This chapter merges a first-person surgical memoir with a structured ethical analysis of residency training on both sides of the Atlantic. Using four autobiographical vignettes that span Marco Patti’s formative years in Italy and the United States, the chapter explores how autonomy, beneficence, justice, and non-maleficence are taught, or neglected, in surgical education. Short reflective overlays transform lived experience into teachable moments, providing discussion prompts for residents, program directors, and policymakers. Recommendations focus on restoring educational integrity amid financial pressure and shifting professional identities.