Surgical critical care: still at risk?

It has been a great honor and privilege to serve as your president and to give this year's presidential address. Considering that this is the last Western Surgical Association presidential address to be given in the 1900s, it seems necessary to mention the rapidly approaching third millennium. With only a little more than 46 days left, I am not particularly excited about having to write a "00" whenever I date something. It just does not seem like a real date to me. I have, however, resisted the temptation to speculate on the 21st century, let alone the next millennium, largely because my crystal ball is no better than any of yours. When I began as a medical student in the mid 1950s, my wildest dreams could not have predicted what dramatic advances would occur in the last half of this century. At that time, the first cardiopulmonary bypass cases were being performed for valvular and congenital disease. Kidneys had only recently been transplanted in Paris, France, and Boston, Massachusetts. Plastic surgery had yet to do a free flap and video-guided endoscopic surgery was still decades away. Intensive care units (ICUs) were just opening up, but they were little more than places where frequent vital signs and reliable intake and outputs were obtained.