My medical doctorate turned 10 years old this month. Here is the speech I gave at my graduation ceremony back in 2004, at the UCLA David Geffen School of Medicine.
Before I begin, I wish to thank the families, the friends, and the faculty for their unconditional love, support, and faith in our class. We are indebted to all of you. And after looking at my loan repayment schedule, I think this is the only debt that feels good.
Well, here we are: GRADUATION.
Commencements and graduations often celebrate the same-old, clichéd idea that the newly graduated will embark on yet another journey to lead others into new frontiers, face and overcome new challenges, and achieve once again new heights and glories. It's like being in the middle of the Olympics, and NBC does that special on some kid who can run like Forrest Gump. A town is rooting for this guy because he's going to win the gold medal. You can almost hear the music: "It's the eye of the tiger..." or maybe you're a "Chariots of Fire" person. And that's cool, but I want to put these dreams of frontiers and challenges and glory in context.
To me, we're the newest recruits to join the age-old struggles against the violence of apathy and ignorance. While we can expect to venture into new areas of knowledge, and we may be the first to confront new illnesses, these forces of violence will be at work, and they are anything but new. Illness has often played a supporting role in the drama of human history, but no one can deny its impact. There are the obvious examples of The Black Death and other epidemics, but more common ailments have had their effects on history as well. Imagine if Edgar Allen Poe had been given a prescription for Paxil. Or if someone had checked Monet's eyes for cataracts. Or if Barbara Bush had had better prenatal counseling.
But more important than the effects of the actual diseases and illnesses are the conditions which give rise to them: the conditions of poverty, ignorance, and worst of all, indifference. Today, a child born in the United States has a life expectancy of 78 years, while a child born in Sierra Leone has a life expectancy of 48 years. In some African nations, over 40% of the adult population is HIV-positive. These conditions arise from apathy and ignorance, which together wreak an insidious form of violence: worse than war because it is daily, it is unrelenting, and because it is indiscriminate as it deteriorates the human potential to prosper.
Having been raised during the war on drugs, and having been spectators to the rise of the war on terror, we might argue that war and violence are sometimes the necessary means to justify an end. But these ends always result in a winner who has more, and a loser who has less. One problem of the past is solved only to give rise to a new problem for the future.
This cycle, though unfortunate and full of challenges, poses opportunities for all of us to face those challenges, and to demonstrate our will and determination. Louis Pasteur wrote of this in 1888, following decades of wars, but prior to one of the most violent centuries of all time. Pasteur wrote, "Two contrary laws seem to be wrestling with each other nowadays; the one, a law of blood and death, ever imagining new means of destruction and forcing nations to be constantly ready for the battlefield - the other, a law of peace, work and health, ever evolving new means of delivering man from the scourges that beset him. The one seeks violent conquests; the other, the relief of humanity. Which of those two laws will ultimately prevail, God alone knows."
If apathy and war are mankind's oldest forms of violence, then indeed medicine is among mankind's oldest forms of relief and peace. This movement may not have had a very tranquil start, and there have been some not-so-bright ideas along the way. After all, putting a hole in the skull to exorcise demons sounds brutal, and bloodletting with leeches to relieve edema is not all that smart. Nonetheless, our endeavors with medicine, from these early rituals to the discovery of germs and now into the decoding of the genome, have always had the same drive: to never accept or surrender to the injustice of morbidity and mortality, but to fight for and restore the dignity of human life.
It was this fundamental belief that drew me to medicine. Seven years ago, I volunteered in a burn ward at a government hospital in India. Like any other hospital, there were people there who lived hard lives to begin with, made only more difficult by a cruel twist of fate. Many of the patients were not expected to survive, but no one died alone, or afraid, or in pain. For those who recovered, the return to normality, though difficult, proved to be a living statement against the hopelessness that would have otherwise consumed them. All of this was made possible by the physicians and nurses who, like in any other hospital, conveyed their empathy through their work.
Medicine's strength lies in making compassion an active process rather than a mere sentiment. His Holiness the Dalai Lama best articulated this philosophy in stating "The basic meaning of compassion is not just a feeling of closeness, or just a feeling of pity. Rather, I think that with genuine compassion we not only feel the pains and suffering of others but we also have a feeling of determination to overcome that suffering. One aspect of compassion is some kind of determination and responsibility. Therefore, compassion brings us tranquility and also inner strength. Inner strength is the ultimate source of success." That kind of compassion, despite its strength, is not flashy, and has a subtlety of its own.
The unassuming character of medicine's compassion makes it incredibly effective against the violence of apathy and ignorance, but that is not to say that health care providers are not susceptible to weakness. There are physicians who have become jaded from contending with the inequalities of access to care, and the daily frustrations of practicing under endless corporate requirements. We've all met these doctors: they tell us to leave medicine while we still can, that the good old days are long gone, or that if I wanted to go into pediatrics I should have gone to veterinary school.
The cynicism is understandable. We can be overworked at times, and it can be very hard to tell whether we are making the dent that we set out to make. If medical work is like a Looney Toons cartoon, there are days when we get to be the happy, fast Roadrunner, avoiding danger at every turn, looking smarter than we really are. Then there are all the other days when we get to be Wile E. Coyote, trying so hard to apply all of our knowledge in new and clever ways, but still finding ourselves flying off some cliff. But like the coyote we need to come back, try again, and not lose hope, because cynicism, in the long run, detracts from our efforts, and that dent we are trying to make becomes less and less a reality.
It is at times like these that we should turn to each other, for cynicism diminishes in the presence of solidarity. Medicine is a movement made up of many people crossing the lines that the rest of society has a difficult time crossing. One does not have to look much further than this field to find an inspired community that looks beyond whether you're male, female, white, black, brown, Christian, Jewish, Muslim or Hindu, gay, straight, Republican or Democrat, rich or poor. Though the history of medicine celebrates individual accomplishments, and the road to medical education is competitive, it is only through the collaboration of our efforts that we can perform our duties and make our mark.
So. Solidarity, perseverance, and compassion. That's what we've got. The violence of apathy, ignorance, and war gets to have weapons of mass destruction, billions and billions of dollars, and primetime TV spots, and all we've got are three words that you could have found in a Disney movie or a fortune cookie. Of course, there's more to it than that. There's all that learning and hard work and knowledge, too. But solidarity, perseverance, and compassion have brought medicine this far, and there have been some very impressive victories. And now it's our turn: there's a dent to make, a roadrunner to catch, a peace to strive for.
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