February 20, 2004 talk for the First Year Medical School class retreat at the University of Chicago Pritzker School of Medicine
[the students asked me to speak because I had spoken to them on several occasions which seemed to be well received]
I was told to say something to help the digestive juices flow, perhaps be encouraging, and above all, be brief.
I appreciate your vote of confidence asking me to do this,
But I sort of feel like Beyoncé’s new husband on their wedding night.
I know what is expected of me.
I’m just not sure I have the ability to make it interesting.
I do want to acknowledge that be asked to give this talk at the first year retreat is a powerful change agent. If we look at the current four years of students, the seniors asked Norma Wagoner to speak—she is gone; the juniors asked David Cronin to speak—he is gone; the sophomores asked Darrel Waggoner to speak—he wasn’t smart enough to recognize the name issue and is still here and now you have asked me and I am history next January—three out of four—pretty powerful. Make sure you advise next year’s class to pick someone they really want to get rid of.
Since we have two first year medical students now, and
I had a major problem with the first year of medical school,
your invitation opened up some interesting thoughts and
reflections.
The first year of medical school really is a tough transition.
I think I have had a successful career or careers even, but
it didn’t start out that way.
As I look back to 1962, my first year, I don’t think I was ready.
I had been accepted to Wash U in my junior year, but
elected to stay in school and complete my fourth year of college–
It was glorious.
I worked in the lab most of the time, skipped almost all of my classes during the second semester and almost wasn’t allowed to graduate,
I had a hot girl friend, access to wheels—life was very good.
I traveled to Europe that summer and then started medical school.
At that time, we had to go to class,
Lots of lectures,
No designated note takers,
No computers—-
Nothing even remotely like case presentations or research,
I hated it!
Plus, it was pretty parochial—it was all rote
(one of my classmates became overtly psychotic trying to memorize all of Gray’s Anatomy)—and blamed the rest of us for years.
And of course, there was that cadaver–
In those days, 2 of us to a body dissected the whole thing—
UGH!
I never got into it, but fortunately my body mate, Larry Shaffer,
Really did, and after a while, he did it all while I read the directions.
It is interesting to reflect on how much I loved surgery later on.
Millie Trotter, a tough, no nonsense institution in the Anatomy Dept, ran the Gross Anatomy course, and at one point, described me as being
“seedy”—-I’m not sure that was true, but I was dispirited—
This was not the exciting world I had imagined and
I couldn’t see the end of it.
At that time, my best friend from high school was in graduate school in San Francisco.
On a particularly down day in that first 6 months, the lure was simply irresistible.
I cleaned out my dorm room,
packed the car with all my worldly possessions, and
without talking to anyone,
headed west on Lindell Blvd toward highway 40 and SF.
Lindell Blvd is just that, wide, fast, handsome with
Forest Park on one side and big mansions on the other.
I can’t remember what my emotions were, but
I am sure I was both exhilarated and petrified at the same time.
After all, what would my parents, friends, classmates, everyone say.
I was a quitter, a failure. The thoughts must have been cascading
through my mind.
And then——-,
The unbelievable event occurred.
Now picture this, I am driving west in my
unsafe at any speed Corvair when
a car passes me on the left,
cuts across in front of me,
bounces up over the curb,
and plows head on into a tree.
It happened in an instant;
The car was a convertible;
It was smoking;
I was stunned;
I pulled over, jumped out and ran to the car.
The driver had obviously smashed his head into the windshield;
There was blood everywhere;
It seemed like he was seizing;
I tried to open the car doors but they were jammed shut.
With smoke pouring out, I thought there would be a fire—
or an explosion.
I took my pocket knife and
cut open the convertible top,
got into the car, and turned off the ignition.
At this point, other people had stopped and
I asked them to call for help while
I tried to keep this flopping, flailing man
from hitting his head even more.
I was cradling him—
No one seemed to want to help;
they just gaped and stared.
Finally the fire department showed up, and
with their “jaws of life”,
ripped open the car door,
reached in
and literally yanked the guy out of my grasp
and onto the ground.
I protested, saying something like
they needed to be careful of his head and neck.
The response was,
“get out of the way kid”.
I remember thinking, if only I knew something,
I could possibly have done something—but I didn’t;
I was a failed first year, first semester medical student.
So I got back in the car,— turned around,— and went back to school.
I never talked about it at the time and
have only recently (42 years later) begun to reflect on
how different my tape would have played out
without that extraordinary event.
