Strategic thinking

The most obvious example of strategic thinking is the creation of the trauma center. Dr Fabian was recruited from Dr Harlan Stone in Atlanta to lead the trauma service. Arriving when the building was a giant hole in the ground, Dr Fabian helped oversee its layout. This layout, with trauma admitting, resuscitation suites, radiology, lab, four dedicated trauma operating rooms, and the trauma intensive care unit (ICU) remains state-of-the-art some 40 years later. Severely injured patients are immediately treated and do not have to travel. He knew that communication was critical to the trauma center’s success, so he helped establish the Regional Communications Center within the trauma center. Some lamented the fact that the trauma center was named in honor of Elvis Presley, suggesting that somehow it lessened the significance of the trauma center. Not Dr Fabian. He embraced it, pointing out that naming it in memory of Elvis Presley gave us instant notoriety. Who has not heard of Elvis Presley? And while Tennessee may be lagging behind other states with most things, we were among the first states to have formal state designation of trauma centers—thanks to work done by Dr Fabian and others.

Dr Fabian also had a keen interest in vascular surgery. He realized the benefits of endovascular stenting in trauma patients long before it became popular. He did a mini fellowship in Phoenix to learn the techniques and brought these procedures back to Memphis. For patients who needed open surgery, he was insistent that the trauma surgeon performed the procedure. This allowed us to have a more complete repertoire of procedures to provide care for our patients (figure 1).

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Figure 1

Dr Fabian placing an endovascular stent.

Team building

Dr Fabian realized very early that the complexities of caring for the multiply injured patient required more expertise than the surgeons could readily supply. He incorporated members of the Pharmacy team into the trauma ICU team. This practice later became commonplace nationally. We also started a team of nurse practitioners to care for patients in the step down unit. This was done before the resident work hour restrictions were instituted. More than creating innovative ways to optimize patient care, Dr Fabian fostered the team concept outside the hospital. Credit to his lovely bride Denise for being the ringleader here. She was, and remains, incredibly gracious (figures 2 and 3).

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Figure 2

Tim and Denise in Key West.

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Figure 3

Tim and Denise Fabian with Martin and Celine Croce in Madrid.

Effective communication

Dr Fabian has little trouble making his point. While he may not always be the clearest with annunciation, there is never a doubt about what he is saying. As an aside, I will occasionally ask him to repeat himself even though I heard him clearly. He loves that. Whether he says something with a grin, the ‘look’, or quoting someone, there is no confusion. A favorite quote when encouraging someone to write a paper was from one of his mentors, Dr Robert Zollinger, “If you want to be an academic surgeon, you’d better be like a squid and drop some ink.”

Accountability and setting clear goals

These traits are self-explanatory and exemplify Dr Fabian’s philosophy. Never did he allow someone else to take blame publicly. Private conversations may be very different, but publicly, he always accepted responsibility. On the other hand, he always deflected praise to the junior faculty and residents.

Technical expertise

There was no better first assistant than Dr Fabian. He emphasized exposure and meticulous technique. Using his complete understanding of the anatomy and ‘smart fingers’, a difficult case became routine. It was not just the technical aspect of patient care, however. He would walk through the trauma ICU and point to a patient who is seemingly quite stable and say, “Better watch this guy.” Sure enough, in a few hours the patient would take a turn for the worse. Of course, Dr Fabian was always available to help and bail out the resident.

Faculty development

Dr Fabian is a firm believer in the adage ‘a rising tide lifts all boats’. He surrounded himself with smart hardworking people and would give them all the rope that they needed to succeed. Most often, they would take that rope and run with it. Most members of the Fabian tree are leaders in their institutions and in the world of Trauma and Acute Care Surgery. That fact speaks volumes about his faculty development. He knew the buttons to push when dealing with mentees. He once introduced me to a new faculty member as ‘stupid, lazy, with no stick-to-itiveness’. To quote Meat Loaf, ‘Two out of three ain’t bad’—since we have been partners over 30 years.

While Chairman of Surgery at the University of Tennessee Health Science Center, he was not just concerned with trauma faculty development. In order to develop faculty, one has to have faculty. Over his 17 years as Chairman, Dr Fabian basically doubled the number of faculty. Turnover was minimal, and those who left, took leadership positions at other institutions.

Research

The commitment to research by Dr Fabian is unwavering. He would challenge residents, fellows, and faculty to ponder over clinical issues, and he was prolific with basic science research studies. Such papers have been presented at virtually all major scientific meetings. Regarding the clinical studies, there is basically no major trauma issue that was not studied by the Memphis group. Some evidence of that is here today.

In summary, it is crystal clear that Tim Fabian checks all the boxes for leadership. Many more examples exist as those mentioned barely scratch the surface of his abilities. Personally, I cannot thank him enough. We had a great run. He is my mentor, my friend, and the Godfather to our youngest son. Tim and Denise welcomed Celine and me as family and that will never change. Let us enjoy his contributions as presented by members of the Memphis Mafia.