May 1, 2019, marked the beginning of a new era in Japan—Reiwa, meaning “beautiful harmony”—with the ascension of the Tenno (“heavenly sovereign”) emperor Naruhito. In Thailand, Vajiralongkorn, King Rama X, was coronated in magnificent fashion in a ceremony lasting from May 4 through 6. Astride these auspicious events, this wide-eyed Tennessean travelled from Tokyo to Bangkok to participate in the 88th Royal Australasian College of Surgeons meeting, May 6–10. Surely even the first half-American British royal, Master Archie Harrison Mountbatten-Windsor, born on May 6, did not receive a warmer welcome by citizens of the Commonwealth.
Transplantation surgery talks were held on the first day of the meeting. Presentations by visitors Peter Friend, Oxford University, and Jayme Locke, University of Alabama at Birmingham, were very clear, and their motivation to push the boundaries of knowledge to overcome organ failure and shortage for their patients was inspiring. Tumuaki and professor Papaarangi Reid gave an outstanding perspective on organ donation in indigenous communities. Sessions in trauma, including a retrospective on pendulums in resuscitation trends by current American College of Surgeons president Ronald V. Maier, liver trauma including a description of concentric anatomic liver packing by John McCall seconded by Mark Stringer, and an outstanding reexamination the foundations of damage control surgery by David Lockwood were particularly interesting. I also particularly enjoyed the high-quality discussions of difficult HBP cases, including management of disrupted pancreatic ducts, and a masterclass featuring a video of a gangrenous wrong-sided bile-bag. I was amazed to hear the rates of common bile duct exploration in some Australian hospitals, but otherwise the discussions about deciding to open, when and how to perform a subtotal cholecystectomy, and how to safely “bail” demonstrated that this incredibly common general surgical pathology can serve as a great equalizer, a reminder that humility can serve the patient regardless of where one might practice.
I had the pleasure of meeting trainees and young RACS fellows from all over Australia, New Zealand and the world. At the section dinner for trainees and younger fellows, I heard what it was like to train in surgery in Western Australia, Tazmania, Wellington, and Israel. A particularly kind group of trainees from Brisbane (which sounds like a really nice place, at least on one side of the river, depending on who you ask) allowed me to join in their evening activities, as it is definitely safer to travel in numbers in Bangkok. Concerns over case volume during training, work-life harmony, the difficulty of building and maintaining a culture of respect free from abuses of power, and the plight of non-accredited trainees are seemingly universal; I heard no complaints. While I did not anticipate seeing her, I was not at all surprised to find my jet-setting co-resident at Vanderbilt, Rachel Koch, presenting on national surgical planning in her role as a senior fellow of the Harvard Medical School Program in Global Surgery and Social Change. I also had a chance to meet with a US-trained native Thai surgeon working in Phuket, Art Hiranyakas, as well as a junior surgeon from Cambodia enjoying his first few days of rest this year. RACS seems particularly well positioned to build mutually beneficial partnerships to support development of sustainable surgical workforces globally and at home. Amid global trends towards nationalism, I sure hope I continue to be blessed to cooperate transnationally with folks as affable and generous as those I met at RACS.
