Even in the twenty-first century, humans continue to be as selfish, jealous, ambitious, belligerent, prejudiced, and short-sighted as ever. Even as we resist internal change, we have actively and enthusiastically affected change in the World. The climate has changed. Old species have disappeared. We have changed our lifestyles dramatically through the expansion of science and technology—fast, fancy cars, space shuttles, computers, cell phones, and fast food. Life in this century moves more quickly and offers more conveniences compared to previous centuries. Yet the basic struggle for survival has remained an uphill battle. We have not solved world hunger or civil unrest. Our peace of mind has been battered most recently by worldwide economic downturn and a visible upsurge of unrest and violence.

Two famous corporate slogans should come to mind when we consider our place in the World—Shape up or ship out and Move up or move out. Irrespective of the number of years you have loyally served an organization, if you don’t anticipate the changes around you and make necessary adjustments in your skills, temperament, and disposition, you will be out of the game in no time. In the medical field, the introduction of fiber optics, miniature cameras, powerful microscopes, and laser technology, to name a few, have changed the dynamics of diagnosing and treating many illnesses. Whereas a surgeon in the past treated gastrointestinal ailments such as perforated gastric ulcers or colon cancers through major surgery, the advent of endoscopies and powerful cancer drugs has eliminated the need for surgical intervention in many such cases. Certainly, this is good news for the patient, but the surgeon must be retrained in more current, less-invasive procedures using the latest technology, such as bariatric surgery, if he or she intends to survive.

In a rapidly changing environment, what you learn today may be obsolete tomorrow. However, we need not fret over this aspect of our struggle, because it is an unavoidable reality of life. Instead we can be vigilant to the changes occurring in the World around us and proactive in keeping up with those changes. As dictated by Nature, the World will never bend over backwards to accommodate our needs, and to expect it to do so is to be utterly disappointed. We must prepare ourselves for a tough fight in order to succeed. To paraphrase Pulitzer Prize–winning journalist George Will, it’s not the size of the dog in the fight that counts, it’s the size of the fight in the dog.