Now I like the way it has played, but
I wonder—
So, since I am spilling the beans,
let me also tell you that I was far from
the smartest in our class.
Bill Wood was a true savant;
we also had poets, authors, and
real intellectuals.
My strength was in always showing up,
being persistent, and ultimately,
my refusal to let the work get the best of me.
And maybe more important,
I met my Muse.
Little did I know that Sarah Luce,
Prof of Pathology and Anatomy, and
terrorizer of medical students
was going to be my channeler to the future.
Sarah knew everyone’s name,
called on us—
We thought picked on us and somehow, somehow,
her radar could always find me with not quite the right answer.
She scared the hell out of me!
But Sarah, like all of us, may have had different
intentions than the directly obvious.
She wanted us to be the best, and
Lord knows she pushed.
I learned to run 2 electron microscopes at the same time
and my “yellow beret” position at the NIH-NCI during the Vietnam War
came out of this work.
In contrast to George W., I did show up for duty and have a
real record to back it up.
Sarah cursed like a sailor,
worked us really hard, but
then came the softer side—
good restaurants, good talk,
good mentoring—something we discussed at our first meeting.
I saved myself with these projects and
Sarah was my guide.
Each of you has to find your own guide/mentor or mentors, but
let’s review a few general issues:
First thing—- if you haven’t done it already, read Robert Fulghum—
“All I really need to know I learned in kindergarten” and
“It was on fire when I lay down on it” and there are other homespun books of his.
These are fine principles for interacting whether as a medical student, a house officer, an attending, a mentor or what have you.
So for instance:
Learn how to play nicely in the sandbox;
Share everything;
Hold hands and stick together;
Don’t hit people;
Say you’re sorry when you hurt somebody.
One of his quotes that I particularly like is:
“Be aware of wonder.
Live a balanced life—
Learn some and think some and draw
And paint and sing and dance and
Play and work every day
Some”.
Next, think about what you want to do more of:
I hope that includes what made you want to go to Medical
School in the first place. When we look at our applicants, there is a lot of volunteering and service listed—but much of that tends to go by the wayside once students are accepted.
Martin Luther King said, “Anybody can be great, because everyone can serve”—-what are you doing for others?
In his book The Snow Leopard, Peter Matthiessen
Writes about sherpas—-“The sherpas are alert for ways in which
to be of use, yet are never insistent, far less servile; since
they are paid to perform a service, why not do it as well as possible?(what a unique idea!!) When the going gets rough,
they take care of you first—-
Yet their dignity is unassailable, for the service is rendered for its own sake—–it is the TASK not the employer that is served.
As Buddhists, they know that the doing matters more than the
attainment or reward, that to serve in this selfless way is to be
Free.”
Speaking of free, the end of this first year will be one of the few
opportunities you will have to travel, gain perspective and
inject variety into your life, because summers for the next few
years are spoken for. Our two first year medical student sons
have very bright eyes for this summer.
A couple more things to touch on:
In the first two years and on all tests, you will be asked for
specific answers—and you will produce, but I want you to
remember that this is not the real world of caring for patients in
which there is almost always uncertainty.
According to Atul Gawande in his book “Complications”, uncertainty is the core predicament of medicine—the thing that makes being a patient so wrenching and being a doctor so difficult. With all that we know nowadays about people and diseases and how to diagnose And treat them, it can be hard to see this, hard to grasp how deeply the uncertainty runs. As a doctor, you come to find, however, that
the struggle in caring for people is more often
with what you do not know than what you do.
Medicine’s ground state is uncertainty. And wisdom—for both patients and doctors—is defined by how one copes with it.
I view myself as pretty good at doctoring after almost 40 years, but I challenge you to be better than me—-and unless you are,
we will have made no headway against this vast uncertainty.
Take this challenge seriously, but not so much yourselves. Gravitate toward what is positive in people, ideas, and philosophy–
If for no other reason than you will be happier than those who do the opposite.
Experience everything you can.
The poet Rainer Marie Rilke in his “Book of Hours: Love Poems to God” writes:
“Let everything happen to you
Beauty and terror
Just keep going
No feeling is final”.
Remember the “C” words from our first session:
Commitment
Competence and culturally competent
Carefulness
Compassion
Caring—make that continuous and coordinated
Curiosity
Critical
And their counterparts:
Be Kind and Gentle—and Laugh often.
