doi:10.1016/S0741-5214(03)00465-8


CLINICAL RESEARCH STUDIES
From the Southern Association for Vascular Surgery

Leadership in difficult times
James M. Seeger, MD, Gainesville, Fla

When I began to consider what to speak about in this
address, I decided that I would not spend time reviewing
the difficulties we face in the current practice of vascular
surgery. We don’t need another recitation of how bad
things are. Change is a constant, and challenges are what
make life interesting, although I am sure that we all wish
that things were not so interesting at times. However, it was
important to choose a topic that had at least some relevance
to our professional lives, as for each of us our profession
activities make up such a substantial portion of our exis-
tence. And so I chose to address the topic of leadership, in
particular, leadership in difficult times.

Ralph Waldo Emerson wrote, “There is properly no
history, only biography.” To me, this means that despite
external forces that at times seem both uncontrollable and
larger than the people affected by those forces, events and
outcomes are profoundly shaped by the individuals in-
volved. Furthermore, the most difficult times often result in
emergence of the best leaders, and the quality of the
leadership in such situations most clearly influences out-
come. This has become more and more evident to me as I
have observed the organizations with which I have been
associated during my career. It has seemed to me that often
we chose our leaders on the basis of criteria other than their
leadership skills and that people who seek leadership posi-
tions at times do so for the wrong reasons. In the health
care environment of the past, it may have been acceptable
for our leaders to have poor leadership skills or to “learn on
the job.” But now the environment has changed. Now the
people selected for leadership positions in our profession
must be successful leaders in difficult times. However, the
question is, How do we identify such individuals, and what

are the characteristics of a leader that result in success of the
organizations or ventures that he or she leads?

To try to answer this question, I would like to share
with you some leadership lessons from the history of explo-
ration of our globe, in particular, the exploration of the
earth’s polar regions, some of the last places on the surface
of the earth to be visited by human beings. The story of the
exploration of the polar regions represents some of the best
and worst examples of leadership in difficult circumstances.
In addition, these were the last great adventures in which
small groups of individuals could accomplish something
truly unique in the exploration of our surroundings. How-
ever, despite the allure of adventure associated with polar
exploration, the polar regions of our planet are harsh,
unforgiving places that severely test an individual’s organi-
zation and leadership skills, and extract the ultimate price
for failure. Because of this, many who have studied leader-
ship, in particular, leadership in difficult times, have turned
to the history of polar exploration and the stories of the
individuals involved to understand and to teach us what
makes a truly great leader.

The initial recorded visits to the earth’s polar regions
were to the arctic by the Greeks in the fourth century BC and
by the Norwegian Vikings in the Middle Ages.1 However,
the full flowering of polar exploration did not occur until
the 1700s and 1800s, when, driven by a desire for a short
route to the riches of the glorious East, multiple English
expeditions were undertaken in a futile search for the
Northwest Passage and the mystical North Polar Sea. These
were primarily Royal Navy expeditions, and success in such
ventures became an alternate route to promotion in that
peerage-clogged organization. Exploration of the southern
polar region also was undertaken during this time, and
James Cook, a Royal Naval Officer, attempted to reach the
southern Arctic continent in 1773 and 1774. However, he
was turned back by ice, and it was not until 1820 that
Edward Barnsfield, another Royal Naval Officer, first set
foot on the antarctic continent. Subsequently, in 1834
James Clark Ross, also a Royal Naval Officer, mapped a
portion of the coast of the continent, sited the great vol-
cano Mount Erebus, and discovered the Great Ice Barrier,
the Ross Sea, and the Weddell Sea. Polar exploration then
shifted again to the North, driven by the search for Sir John
Franklin and his 128 men, who died of exposure and

From the Division of Vascular Surgery, Department of Surgery, University
of Florida.

Competition of interest: none.
Presented at the Twenty-seventh Annual Meeting of the Southern Associa-

tion for Vascular Surgery, Tucson, Ariz, Jan 15-18, 2003.
Reprint requests: J. M. Seeger, MD, University of Florida, Vascular Surgery,

Box 100286, JHMC, 1600 Archer Rd, Gainesville, FL 32610 (e-mail:
seeger@surgery.ufl.edu).

