How does a doctor recognize the point in time when he is finally a surgeon? As my year as chief resident drew to a close I asked myself this question on more than one occasion.The answer, I concluded, was self-confidence. When you can say to yourself, There is no surgical patient I cannot treat competently, treat just as well as or better than any other surgeon - then, and not until then, you are indeed a surgeon. I was nearing that point. Take, for example, the emergency situations that we encountered almost every night. The first few months of the year I had dreaded the ringing of the telephone. I knew it meant another critical decision to be made. Often, after I had told Walt or Larry what to do in a particular situation, Id have trouble getting back to sleep. Id review all the facts of the case and, not infrequently, wonder if I hadnt made a poor decision. More than once at two or three in the morning, after lying awake for an hour, Id get out of bed, dress and drive to the hospital to see the patient myself. It was the only way I could find the peace of mind I needed to relax. Now, in the last month of my residency, sleeping was no longer a problem. There were still situations in which I couldnt be certain my decision had been the right one, but I had learned to accept this as a constant problem for a surgeon, one that could never be completely resolved - and I could live with it. So, once I had made a considered decision, I no longer dwelt on it. Reviewing it wasnt going to help and I knew that with my knowledge and experience, any decision Id made was bound to be a sound one. It was a nice feeling.