These words are all value laden and oh so important.
We could really spend the whole time just talking
about them.
As I reflect at this point in my career, my most important moments have not revolved around the laboratory or teaching—critical as I hold these to be—but rather occurred when I revealed my vulnerability to my patients when delivering bad news or when trying to help them resolve the frustration and disappointment of unfulfilled dreams—-the impetus is to do better and to be better.
It is simultaneously humbling and uplifting.
As I also reflect on conversations with parents many years ago about our new untried drugs, 6MP and L-asparaginase, about central nervous system prophylaxis for ALL and the use of high dose MTX for osteosarcoma, and so many other therapies, these conversations were all couched in nervous tones about uncertain outcomes and serious side-effects. It is far from perfect now, but it is so much better. When one of my patients, Tom, had a leukemia relapse in his central nervous system after being disease free for more than 10 years, this fine Harvard student’s devastation was matched by his parent’s grief and mine was not far behind. This kind of outcome is increasingly infrequent as we learn more and understand more and demand more of our art and science.
So again I will challenge you to be the vanguard of new knowledge,
To be as good as you can be,
because to make a difference and touch people’s lives and
help them,
is as good as it gets.
Address to the 2011 Graduation class of Pritzker
This address to the 2011 Pritzker graduating class utilizes much of what I presented to the University of Washington graduating class in 1992; it was particularly poignant in that I admitted all of these students and we were all leaving Pritzker at the same time.
Values-June 10, 2011
Thank you Dean Polonsky—Dean Humphrey, Dean Prince, Dr. Fields, faculty colleagues, staff, parents, spouses, relatives, SO’s, guests and most important…
HELLO PRITZKER GRADUATING CLASS OF 2011!!
I had the great good fortune to meet most of you four years ago and help bring you to Pritzker and now, as we all depart this incredible medical school, you do me a great honor with this opportunity to speak with you one more time and act as your faculty marshal. I am thrilled, humbled and appreciative of your generosity because I really do care what happens to you and I am so pleased to share this special day with you. I want to relate some of my thoughts and experiences gathered over many years, kind-of down home stuff, not earth shattering, but I think important.
But first however, you have made it. The great day has arrived for you, your families and loved ones (thank you so much families and loved ones)—this day begins another transition with new uncertainties, opportunities and challenges which never seem to end. It is also full of the excitement and anticipation of getting on with your life. As you are well aware, life is a succession of vignettes and choices and you don’t always feel like you were dealt the best hand. However, how you play each episode will define not only what happens to you but how others will judge you. Of the many transitions or passages in your lives, this one is particularly important since it should signify a major direction in your ultimate career path. So I would like to touch on some complex, often times disturbing and difficult personal and professional issues that you will and probably already have faced and must resolve with solutions that bear on every aspect of your life.
A colleague of mine, Dr. Robert Brent, talks about medicine—as an excuse from living. I said that correctly and did not mean—an excuse for living. This profession, of which I am so proud, and you are about to enter, is seductive and potentially consuming—an insatiable mistress or lover. Each year I tried to emphasize to our pediatric interns the importance of striking a balance between professional aspirations and outside or personal relationships with family and friends, and today, I say the same to you. In spite of the opportunities for maturation that experiencing a medical education offers, some of us slip through untouched. The benefits of being a physician can become a personal and family liability; for although the MD degree provides the potential for: intellectual stimulation, flexibility and independence, choice of locale and position, excellent financial compensation, and direct service to people in need, it all comes at a price.
With many physicians, trouble begins with this last point, namely being of service. For some, being of service can become a mechanism for escaping from very important responsibilities, namely, the responsibilities to one’s parents, spouse, children, friends—and to yourself! I am certain that many students entering medical school consider their professional responsibilities to be the most important part of their lives—I know I did. Furthermore, many of the parents of medical students have reinforced the concept that the study of medicine has first priority in their households—mine certainly did. The very same issues carry over to being an intern. This is not necessarily healthy; becoming a really good doctor, is a very respectable goal which we hope all of you achieve, but as I just said, everything comes at a price.
