few men to originate a surgical specialty.”
      American Society for Surgery of the Hand. About ASSH.
      These few men started the American Society for Surgery of the Hand in Chicago over 75 years ago, which shaped who we are and who we aspired to be. From the tragedies of World War II to the COVID-19 pandemic, the genesis of the American Society for Surgery of the Hand resonated in America and the world through our Touching Hands Project by caring for people without means and empowering through educating those in underserved regions of America and low-income countries. By collaborating with one another, we can be the heroes and the helpers on our way to achieve many great advancements in our field. When you elected me to be the 75th President of the American Society for Surgery of the Hand, I had a dream (Fig. 1). This is the beautiful calligraphy Chinese character for “dream,” Meng, a word I would like to share with you.
      I never dreamed that I would be on the podium with you today. When my parents brought my brother and me to the shores of America, we did not know whether we would survive. The cultural differences and language barriers were almost insurmountable. My parents worked close to 18 hours a day in our small clothing alteration shop in Atlanta next to Northlake Mall, one stitch at a time, to put my brother and me through college and medical school at Emory University. The countless skirts that I sewed not only honed my skills for a surgical career but also gave me time to think about how I could pursue a career that would help others. In fact, during the first few weeks when I was a surgical intern in San Antonio, my attendings would ask, “where did you learn to sew so well and so fast?” After seeing me sew, they would also say, “what is wrong with you, Kevin, is that a seamstress knot you are tying? We do not do that fancy knot in Surgery.”
      As Van Gogh elegantly stated, “I dream my painting, and then I paint my dream” (Fig. 2).
      • Alexos A.
      Let’s Van Gogh to Chicago’s immersive exhibit.
      Our immigrant families of our great nation dreamt to better their children’s lives as well as the lives of others by painting their dreams through hard work, integrity, and kindness. The dream for my presidential year is knowledge, commitment, and compassion, which mirrors my initials, K.C.C. We will contribute knowledge for the betterment of our patients and trainees, we will commit to excellence in our personal and professional lives, and we will act with compassion to speak for those without a voice and advocate for those without means. One of my fellows is a calligrapher, and she wrote this for us (Fig. 3). It has the word “dream” (Meng) in this idiom. When I first read this, I wondered which Chinese philosopher and dynasty this saying came from. This is not from any ancient scholar, but from America, a classic translation from the revered American actor James Dean, who died prematurely. Dean said, “dream as if you will live forever, live as if you will die today.” Past generations have weathered overwhelming challenges. It is up to our generation to create a better world for the next generation.
      Figure thumbnail gr2
      Figure 2Vincent Van Gogh’s “Starry Night.”
      Figure thumbnail gr3
      Figure 3Chinese calligraphy that translates to a quote by James Dean, “Dream as if you will live forever, live as if you will die today.”
      Ladies and gentlemen, we are faced with a paradox of enormous proportion. But with courage, conviction, and compassion, we shall prevail. I am grateful and emotional to see you in the audience and to speak to you who are watching us in America and around the world. Our council is in our proud regal outfits of our colleges and our high schools for our spring council meeting in my hometown of Atlanta (Fig. 4). We value inclusion. Our council represents the diversity of our society, a value we are committed to. This is a mosaic of our current and future members. Look for the pictures of you and your friends. We come from all walks of life, all ethnicities, all age groups, and from all corners of the world (Fig. 5). Our founders said to us, “it falls to a few men to originate a surgical specialty.” Today, it falls on all of us to be heroes and helpers of the American Society for Surgery of the Hand. Thank you.
      Figure thumbnail gr4
      Figure 4A photograph of 2021 American Society for Surgery of the Hand Council.
      Figure thumbnail gr5
      Figure 5Members of American Society for Surgery of the Hand.

      Acknowledgments

      The author thanks Meghan Cichocki, Anne Seyferth, Shannon Wood, Natalie Baxter, Nishant Kumar, and Yuki Zhou for their contributions to the writing and creative development of this speech.

      References

        • Lohnes K.
        The Fermi paradox: where are all the aliens?.
        • Taleb N.N.
        The Black Swan: The Impact of the Highly Improbable.
        in: New York Times. April 22, 2007
      1. The Dickens Project. The Best of Times, the Worst of Times. June 29, 2020.
        • Alexanyan S.M.
        • Krivchenko V.I.
        Vavilov Institute scientists heroically preserve world plant genetic resources collections during World War II Siege of Leningrad.
        Diversity. 1991; 7: 10-14
        • Koreneva M.
        Russia’s Vavilov institute guardian of world's lost plants.
        • Pratibha A.
        The Stockdale paradox.
        • Pager T.
        • Rauhala E.
        Biden administration to buy 500 million Pfizer coronavirus vaccine doses to donate to the world. The Washington Post. June 9, 2021.
        • Dyer O.
        Covid-19: many poor countries will see almost no vaccine next year, aid groups warn.
        BMJ. 2020; 371: m4809
        • Dunn J.C.
        • Lenhart M.K.
        • Higgins J.P.
        • Nesti L.J.
        How the US army forged hand surgery.
        J Hand Surg. 2020; 45: 354-357
      2. American Society for Surgery of the Hand. About ASSH.
        https://www.assh.org/s/about-assh
        Date accessed: February 17, 2021
        • Alexos A.
        Let’s Van Gogh to Chicago’s immersive exhibit.