J Vasc Surg 2003;38:413-21.
Copyright © 2003 by The Society for Vascular Surgery.
0741-5214/2003/$30.00 � 0
doi:10.1016/S0741-5214(03)00465-8

413



Fig 1. A, Robert Falcon Scott in 1909, before his last expedition. (From Huntford R. The last place on earth. New
York: Atheneum Press; 1985. [Original title: Scott and Amundsen. Fairfield, Pa: Fairfield Graphics, 1979.]) B, Roald
Amundsen. (From Huntford R, Jacobsen A-C. The Amundsen photographs. New York, NY: The Atlantic Monthly
Press; 1987. p 169.) C, Sir Ernest Shackleton. (From Alexander C. 1998. The Endurance: Shackleton’s legendary
Antarctic expedition. New York, NY: Alfred A. Knopf; 1998.)

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September 2003414 Seeger



starvation between 1848 and 1850 while again searching
for the Northwest Passage. Franklin’s expedition ended the
era of polar expedition funded by the Royal Navy, because
the cost had become too high and the embarrassment from
incompetence too great to bear. In the south, not much
more of significance happened until the geographic North
Pole was finally reached by the American Robert Peary in
1909. After this, only the South Pole remained to be taken,

and the exploration of the “last place on earth” began in
earnest.

Explorations of Antarctica in the early 20th century
would be the greatest challenge faced by polar explorers,
because the antarctic continent is the coldest (�128.6°F),
windiest, and driest place on earth.1 Three interesting and
very different men, Robert Falcon Scott of England (Fig 1,
A), Roald Amundsen of Norway (Fig 1, B), and Earnest

Fig 2. Amundsen’s route to the South Pole. (From Huntford R. The last place on earth. New York: Atheneum Press;
1985. p 449. [Original title: Scott and Amundsen. Fairfield, Pa: Fairfield Graphics, 1979.])

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Shackleton of Ireland (Fig 1, C), dominated these explora-
tions. Scott, accompanied by Shackleton, first went south
in 1902-1903, leading the Discovery Expedition, which
included a heroic but ill-conceived and ill-managed sledge
journey that, while reaching a new farthest south point of
82°17�, almost ended in tragedy.1 Subsequently Shackle-
ton returned in 1907-1908 to lead the Nimrod Expedition,
in which the magnetic South Pole was discovered, climbed
Mount Erebus, and first explored King Edward Land.
During this expedition Shackleton also led a sledge journey
to within 97 miles of the geographic south pole, but turned
back, almost within sight of his goal, to save the lives of the
expedition members. These initial expeditions to explore
the antarctic continent set the stage for the race between
Amundsen and Scott to be the first to reach the South Pole
and the subsequent attempt by Shackleton to be the first to
cross the antarctic continent.

Roald Amundsen devoted his life to making himself a
“professional” polar explorer.1 Amundsen was an expert
skier and arctic outdoorsman who “apprenticed” aboard
whaling ships in the arctic, and was the second mate on
Belgica when, in 1898-1899, she became the first ship to
winter over in the antarctic pack ice. He then lead the Gjoa
Expedition, between 1903 and 1906, during which he
spent 3 years drifting through the arctic pack ice and
demonstrated for the first time the presence of the fabled,
but impassable, Northwest Sea passage. During the Gjoa
Expedition Amundsen studied the methods by which the
Eskimo lived and prospered at high latitude, acquiring
many aspects of their clothing, dog driving skills, and diet.
He then spent 2 years meticulously planning an attempt to
reach the South Pole, carefully selecting the men for his

expedition and refining every aspect of equipment, from
clothing to dogs to sledges to food. Furthermore, he was by
then a seasoned leader who led by force of personality;
respected the man, not the rank; selected men for his
expedition on the basis of their expertise and previous arctic
experience; and was personally involved in every detail of
the expedition.

Amundsen began his journey to the South Pole from
the Bay of Whales in the Ross Ice Barrier on October 15,
1911, after spending the previous winter preparing at
Framheim, his base on the Ross Ice Barrier (Fig 2).1 During
the previous antarctic summer and fall he had established
depots with almost two tons of supplies on the Ross Ice
Shelf at latitudes 80°, 81°, and 82° along his planned route.
He also had carefully marked both the locations of these
depots and his proposed route south across the ice shelf the
next summer. His attempt to reach the South Pole was thus
carefully planned and included a large margin of safety in
supplies, tried and tested arctic equipment, and a polar crew
experienced in travel in the arctic regions. His men were
expert skiers (one was a cross-country champion) and
sledge dog drivers, and they used the method of polar travel
perfected by the Norwegians, that is, men skiing beside
sledges pulled by Eskimo dogs.