The most difficult and most important accomplishments in life include the development of warm, generous, giving relationships with other human beings, be they spouse, parents, children or friends. If you compare the rewards of developing mature inter-personal relationships with the attainment of excellence in the medical profession, certainly the rewards maybe publicly recognized and quicker from one’s profession. However, in spite of what appears to be more meager recognition at home, there are long-term rewards; when things go wrong at the interpersonal level, the anguish and heartache are immeasurably greater than you will ever experience from disappointments in your profession. There is no comparison between failing a course, not obtaining a desired internship, or not receiving an award and going through a divorce, having a runaway child, or seeing indifference or contempt in the eyes of one of your loved ones. How does the profession of medicine become number one in an individual’s or a family’s list of priorities? Parents or spouses may become overprotective of the student or doctor and overlook indiscretions or failures on their part to contribute to family functions because he or she “has to study” or “has to see their patients.” Everyone has to be quiet because the medical student is studying or the doctor is sleeping. Other people do the grunt work because we are protected. Soon we learn that we can get out of almost anything because of our training. Spouses give up their education, recreation, friends, and vacations because we are interning, but even more important, our interpersonal relationships may fail to mature because we are immersed in our training. Little by little with everyone bending and twisting their lives so that we can become really good doctors, we intuitively learn that our studies and medical responsibilities can be used to defer other responsibilities, whenever and wherever we choose. Some of us will use our indispensability to patients as a way of life and our loved ones can be made to feel guilty about taking us away from our sick patients. This exploitation of guilt can be the physician’s method of suppressing the goals, aspirations, and needs of other members of the family unit as well as his or her own needs. Medicine should not be our escape from dealing with the tough issues of our own lives.
Somewhere early in our development as physicians, the matter of family and personal life versus professional life has to be considered and dealt with through frequent discussions between family members where everyone’s needs are evaluated, considered, and appropriately satisfied. I do not believe these comments would have been made at the time of my graduation from medical school, 45 years ago, and I suspect that there are some of you who may disagree with them now while others may consciously agree yet sub-consciously continue to place prime emphasis on their professional lives. I have no simple answer or prescription for these tough issues about how we should establish realistic goals for our family units. I have been particularly fortunate in having a very wise spouse who intuitively understood these pitfalls and helped me steer a steady course. Be careful, be vigilant, you must be aware and actively work at it. I am pleased to observe that I sense you and your generation understands this somewhat better than mine did, but I urge you to be on constant guard.
Balancing these priorities is not incompatible with striving for highest professional goals. Here I speak to another set of values which I also urge you to consider. I remember these as my “C” words: commitment, competence, careful, compassion, caring, curiosity, critical and kind—the latter not a “C” word but it sounds like it and is complimentary to the others and lastly “come home” as I discussed earlier. Let me elaborate just a bit on these.
Commitment is the attribute that translates as hard work and perseverance. It requires us to show up, be careful and spend the extra effort to see things are done right; it is the competence which is indispensable to medicine and which we must display as honesty and integrity in our interactions. It is the patience and perseverance which allows us to try to assimilate the enormous breadth and depth of information that must be integrated to provide the very best care for our patients. This is tempered by the reality that medicine has become so complex that we are dependent on one another in ways that might have been scoffed at in the past. It is critical to be a good colleague, a good team member, a partner and to work in a complimentary mode with everyone. Try to remember Robert Fulghum’s books—I can’t recommend enough “All I really need to know I learned in Kindergarten”.
Compassion or caring is the basis for our relationships with our patients. It is the art of medicine, its humanistic side; it is a critical aspect of learning to be a physician since medicine is really learned at the bedside by observing, listening, feeling, touching; the laying on of hands is as old as medicine, and as important today as in the time of Hypocrites. Medicine provides us with an intimacy, an ability to physically touch other individuals—almost a taboo in our society—to enter their space, query their most intimate thoughts, yet almost nothing connects us more directly with our patients than holding their hand or touching them while discussing difficult issues; maintaining physical contact with them is a bond and bridge which we should create and cross with pride and expectation that it will be a major part of our therapeutic plan. Compassion and caring are necessarily an act of giving. Compassion is our ability to understand our patient’s needs and concerns and to help alleviate their fears and anxieties. Compassion is a fragile thing and must be carefully and constantly nurtured, for if allowed to flag, the flip side can be cynicism which is destructive to what is so special about being a physician.
Do not underestimate your patients—their life experiences maybe more worthwhile than your medical knowledge, biases, beliefs or prejudices—so add them eagerly to your health care team. We must work with our patients to demystify medicine, to humanize it, and at the same time, humanize ourselves. Our sense of self-importance, at times even arrogance, is inflated by our position of power over patients and by the deference still given to doctors in general; it often gets in the way of the empathy which we need to possess to become really complete physicians. Take your patients’ problems seriously, but not yourselves—humor and laughter are therapeutic; compassion can develop when we accept that medicine truly is a special profession, but that we are truly not special people.
