It has been suggested that life is a series of milestones: birth, education, graduation, marriage, family. I count myself fortunate to be in the “moyen age”: nurturing my surgical practice, enjoying the company of children who are developing independently and all the while, evolving. One of my guiding principles is that change is inevitable and requires the investment of energy and the temporary abandonment of security. We are charged to navigate the challenges of life, sometimes unconsciously following Abraham Maslow’s pyramid of deficit needs. Maslow established 5 levels of motivational needs, (physiological, safety, social, esteem, self-actualization) and suggested that as one need is fulfilled, a person seeks to fulfill the next in the hierarchy. In providing “solutions” to so-called problems, I am cognizant to optimize patient’s safety, enhance their social well being and self-esteem; no mean feat, given the complexity of the human condition.