They crossed the Ross Ice Barrier and reached the
trans-Antarctic Mountains on November 17, there discov-
ering and climbing the Axel Heiberg glacier, and reached
the antarctic plateau on November 30. Two weeks later, on
December 15, 1911, they reached the geographic South
Pole (Fig 3). After spending 3 days at the pole they re-
turned by the route that they had pioneered, arriving back
at Framheim on January 26, 1912. They and their remain-
ing dogs arrived at their base fit and healthy after traveling
1400 miles over the ice barrier and polar plateau. Despite
later being criticized for making their journey appear “too
easy,” they had climbed an unmapped glacier that even
today is not used as an approach to the antarctic plateau;
endured fog, blizzards, and temperatures to 20 degrees
below zero; and had not only survived, but prospered,
while exposed to the harshest climate on earth for more
than 3 months.

Robert Falcon Scott was a Royal Navy Officer who
came to polar exploration as a means for attaining promo-
tion when it seemed unlikely that he would achieve rank
through traditional means.1 Although he had spent 2 years
in the Antarctic leading the first major British expedition to
that region, he remained largely an amateur polar explorer.
He could not ski, did not believe that dogs could be
successfully used to pull sledges in the Arctic, and believed
that improvisation was better than careful planning, as was
the philosophy of the British Navy of the time. Further-
more, he led on the basis of the authority of his rank, and
selected men for the expedition who understood Navy
discipline and who would not compete with him for lead-
ership, although most had little if any polar experience. He
also chose to use Siberian ponies to pull his sledges in his
attempt to reach the South Pole, because that was what
Shackleton had done on the expedition that came within 97

Fig 3. Norwegians at the South Pole. Left to right, Oscar Wisting,
Olav Bjaaland, Sverre Hassel, Roald Amundsen. (From Huntford
R. The last place on earth. New York: Atheneum Press; 1985.
[Original title: Scott and Amundsen. Fairfield, Pa: Fairfield Graph-
ics, 1979.])

JOURNAL OF VASCULAR SURGERY
September 2003416 Seeger



miles of the pole. In addition, he brought with him three
untested motor sledges, the first attempted use of motor-
ized transport in polar exploration, but ultimately thought
that hauling by men was the romantic ideal of the true arctic
explorer.

Scott began his journey to the South Pole on Novem-
ber 1, 1911, from Hut Point, where he had wintered over

next to McMurdo Sound (Fig 4).1 However, rather than
preparing for their journey to the pole during the previous
winter, as Amundsen had done, Scott and his men spent the
time in pleasant diversions such as publishing a newspaper
and listening to lectures on nonpolar topics. In addition,
they had been eating a civilized diet of canned food
brought from England that was low in vitamin C and B.

Fig 4. Scott’s route to the South Pole. (From Huntford R. The last place on earth. New York: Atheneum Press; 1985.
p 447. [Original title: Scott and Amundsen. Fairfield, Pa: Fairfield Graphics, 1979.])

JOURNAL OF VASCULAR SURGERY
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Scott did not ascribe to the theory of the American physi-
cian-explorer Cook that fresh meat prevented scurvy, de-
spite Dr Cook’s successful treatment of scurvy with fresh
seal meat during the Belgica expedition. Furthermore, also
in contrast to Amundsen, Scott had layed down only one
depot of one ton of supplies on the Ross Ice Barrier the
previous summer, and even up to the start of his journey south
had not planned his route in more than the general terms of
following the route Shackleton had taken. He also had not
entirely decided how supplies used on the outward journey
would be replenished for use during the return trip to safety.

Five days after starting, just past corner camp, the
motor sledges on which Scott’s “dream of great help from
the machines” rested, broke down, and Siberian ponies,
with their nearest natural food source 2000 miles away,
became the only transport other than man hauling for the
expedition. Scott had dogs with him, but did not really
believe in using them to pull sledges in the arctic. He
therefore used his dog sledges primarily for carrying fodder
for the ponies until they were no longer needed, then sent
the dog sledges back to be used to supply the barrier depots
for the return journey from the pole, a plan he devised only
after his party was on the Ross Ice Barrier. At the base of
Beardmore Glacier, the pony fodder was gone, and they
were shot and stored for meat on the return journey. Man
hauling then became the only transport for the remainder
of the expedition, including the climb up the glacier to the
Antarctic Plateau. Hauling an average of 200 pounds per
man, this took 11 agonizing days. At that point the final
support party turned back, and Scott, Oates, Bowers, Wil-
son, and Evans, rather than a planned polar party of only

four, began the last 150 miles of the journey to the pole.
They were already beginning to suffer from vitamin defi-
ciency and were losing weight from inadequate food to
support the grueling work of man hauling sledges up to 14
hours per day. Furthermore, they had begun to eat the food
planned for the plateau journey while they were still on the
barrier, and now there was also one more mouth to feed on
the remainder of the journey to the pole. In addition, there
was significant dissention in the group, exacerbated by
Scott’s isolation and leadership style.