Curiosity and the need to be critical about our knowledge base is another must. I often say I do not know, and I know that what I often say is only part of the story. You must continually question the status quo; you must strive to be better than your teachers, after all, the facts we propose maybe decades old and possibly not of value even in the good old days. You must be especially critical of your own beliefs; you must guard against dogma; you must be willing and receptive to new ideas and information, and you must have the tools to understand it—I hope we have fulfilled our responsibility in that regard. In reality, you must have learned how to learn and become a true student not just driven by the need to graduate (although this is a sweet day) but driven by the need to know what is new and current and potentially beneficial to your patients. You are going to practice medicine perhaps for the next forty years; will you stay current; can you assess the worth of a clinical study? I hope you will care deeply; we know so little about so much of medicine and human behavior. Use your senses in addition to your considerable intellect; become an observer; collect your own data; correct our misperceptions; I urge and challenge you to winnow out time for yourself during your training years to pursue a project of your own interest as one way of fulfilling and preserving excitement and curiosity. If you do, it will be a welcome escape from the rigors of our training programs which can make us jaded, depressed, disillusioned, and even assault our self-esteem. This was life-saving to me in my internship, hard to do—yes—but most of what we think of as important is not easy.
Be kind, not a “C” word, but so important. Be gentle, patients and their families are frightened and intimidated and often feel guilty; they are frequently overwhelmed; take your time—that precious commodity of which you will never have enough—use it wisely in your interactions; make everyone feel important and valued. As I reflect on my career the most important moments have not revolved around the laboratory or teaching—critical as I hold these to be—but rather occurred when I have revealed MY vulnerability to patients when delivering bad news or when trying to help them resolve the frustration and disappointment of unfulfilled dreams—the impetus is to do better and be better—it is simultaneously humbling and uplifting.
Medicine has been very good to me. I have tried to balance the extraordinary demands of the profession with my commitment to family and friends. It has always been a struggle; I didn’t always win. You are now ready to leave and continue this same struggle whether here or elsewhere, and I wish you great success. Medicine has changed so much in the last almost half century as to be almost unrecognizable to a practitioner of the early 1960’s, and the magnitude and rate of change will be even greater during your practice years; it will challenge every aspect of your art, science and ethic. Even though you are well prepared now from a truly great school of medicine, you will need to periodically change and evolve to be really relevant in the future. There is so much to learn, discover and change if you are willing to be fearless, to deal with uncertainties, to take chances, to not be intimidated and to be prepared for disappointment. This last point is critical because we tend to learn the most from well considered missteps—so add humility to your list of important words. So it is time to step-up Pritzker class of 2011, take the reins and lead yourselves as well as the rest of us to new vistas… I urge you however to invest as much energy into your personal lives as you do into medicine. The rewards associated with family and friends will ultimately inscribe the final chapter in your own book of life.
So I wish your health, happiness, good call schedules, great residents, and understanding attending. I thank you again for asking me to share my thoughts and feelings with you. No one remembers their graduation speaker, and I don’t expect you to be different. I do hope however that you will remember some of the thoughts from today or at least feel them when relevant situations arise and that I assure you will happen. So with that I bid you the fondest possible farewell with the firm knowledge that you are poised and ready for this next adventure and with the warmest possible personal feeling about my interactions with you. I know all of you as wonderful people with the real potential to be wonderful physicians—and I know you will succeed. It has been a great time here at Pritzker for all of us. Remember, this is the first day of the rest of your life—GOOD LUCK!
[as the faculty marshal, I also “hooded” most of the graduates unless they had a specific person to hood them]
GOLD HUMANIST HONOR SOCIETY—KEYNOTE for March 5, 2013
[the GHHS is a society to promote humanism in medicine. Fourth year students deemed most deserving are elected by their peers for this honor. Since it is a fixed percentage of the class, there may be deserving students who are not included. This evening was particularly significant since Joel Schwab was also being recognized by the students at the ceremony.]
MY HEROES
That’s enough already of an introduction Bill; I really don’t like too much formality; you can just call me Your Excellency….
