Sunday, May 26, 2013

Wright State University Boonshoft School of Medicine, commencement address, May 24, 2013

Good evening and congratulations to the Class of 2013!
I graduated medical school almost exactly ten years ago today (which sounds like a much longer span of time than it actually feels) so naturally when I started to write this address I thought back to my own med school commencement ceremony, or what little I remember of it.  Particularly I tried to recall the invited speaker we had that year and what pearls of wisdom he imparted, so that I could frankly plagiarize them and pass his pithy truths off as my own.
The problem is, I can’t remember anything he told us.
Our med school commencement speaker for 2003 was Jimmy Breslin, a reporter for the New York Post and certainly a more illustrious figure than I.  And he had a very well-written speech—I mean, probably he did, because again, I can’t remember—but all I really do recall is that he spoke a lot and he spoke for a long time.  And I remember thinking to myself, as I sat there in my academic regalia, sweating under the layers of polyester like one of those cook-in-the-bag microwave meals, that this man and his endless speech were the only things standing between me and my medical degree.
(He did eventually stop talking, by the way.)
I can’t convey to you what an honor it is to be invited to share this day with you all, which with the possible exception of this address, is likely one of the most important and memorable days of your life.  So when I sat down to write this speech, I had only two goals in mind.  First goal: to give you real advice that you can actually carry with you for the long road ahead.  And my second goal: keep it short.
Now, as a fourth year medical student, you probably already experienced the fact that the world is teeming with people all too eager to give you advice.  Much of the advice from senior doctors in particular will be strangely centered around when, how and if you should eat, sleep, and eliminate during residency.  (Clearly people have strong feelings about such things.)

But as a fairly junior attending physician myself, the idea of giving you all advice outside the realm of the purely practical does feel a little presumptuous.  The field of medicine is constantly changing—maybe now more than ever before—and I can’t pretend that I know what the future will look like any more than you can. Therefore, I only have one piece of advice, so as to make it easier for you to remember, and that is this:

Remember who you are in this moment.
And who, exactly, is that?  At this moment, you are a fourth year medical student, just minutes away from being granted your medical degree. You are proud, and you should be.  You are excited, and you should be. You are a little apprehensive about what comes next—intern year, residency, the hours, the new responsibility. That, you should be too, but I’ll not belabor the point—other than pregnancy, there’s no condition about which people like to recount horror stories more than medical residency.  Finally, and perhaps most importantly, you are still idealistic. I hope, at least, that even at the end of medical school you have retained the idealism that brought you into medicine in the first place.

And why did you go into medicine? I’m sure there are a host of different reasons, phrased in a number of different ways—but I think, and I hope, that it all boils down to this: you want to help make the world a better place, one patient at a time.  And right now, this seems like the most obvious thing in the world, the thing that has powered you through years and years of books and finals and 4:00am scut rounds done on no sleep and an empty stomach.  You’re doing all this not just for yourself, not solely for any kind of personal glory or reward, but to help other people.
Remember who you are in this moment.
Older doctors, particularly the more cynical ones, will speak of idealism as though it’s a bad thing, some sort of marker for naivite.  But I’m going to tell you this right now: idealism is never a bad thing.  And idealism seasoned with experience is maybe one of the very best characteristics a doctor can have.
Remember who you are in this moment.  A young doctor on the cusp of doing great things.  Some of these great things will be large acts, the majority of them will be small, but all of them will stem from who you are in this moment, who is someone with the energy, idealism and work ethic to make the world a better place.  With all the pomp and circumstance of this particular day and all those that preceded, it seems like the concept of service would be difficult to forget.  But believe me when I tell you that forgetting is the easiest thing in the world.  I have forgotten it many times myself.
Because there will come a night on call during internship when you’re going to feel beaten down and tired and regretful of having ever gone to medical school in the first place. And right when you manage to sit down, the first time that you’ll have had a chance to sit down all night, the charge nurse on that floor will yell at you for sitting in her special chair. And right then, you will forget who you are in this moment.

Or during residency, you’ll have a patient who will push all of your buttons.  And that patient will be loud and belligerent and unappreciative and will say things that make you feel inadequate even after the hours and hours of work you’ve put in trying to take care of him. That patient will make you angry, unsympathetic, and when that happens, you will forget who you are in this moment.

Or there there will come a time when you’re an attending, after you’ve been working late for the fourth evening in a row. This will be the one day that you have any hope of getting home to see your spouse and kids before bedtime, and right as you’re finishing up your dictations and ready to hit the door, an emergency case rolls in that no one can staff but you.  And that particular evening, you will forget who you are in this moment.

Cynicism is a protective adaptation.  It is a shell that doctors build around themselves after they feel that they’ve worked too hard, seen too much, been burned too many times.  It’s a way for doctors to broadcast to their colleagues and to the world at large that they’re so expert in the human condition that nothing surprises them anymore.

But don’t be that person.  Don’t be the cynic.  Be for the rest of your career as you are today, someone who doesn’t tuck your idealism away like an obsolete relic of your years in training, but proudly wears it on the lapel of your white coat. 

Be ready for everything you think you know now to change. Be open to new experiences. But always remember who you are in this moment.
Congratulations to the Wright State University Boonshoft School of Medicine Class of 2013.  Congratulations, doctors. May each of you have a long, fulfilling career filled with interesting patients, challenging days, and a lifetime of surprises. The rest of us have been waiting for you, and are so happy to have you join the team.
Now roll up your sleeves and get in here. We’ve got a lot of work to do.