On January 17, 1912, they reached the pole, to find
that the Norwegians had beaten them there by more than a
month. Scott wrote in his diary, “Great God! This is an
awful place, and terrible enough to have labored to it
without the reward of priority.” They spent only 1 day at
the pole, then began the desperate return journey and the
effort to find the return supply depots that had been placed
too far apart, contained too little food, and were poorly
marked. They were too malnourished, too sick with scurvy,
and too worn out from man hauling to accomplish this. On
February 5 Evans died, potentially as the result of a cerebral
hemorrhage secondary to a fall made more likely from
scurvy. On March 17 Oates broke down completely, and
crawled out of the tent into the snow, never to be seen
again. Finally, on March 21, Scott, Bowers, and Wilson
died in their tent, only 11 miles from the one ton depot.
Their bodies were found the next spring; Oates’ body was
never discovered. They were buried where they lay, under a
large cairn built over the tent that was their last resting place
(Fig 5). The publication of Scott’s edited journal made him
an overnight hero. He was hailed as a romantic polar
explorer who gave his life and the lives of his companions in
a noble quest. He was made a hero by the English opinion
leaders of the time as a “glorious failure,” and the evidence
of his weakness as a leader was suppressed to fit this roman-
tic ideal.

Once Amundsen had taken the South Pole, only one
great adventure of Antarctic exploration remained, a trans-
continental crossing. In December 1914 Earnest Shackle-
ton, who had come so close to being the first man to reach
the South Pole, set out to do this aboard the ship Endur-
ance.2

Shackleton, like Scott, was also an amateur polar ex-
plorer, although he became and remained a polar explorer
because, as he told his wife, “it was the thing I am best at.”
Furthermore, he had learned much about survival in the
harsh antarctic environment from his previous polar expe-
ditions. The son of a Quaker physician and a nurturing Irish
mother, he had grown up in a decidedly feminine house-
hold with eight sisters, numerous aunts, and his grand-
mother. He left school early to join the Merchant Marine,
and gained his masters certificate by age 24 years. He also
had spent much of his life before this expedition con-
sciously teaching himself to be a good leader of men,
particularly in difficult circumstances.

The Endurance left St. George’s Island in the South
Atlantic Ocean on December 5, 1914, and entered the
antarctic pack ice on December 7 (Fig 6).2 The pack ice

Fig 5. Cairn marking the site of Robert Falcon Scott’s tent. (From
Collection of Sir Joseph James Kinsey: Antarctic and mountaineer-
ing photographs. 1912. [PAColl-5011]. Reference number PA1-
f-066-086-3. Alexander Turnbull Library, National Library of
New Zealand, Wellington, New Zealand, Te Puna Matauranga o
Aotearoa. With permission.)

JOURNAL OF VASCULAR SURGERY
September 2003418 Seeger



that season was the worst in years, and by January 27, 1915,
despite all of the efforts of the crew, the ship was frozen in
the ice, only 80 miles from their intended landing site at
Vahset Bay. They wintered over in the relative comfort of
the ship while they drifted, trapped in the pack ice in the
Weddell Sea, expecting to continue their expedition when
the ship was released from the ice the next spring. However,
the coming of spring and the return of the sun did not
result in the ship being freed from the ice. Rather, the
spring and summer storms and partial breakup of the ice
significantly increased the pressure of the ice on the ship,
and her hull began to crack. On October 27, 1915, the ship
was finally crushed by the pack ice, and sank on November
21, leaving Shackleton and his 28 men stranded on the
Antarctic sea ice, 180 miles from nearest land and 1000
miles from the nearest human being. To try to survive and
get themselves home, they had only the limited supplies
that they could salvage from the ship before it sank, and the
ship’s three lifeboats. Shackleton’s reaction to this tragedy

was to call his men together, explain the reality of situation,
and say, “So now we will go home.”