Life is so much more fun when you’re happy with your lot and positive in general. But you guys say, “I am a lowly medical student looking forward to being an only slightly less lowly house officer—what do I have to be happy about with the next 3-6 or more years of my life shoveling skit?– To which I say:
There once was a student from Pritzker,
So smart and so savvy who whispered,
That curriculum redo,
Is just so much hoodoo,
I can’t wait to get out on my keister!
What I really want to say is—it’s all good and I am so pleased and proud to spend some more time with you today and talk about things that I feel are important. I am honored by you thinking of me and inviting me this evening.
There are so many possible directions to explore that relate to humanism and are consistent with the philosophy, mission and ideals of the Gold Society. Thank you again for this opportunity and your implied confidence in me; I believe in GHHS and what it stands for.
Let me start my comments with Joel Schwab. You can’t know how pleased I am to share this evening with Joel and of course with you, our wonderful students, family, friends and staff. Joel and I go back to 1996; I came from Seattle to be Chair of Pediatrics at the end of 1995—the department was in trouble in many ways—student teaching was spotty; the residency program in disarray; the facilities outdated; the faculty dispirited, fund raising non-existent; research at a low point—–why on earth did I agree to come??? Well, believe it or not, we worked through all of those issues, but perhaps student teaching and the third year clerkship was the easiest hurdle because Joel was ripe to leave full time private practice and I was lucky enough to recognize after one meeting with him in 1996 that he was going to be a big part of the answer. Joel was one of the first people I appointed and I think he and I have been in sync ever since. His presence at Pritzker has been felt by legions of students who respond rather monotonously that Joel is one of our best teachers, doctors and people. Joel, you’re a gem and an exemplar of much of what I have to say.
Tonight, I want you to think about heroes, not just mentors or role models. What is a hero or in Yiddish, loosely, a mensch? I think a hero is someone who shows great strength and courage or what we think of as noble qualities, a willingness to sacrifice themselves for others, someone we admire and want to emulate, a person of integrity and honor.
So take a short journey with me now; what could or would it be like if our lives were influenced by and filled with people of great character, moral and ethical direction, sensitivity, empathy,—characteristics of great people, not just great physicians.
Two of my heroes are Abraham Lincoln and Moses Judah Folkman. Doris Kearns Goodwin’s book and scores of others as well as Spielberg’s film are primers for our 16th and perhaps greatest president. Lincoln was extraordinary; he was both willing and able to evolve his thinking and actions in the midst of perhaps the most turbulent time in the history of our country. He was self-taught from a limited number of books most of which he committed to memory—books like Shakespeare, many poets, Aesop’s fables, The Pilgrim’s Progress, the Bible and later, some law texts. That was pretty much it for a long time—his formal schooling amounted to less than one year, yet his storytelling, writing, humor, wisdom and actions are almost unparalleled in their greatness; let me give you some examples of Lincolns that are perhaps less well known than his major speeches—I will be both quoting and paraphrasing:— As a young man, Lincoln was asked to tell the story of his life and responded, and here I quote,—“the short and simple annals of the poor.” There are many stories about his looks. It is said that Lincoln was surprised one day, when a man drew a revolver and thrust the weapon almost into his face. What seems to be the matter inquired Lincoln? Well, replied the stranger, some years ago I swore an oath that if I ever came across an uglier man than myself, I’d shoot him on the spot. Lincoln was relieved; “shoot me” he said to the stranger; “for if I am an uglier man than you, I don’t want to live.” To quote Lincoln in the same vein, “if I were two faced, would I be wearing this one?” In his early days, Lincoln was referred to as, judge, arbitrator, referee, umpire, authority in all disputes and games, a pacifier in quarrels; everybody’s friend; the best-natured, the best storyteller, the funniest, the most sensible, the best-informed, the most modest and unassuming, the kindest, gentlest, roughest, strongest, best fellow in the county. “If a man is honest in his mind,” said Lincoln one day, long before he became President, “you are pretty safe in trusting him.” Concerning the Emancipation Proclamation, there are many versions of many stories, but in one Lincoln said something like, “The signature looks a little tremulous, [he had been shaking hands all day] for my hand was tired, but my resolution was firm. And now the promise shall be kept, and not one word of it will I ever recall.” Lincoln rarely asked for opinions as a politician or as a president—he would hear everyone out, then he arrived at conclusions from his own reflections and once formed he never doubted their correctness. // Lincoln’s great love and affinity for children easily won their confidence—which I think is special in its own right and leads to many stories but I have no time to tell them. Homilies, in fact, can go on and on so I’ll stop these with the afternoon preceding his assassination when Lincoln signed a pardon for a soldier sentenced to be shot for desertion, remarking as he did so, “Well I think the boy can do us more good above ground than underground,” and he also approved an application for the discharge, upon taking the oath of allegiance, of a rebel prisoner, in whose petition he wrote, “Let it be done.” This act of mercy was his last official order. Perhaps you can get an additional picture of Lincoln from his comment, “nearly all men can stand adversity, but if you want to test a man’s character, give him power”.
