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“Toto, I’ve a Feeling We’re Not in Kansas Anymore”

James Jeng, MD, FACS

June 1, 2022

I am a native Washingtonian. I lived in DC most of my adult life and raised my four kids inside the Beltway.

I can remember a time I would sneak out of work every chance I got in the early afternoon and put Kid #1 in a jogging stroller. We lived in Georgetown, and we’d sit on the Lincoln Memorial steps with a juice box and cheddar crackers, then move on to the Washington Monument to fly a kite by the circle of American flags at the base of the obelisk. Back then, you could get on the elevator on a whim, ride it to the top, and look out the two tiny windows on each side to watch the jets land at National Airport in the distance.

My, how times have changed. You can’t just ride up that obelisk on a whim anymore. Security screenings and tickets are required in 2022. The same is true for wandering around the Rayburn, Longworth, and Cannon House Office Buildings and the Russell, Dirksen, and Hart Senate Office Buildings to meet with lawmakers.

It’s anybody’s guess when in-person advocacy and lobbying on behalf of the American College of Surgeons (ACS) will return to Capitol Hill. The years 2020 and 2021 brought changes that rocked our world irrevocably, and as Dorothy so aptly surmised in The Wizard of Oz, “Toto, I’ve a feeling we’re not in Kansas anymore.”

But the show must go on, and so the ACS expanded its Advocacy at Home program to ensure ACS members could continue to advocate on Capitol Hill. Those individuals taking the time to read this column likely are among the most farsighted American surgeons. This group knows deep down inside that our ability to practice the best medicine and provide the best surgical care to our cherished patients takes a path right through each of the legislative office buildings enumerated previously.

As a member of the Engagement Workgroup of the ACS Committee on Trauma (COT) Advocacy Pillar, I was tasked with seeking testimony from ACS advocacy veterans and weaving them into a tapestry that aptly fits our uncertain return to Capitol Hill and the pressing need to megaphone our voice in service of all Americans needing surgical care.

COT Advocates’ Experiences

Kristan Staudenmayer, MD, FACS, a general and critical care surgeon from Stanford University Medical Center, CA, said she had a positive experience during her interactions with her representatives’ and senators’ offices. We talked about how jaded so many Americans have become about politics and how, coming into her advocacy sessions, she was unsure how she would feel afterward.

Happily, her elected officials seemed sincerely eager to hear constituent feedback and become educated on healthcare issues. We both quipped about how we’re all part of a grand and still evolving experiment of government of the people, by the people, and for the people.

Finally, Dr. Staudenmayer underscored how easy it was to connect with her representative and senators through the ACS Advocacy at Home program—truly a turnkey solution.

Brendan Campbell, MD, FACS, a pediatric trauma surgeon at Connecticut Children’s Hospital, Hartford, said, “My work through the COT has helped me better understand the critical importance of advocacy in so many of the things we do as surgeons. First, interacting with federal lawmakers allows them to learn firsthand about the important clinical work that we do, but it is also an opportunity to educate them about the other important work that surgeons are involved with related to healthcare quality, disaster preparedness, trauma systems, and injury prevention, to name just a few.”

Dr. Campbell continued, “My friend and mentor, Lenworth M. Jacobs Jr., MD, MPH, FACS, has always known the value and benefit of interacting with federal lawmakers to garner support for important trauma-related programs, like developing the first aeromedical transport program in Connecticut, creating a simulation center for trauma and emergency medical services-related education, and expanding the STOP THE BLEED®. Dr. Jacobs is a master at engaging lawmakers with compelling patient stories and turning them into ardent supporters of the important projects he is developing.”

Amalia Cochran, MD, FACS, is deeply experienced in advocacy on behalf of both the ACS and the American Burn Association, where she chairs the government affairs committee. Given her experience with meeting lawmakers in person, I was anxious to hear her thoughts on the new paradigm of telepresence advocacy.

She said, “The good news about this [model] is that it’s so easy to do Zoom meetings and calls with our legislators and staffers, which opens that option up to more of us. It also helps us to refocus on the importance of doing in-district visits with legislators and staff, particularly having the option of them visiting our facilities and seeing how we support their constituents.”

Ronald M. Stewart, MD, FACS, Immediate Past-Medical Director, ACS Trauma Programs, from The University of Texas (UT) School of Medicine, San Antonio, graciously spoke with me for a full hour to recount in great detail his take-home lessons from more than a quarter-century of direct and intensive advocacy efforts on behalf of American surgery—from the Statehouse in Austin to invited testimony live before the US Congress. This experience perhaps makes him one of the “deans” of ACS advocacy.

His first lesson was from the early days of trying to lobby for Texas State endorsement and funding of a statewide trauma system. The understandably disparate forces at play, in a state so large that it was its own nation before it became one of the lower 48, needed to be tamed and pulled exactly in the same vector on the tug of rope before achieving a legislative victory. Compromise leading to shoulder-to-shoulder consensus is a prerequisite for winning advocacy.

Dr. Stewart’s second lesson was that an emotional connection with lawmakers trumps sterile presentation of facts, numbers, and figures. Back in Austin fighting for more trauma system funding, stories about fabled trauma surgeon and syndicated television personality James Henry “Red” Duke, MD, FACS, from UT Houston, Memorial Hermann, and his uncanny ability to connect with Texas lawmakers carried the day when it was time to further fund the state trauma system. But even the late Dr. Duke was overshadowed by the compelling story of a Texas teenager who was shot and saved by the state trauma system. Not a dry eye remained in the Capitol when she related her story.

And the last lesson from Dr. Stewart’s long campaign was when he testified before Congress to advocate for research into how firearm injuries occur. This experience was a real test of “harmony and invention,” as he was able to gain and maintain the support of organizations defending the right to bear arms, as well as those focused on gun control. He concluded that no matter how polarized American politics may be, common ground can be found when driven by the universal concern to better our way of life.

* * *

A last-minute footnote in the immediate aftermath of the May 24, 2022, massacre of 19 grade school students and their two teachers in Uvalde, TX: So much sacrosanct work remains incumbent upon this fellowship of American surgeons, and advocacy is the singular transcendental tool with which to fulfill our obligations. 

Ours is a fellowship that spans the political spectrum on each and every intractable conflict that shakes the very foundations of this democratic experiment in self-governance. It is self-evident, however, that we can and must all come together when the trio of infamous tragedies—2007 Virginia Tech, 2012 Sandy Hook Elementary School, and now 2022 Robb Elementary School—indelibly stain the most basic fabric of our peoples.

Let us all pick up the mace of advocacy to help strike down this woeful specter.

* * *

Concluding Thoughts

I would like to sincerely thank my four esteemed colleagues for generously sharing their time and unfiltered experiences tirelessly advocating for the ACS and all that is important for surgical patients.

This deep dive into ACS Advocacy for 2022 and beyond proves that we are truly “not in Kansas anymore.” We must pivot to a new reality where we lobby from home, as the timing of return to in-person visits is anybody’s guess. Thankfully, the advocacy infrastructure of the College has been prescient in developing the tools for Advocacy at Home. Moreover, key staff members at the College are just a phone call or email away to lend expertise so that we shine in our virtual visits.

Many of us have been effective advocates, as the previous testimony demonstrates. Many more of us need to jump on the bandwagon in 2022 and beyond. It is so easy to do with the tools and support of the ACS Advocacy at Home webpage.

It’s important. What are you waiting for? As Dorothy said at the end of The Wizard of Oz: “There’s no place like home.”



The thoughts and opinions expressed in this column are solely those of the author and do not necessarily reflect those of the American College of Surgeons.