After first attempting to man haul their boats and
supplies to land, they drifted on the ice floes for almost 7
months. Despite their dire situation, their time on the ice at
Ocean Camp was relatively pleasant, and they always had
confidence that “the boss” would get them home. When
the pack ice finally broke up on April 9, 1916, they took to
the lifeboats, and sailed and rowed the dangerously over-
loaded boats continuously for 6 days to reach Elephant
Island, setting foot on solid land on April 15 for the first
time in more than 16 months. Elephant Island was deserted
and so isolated that it was unlikely that they would be
discovered there. It was also evident that, as the pack ice
began to expand around the island in the coming antarctic
winter, seals and penguins, on which they depended for
food, would become increasingly scarce.

Shackleton therefore decided they must attempt to
reach the whaling station on St. George’s Island, from

Fig 6. The journey of the Endurance crew. (From Alexander C. The Endurance: Shackleton’s legendary Antarctic
expedition. New York, NY: Alfred A. Knopf; 1998. Map from National Geographic Maps, National Geographic Image
Collection, 1998.)

JOURNAL OF VASCULAR SURGERY
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which a rescue operation could be mounted. To do this,
they refitted the largest of the lifeboats, the James Caird,
adding decking from packing crates to make it dryer and
more seaworthy, and loading it with rocks for ballast.
Shackleton and four companions, including Wolsley, the
former captain of the Endurance, set out on May 2, 1916,
to attempt an 800 mile journey in an open 221⁄2 foot boat
over the most dangerous ocean in the world. Because of
clouds and storms, Wolsley was only able to take two
sextant readings during the journey, but using those fixes
and superb dead reckoning, they arrived at St. George’s
Island on May 10, and safely landed the next day. Had they
missed the island, they and likely all of the men on Elephant
Island would have died, because past St. George’s Island
was only open sea. That boat journey is now recognized as
one of the greatest small boat voyages ever undertaken.

Unfortunately, they had landed on the opposite side of
St. George’s Island from the whaling station, and it was too
dangerous to attempt to sail to the other side. Therefore
Shackleton and the two of his men who were still able to
travel set out at 2:00 AM on May 19, 1916, to cross the heart
of the island on foot. They crossed mountains and glaciers
that were not subsequently crossed until the 1950s by
professional mountain climbers, and reached Stromness
Whaling Station on May 20. The foreman took them to the
station manager, whom Shackleton knew, and when Shack-
leton asked the station manager if he knew him, the man-
ager replied, “Who the hell are you?” Shackleton replied,
“My name is Shackleton.” The foreman turned aside and
wept. A boat was dispatched to collect the remainder of the
James Caird crew from the opposite side of the island.

The situation for the remaining men on Elephant Is-
land was still bleak. Thus, despite the long and arduous
boat journey that he had just completed, Shackleton imme-
diately set out to organize their rescue. Finally, after several
failed attempts and numerous delays, he returned to Ele-
phant Island on August 30, 1916, to retrieve the remainder
of his crew (Fig 7). Despite almost 2 years on the ice, with
innumerable hardships and dangers, everyone returned
alive. Because of the “failure” of the planned trans-Antarc-
tic crossing, Shackleton’s exploits were largely ignored until
recently, when the remarkable nature of his leadership in
keeping his men together as a team and managing against
almost impossible odds to lead them all safely home has
begun to be studied. Shackleton’s accomplishment is now
recognized as one of the greatest feats of leadership in the
history of polar exploration, if not for all times. As was well
said by British explorer Apsley Cherry-Garrord, a member
of Scott’s tragic polar expedition, “and if I am in the devil of
a hole and want to get out of it, give me Shackleton every
time.”

What lessons from these stories of exploration of the
Antarctic continent at the turn of the 20th century and the
men who led them can be applied to the challenges we face
today? The first and most obvious lesson is that good
leadership makes the difference.3,4

Amundsen won the race to the pole because he was
better prepared, better equipped, and led a “happier”
group than Scott. His work as the leader of that expedition
made what was a long and dangerous journey to the heart
of an entirely unknown continent in one of the harshest
climates on earth look “easy.” In contrast, Scott’s failure as
a leader, because of poorly planning his expedition, leaving
too narrow a margin of safety, and limiting the effectiveness
of his sledge journey team by using poor equipment, meth-
ods, and leadership techniques, cost the entire group their
lives. More strikingly, Shackleton, almost entirely through
his leadership skills, saved his entire crew after their ship was
crushed, and brought them home despite almost insur-
mountable obstacles. Perhaps Shackleton’s greatest at-
tribute in this accomplishment was the ability to keep his
men focused, optimistic about survival, and working as a
team toward the goal of getting home safely, for almost 2
years, when they were constantly wet, cold, hungry, and in
imminent danger of death. Numerous other expeditions to
the polar regions, beset by problems less severe than those
faced by Shackleton’s group, met with tragedy.