Now I want to turn to Judah Folkman who is reprised in Robert Cooke’s book, Dr. Folkman’s War—Angiogenesis and the struggle to defeat cancer. I knew Judah from my years in Boston; we met in 1969 when I was a resident and he was Professor of Surgery at Harvard and the Chief of Pediatric Surgery at Boston Children’s Hospital, a position he was appointed to several years before at age 34 after being an instructor at Harvard for one year—maybe the fastest rise ever to Harvard professor. Do you think Judah was special? Oh my, so special, a surgeon who was all heart and with an incredible vision. From his many observations of tumors, he not only believed, but knew there must be a biochemical and molecular basis of new vessel formation—and he was going to find it. This is more than 40 years ago; you have to know that at that time surgeons around Boston said Judah couldn’t operate; scientists said he was naïve and both incompetent and unqualified to be doing research…. Students at the Medical School and patients and families at the Children’s Hospital, however, loved Judah—he was kind, selfless, dedicated–with an unquenchable fountain of knowledge and wisdom and interest in his patients and students and, of course, in their welfare. Perhaps it was an outgrowth of his rabbi father’s teaching that he became a rabbi-like doctor. Our first child, Matt, was born in 1971 and in his baby book we note that Judah Folkman was the great man of our time; not because of his discoveries; they had not yet occurred; he was not a famous scientist, but rather because he was an extraordinary person. He was known for his illuminating lectures that left his listeners spellbound. His lecture style was enthralling, his enthusiasm contagious and his humor self-deprecating. Judah always shared his latest insights and unpublished data because he saw his scientific competitors as potential allies, not the enemy. Judah was an inspirational leader in everything he did. I remember him best for his warmth, his humor, and his incredible mentoring skills. Judah mentored by the example of his perseverance, his openness, and his sheer boyish delight in discovery. He met each year with the graduating fourth year class to impart his unique strategies and wisdom about how to be a great intern—and survive the process. To Judah, a lump of coal was an opportunity to turn it over and find a diamond. He did this with experiments, but more importantly, he did this with people, whether patients, students, technicians, workmen, colleagues or competitors. Judah died in 2007 in the Denver airport on his way to give a Key Note address. Angiogenesis, as you know, is a big deal and unfortunately, Folkman, like Lincoln, died before the final chapter of their work was realized. Both suffered greatly from the miss-judgments of their peers and maybe that is part of the price one pays to be great—to have a big idea, an all-encompassing vision and dream and the refusal to let it go, no matter what—mensch’s, two of my heroes.
Now heroes come in all sizes and kids have generally filled that bill for me. Why are they so appealing? You know the old saw—“Children are not small adults, but adults frequently act like large children”. Can you retain kid-like qualities and still behave like an adult—I throw that gauntlet out to you? Kids are spunky, spontaneous, exuberant, honest, playful, innocent, empathetic, cute—and of course, lots of other descriptors. Perry Class wrote recently in the NY Times about kids acquiring early on traits of empathy, sympathy, kindness and charity, so called “prosaically behavior”. Although there may be some degree of heritability, there is no known gene for empathy or sympathy or altruism. It does feel good to help other people and parental modeling is so important—compassion and sympathy should be part of a child’s experience long before they know the words. We should help children frame their behavior as generous, kind, and helpful, understanding that empathy, sympathy, compassion, kindness and charity begin at home—and very early. Parents really can be and should be heroes for their children.
So let’s compare some of those positive adjectives for kids—not quite the same as those previously describing adult heroes, but if I age-adjust them, I’m OK —with a more typical adult description or response. So for spontaneous and energetic, we might describe guarded or cynical; for exuberant, we run into tired, staid and stale; honest often begets dishonest or duplicitous; playful becomes distant and often ornery; cute—I can’t help any of us with that; innocent can transform into many OK things but unfortunately also into the obscene and unthinkable as we witnessed in Newtown, CT where heroes were instantly defined at the Sandy Hook Elementary School—the principal, teachers, psychologist and the kids themselves. Would we be ready; could we have done the right thing? It all happened in an instant when reactions are almost reflexive, which may account for why there are so many heroes among our young men and women in the military; they have each other’s back, understand the mission and want to be brave. There are many lessons to be learned from the Connecticut tragedy; I hope the children, their siblings and families, are shepherded through this awful time by parents and other adults who understand how to support them as they all work through their great loss. There is nothing in our lives that compares to any of this—but unfortunately it is the repetition which is so tragic and horrific.
I do want you to clearly remember that our so-called heroes can also be very complex and fragile—and they can let us down hard, as witnessed by the recent coming clean of Lance Armstrong, so “caveat emptor”—let the buyer beware.
So,— how do we keep our priorities straight? It can be hard; there are so many competing issues, but a few things are obvious to me: working hard—almost all of the time; trying to be your best; being nice; honest, kind, respectful; always looking to improve.
I have an old story about priorities that involves David Baltimore who was the co-discoverer of reverse transcriptase. The Red Sox Nation was on fire in the mid 1970’s and the 1975 World Series against Cincinnati was spectacular. In game 6, Carlton Purge Fisk hit a walk-off homer in the 12th inning to even the series at 3 games apiece. For game 7, the Red Sox brass wanted a kid from the Jimmy Fund at the Dana-Farber Cancer Institute to throw out the first ball and since I took the call, it was easy to get one of my patients—Joey. Joey, his dad big Joe, MASS Senator Ed Brooke, the then Commissioner of Baseball Bowie Kuhn and I were in the Commissioner’s box when Joey threw the ball out to Purge. Unfortunately, the Sox lost the game 4-3. The point of the story about priorities however happened the next day when I had to call David Baltimore about an experiment; he was in NY when I got him on the phone. He proceeded to shout at me about how did I get into the Commissioner’s Box for the game—Joey’s toss to Purge was televised and Baltimore was tuned in– to which I think I made the right reply—“I said something like, David, you just won the Nobel Prize; what difference does it make how I got into the Commissioner’s box”?
So maybe a few of my pearls for you to chew on before I finish, which I hope relate to what I am trying to say:
#1. “to be great, don’t be late”,
#2. “avoid nasty people, they are a plague”,
#3. “if you whine and complain, you will be noticed, but you won’t be liked”,
#4. “not all efforts are rewarded, maintain your composure”,
#5. “unkindness begets misunderstanding leading to anger and retaliation”, so be nice,
#6. “recovering from a failure or disappointment is the path to knowledge, so never stop trying”—we all get to choose what kind of human being we want to be, ……….so another pearl is,
#7. “dream, don’t scheme”,
More directly to the GHHS theme, the essence of doctoring, in my opinion, is to comfort, relieve anxiety, alleviate fear, correct misconceptions, explain what is happening, reassure patients and help them view the future. It helps a lot to take your time, so slow down, and be gentle, kind and understanding—it will never let you down.
Remember, there is so much to learn, discover and change if you are willing to be fearless, to deal with uncertainties, to take chances, to keep your priorities straight, to not be intimidated and to be prepared for disappointment. This last point is critical because, as I said earlier, we tend to learn the most from well considered missteps—so be humble—it is a trait that wears well—another pearl for the evening.
In keeping with the spirit of GHHS, I challenge all of you to be in the vanguard of sensitive, humane physicians; to be as good as you can be, because to make a difference and touch other people’s lives and help them, is as good as it gets which circles us right back to Joel Schwab because all of this fits him well—he is a mensch.
I am about to stop, but first a couple more quotes from Lincoln:
“whatever you are, be a good one”, and finally,
“be sure you put your feet in the right place, then stand firm”.
I will stop now with three rules for living from Brendan Gill, late author and critic of the New Yorker:
Rule #1: Life should be fun
Rule #2: Do everything you can not to hurt anyone
There is no Rule #3——so, thank you again for letting me share this wonderful evening with you and I wish you great good news on Match Day and for the future.
[I asked if they wanted another limerick, and when the answer was yes, I added the following]
You are the inductees to Gold,
So sensitive, caring and bold,
You say service is key,
It’s not about me,
There is a standard to uphold.
htapoemscom 