If leadership is of paramount importance in the success
or failure of organizations and ventures, what are the char-
acteristics of successful leaders, particularly in difficult
times? To be successful, leaders must be visible and set a
personal example; must be optimistic but grounded; must
be scrupulously fair and minimize status differences; must
master conflict; must be willing to take risks, while being
ever concerned about the well-being of those they lead;
must never lose sight of the ultimate goal, while adapting to
changing circumstances; and must never give up (Table).3,4

Furthermore, they must always remember that leadership is
a responsibility, not a privilege. As Shackleton said, “leaders

Fig 7. Rescue from Elephant Island. Picture from “30 August,
Wednesday, Day of Wonders,” Hurley diary. (From Alexander C.
The Endurance: Shackleton’s legendary Antarctic expedition. New
York, NY: Alfred A. Knopf; 1998. p 203.)

JOURNAL OF VASCULAR SURGERY
September 2003420 Seeger



face a thankless and lonely job, especially in hard times.”3

Leadership is something that, at least in part, must be
learned and must constantly be developed. Some individu-
als may be born with the talent for leadership, but without
educating themselves they will likely be ineffective. Identi-
fying and selecting good leaders is a remarkable challenge,
but we must successfully accomplish this task if our organi-
zations and ventures are to succeed.

Although we as a profession and specialty are facing
difficult times, we must remind ourselves that time and
demographics are on our side. Patients need what we can
do, and in the future even more patients will seek our care.

Though we may well be doing different things in the
future, those likely will be more interesting and exciting
things, as our new generation of vascular surgeons under-
stands. Good leadership will take us through these difficult
times, just as Amundsen safely led his men on the first
successful visit to the geographic South Pole and Shackle-
ton led his men to safety after being stranded on the
Antarctic pack ice 1000 miles from civilization. Although
the stories of these men who first explored the “last place on
earth” are almost 100 years old, they still have much to
teach us.

REFERENCES

1. Huntford R. The last place on earth. New York: Atheneum Press; 1985.
[Original title: Scott and Amundsen. Fairfield, Pa: Fairfield Graphics,
1979.].

2. Alexander C. The Endurance: Shackleton’s legendary Antarctic expedi-
tion. New York, NY: Alfred A. Knopf, 1998.

3. Morrell M, Capperell S. 2001. Shakleton’s way. New York, NY: Penguin
Books; 2001.

4. Perkins D. 2000. Leading at the edge: leadership lessons from the
extraordinary saga of Shakleton’s Antarctic expedition. New York, NY:
American Management Association.

Submitted Mar 18, 2003; accepted Mar 19, 2003.

ANNOUNCING A NEW SECTION: VASCULAR IMAGES

The Vascular Images section presents interesting vascular images and associated short educational summaries in a
focused, case report format. One of the images will be chosen for the cover of each issue of the Journal. Submission
of color illustrations suitable for the Journal cover is encouraged. Appropriate images include radiographs, pathology,
anatomy, operative findings, and other relevant clinical pictures. The images should illustrate features of vascular
disease, including technical approaches. Illustrations and text must be confined to one printed page (no more than
350 words; perhaps less depending on the number and size of illustrations), and images for the cover should possess
both scientific and artistic merit. Descriptions of images must be included in the text, and only key references should
be provided (with a limit of two). Images must be of professional quality and should be provided electronically in
either TIFF or EPS format and uploaded (with the rest of the manuscript) via the Editorial Manager electronic
submission system at http://jvs.editorialmanager.com. Detailed artwork instructions and help with formatting,
sizing, scanning, and file naming can be found at http://www.elsevier.nl/homepage/sab/artwork. A high-
quality print or computer-generated image of each illustration must be submitted to the Journal office for accepted
submissions, even though the illustrations have been submitted previously via Editorial Manager. For more
information regarding hard copy requirements, please see “Guidelines to Complete Submission of an Accepted
Manuscript” at http://jvs.editorialmanager.com.

Contributions for the Vascular Images section are now invited.

Qualities necessary for leadership in difficult times

● Be visible/personally involved
● Be optimistic but grounded
● Be scrupulously fair
● Minimize status differences/respect the individual
● Master conflict
● Balance safety and risk
● Be focused but adaptable
● Never give up

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Volume 38, Number 3 Seeger 421


	Leadership in difficult times
	REFERENCES