Good morning to you all.
What a treat to be here with you today.
I'm so sorry I can't be live to see you
all gathered together to give you a masked elbow or fist bump,
and to see you laugh at my jokes.
I'll get back to the reason for my absence towards the tail end
of my remarks.
First off, congratulations to all of you
for this truly remarkable achievement of your graduation
from medical school--
from the Alpert Medical School of Brown University.
Secondly, thank you for this lovely, lovely invitation
to join you on this special day--
your special day.
I am truly flattered to be here, and to be able to participate
in your graduation ceremony.
This is terrific.
You should be proud.
I know at Brown, all of administration, your teachers,
your friends, and your families are immensely proud of
and happy for you.
Well done.
It dawned on me when contemplating
what I might speak about that at my age,
I should be navigating the Eriksonian developmental stage
of generativity.
Or I should be accruing wisdom, and using that wisdom
to reach down and engage the care, growth, and success
of the next generation.
I love that idea, and hope to do my very best in that
all-important work.
I realize also that I am still working on that wisdom thing.
I thought as well that I might speak
to the notion of clinical pearls.
But that's been done, and it's certainly
too narrow for this occasion.
Never mind that I don't think I've reached
the clinical mountaintop.
Does anyone?
Or achieved enlightenment.
So I opted for something more modest still.
I have, amongst other things, I hope, experience as a clinician
and as a teacher.
And experience, a good and sometimes difficult teacher,
is worth exploring.
So I thought I could speak from experience and share some
observations and related suggestions--
clinical and otherwise--
that might help carry you forward happily,
healthily, and successfully.
And I will do so briefly, as I know that I and others stand
between you and your diplomas and hugs from your loved ones.
And I hope not to be preachy, but simple,
direct, and from the heart.
So notes from the floors--
insights, observations, and suggestions
for my newest colleagues.
To begin, let's frame.
Delirium is an acute form of encephalopathy,
as opposed to chronic progressive or chronic static
forms of encephalopathy.
Whoops.
Hang on here.
Wrong talk.
Let's try it again.
A top 10 list of sorts--
though I have 12 points to consider.
Number one, first and foremost, remember what got you here--
a love of science, an altruistic and inclusive view
of the world, a wish to do good for your fellow person,
your fellow human being, and for your communities--
local and global.
Let this be your compass.
Number two-- let beneficence be the rule.
No more OSCEs.
Dive in.
Be genuine.
Bring your genuine self.
Be kind.
Be humble.
Be earnest.
If this work doesn't keep you humble, nothing will.
And be confident.
Avoid hubris, but be confident.
It's hard work being a doctor.
There's nothing like it.
Our decisions are weighty.
Our patients and their families are suffering and anxious,
sometimes angry and undone.
Keep a level head, and be guided by beneficence.
Beneficence has the power to disarm.
It will never fail you.
Number three-- be available, be present, slow down,
and take time.
This is far from easy.
Indeed, it's flat-out hard.
I know.
Especially when everybody is looking to you
for answers and orders, when your seven
inboxes are lighting up.
And yeah, there are at least seven.
I've counted them-- phone, text, pager, emails, plural,
Epic InBasket, secure chat, and snail mail.
The cards are often stacked against you.
Time is precious.
Time is short.
Things happen.
Illness doesn't wait or punch the clock.
Plaques rupture.
Vessel walls are breached.
Bacteria multiply.
Toxins are elaborated, and sepsis overwhelms.
But take time when you can during a slower
time of the day, or on a slower day--
take the extra minute to consider your patient's
situation and plight.
Join them, guide them, educate, explain, reassure.
Bring all your science to bear, and bring yourself, too.
Your patients and their families will invariably appreciate it
and be better for it.
You'll be better for it--
better informed, better connected,
more insightful regarding diagnosis and treatment,
enriched.
Your kindness, time, and presence
can make a huge difference.
You, they, compliment our science.
You, they, can sustain when our best science fails.
As Abraham Verghese's young Dr. Stone
answers his father's, the elder Dr. Stone's, question
from the back of the room in a surgical conference,
what treatment in an emergency is administered by ear?
Words of comfort.
Number four-- teach like your hair's on fire.
Doctor, as we know, comes from the Latin word for teacher.
Teaching is a part of the work.
It's actually a really fun part of the work.
Teach your students, peers, attendings.
Teach your patients.
With teaching and education comes knowledge.
With knowledge comes the ability to understand, to reason,
and to navigate.
With knowledge comes a sense of control.
With a sense of control comes greater
ease in the face of disease.
Knowledge empowers, too.
And with equally empowered parts of the doctor/patient
relationship comes mutually engaged and productive work
and optimal shared decision-making.
Isn't that the idea?
Number five-- sleep when you can.
I'm sorry to be so pragmatic, but this
did make my short list.
Some nights you can't sleep because you're on call.
Some nights you won't sleep because you're anxious,
worried about your patients.
Some nights you won't sleep because your child
won't let you sleep.
Sleep when you can.
Number six-- keep your eye on the clinical ball.
Pause, and be true to your clinical focus.
As your careers grow and evolve, you
will take on more and more duties.
You will explore and have more opportunities.
You will take on more obligations
and play more roles.
It's great.
It's a load of fun.
It's a chance to make change.
And remember, the end game--
patients and patient care.
So when these schedules conflict and you're harried,
pause again, and ask if your clinical work
is being shortchanged.
Get back to the bedside when necessary.
Sit, scratch your head, ask, review,
explore with your teammates.
Avoid anchoring of all kinds.
To those of you who will be pursuing research,
administration, public policy, we
know you have the patient and patient care in your sights
as well.
Help show us the way.
Number seven-- be an agent of change.
Grab the reins of Obamacare, and don't let them
or it slip away no matter what.
Use the EMR for all of its remarkable power and potential,
and work to make sure that you and your peers
are not enslaved by its documentation requirements--
less typing, more time with patients.
Push back when it makes sense.
Usher it forward thoughtfully.
And make sure telemedicine is here to stay.
We've had the ability to engage this technology for 15 years.
We flipped a switch and deployed it with ease
in the face of COVID.
It's powerful.
It brings ill, fragile, marginalized,
and disadvantaged patients who cannot physically make it
to the clinic back to the doctor.
Don't let anyone walk it back.
Number eight-- practice translational medicine,
and insert yourself into the treatment.
Our science is flat-out beautiful.
I could not get enough of it in college as a biology major.
I taught high school biology after college,
and could not have had more fun exploring the natural world
with my students.
The first two years of medical school were hard work,
but the material is sheer wonder to me.
We have incredible tools at our hands--
translational medicine, molecular biology,
immune therapies, checkpoint inhibitors,
crazy new imaging modalities,
fantastically supported and cultivated here at Brown
under the leadership of Dean Elias.
From the lab to the clinic, in the form of new therapies,
what could be better?
I'm suggesting that translational medicine speaks
as well to your role in translating science
to your patients, to their families,
and through your communities.
Translating that science to the bedside is crucial,
and it's your job.
You may literally need to translate at times.
You will always need to be present to optimize
communication.
Explain, diagram, rejoice in the beauty of anatomy, physiology,
remarkable new therapies.
Give your patient and their families
a glimpse of the same, of what you know,
of what you rejoice in as you forge a path forward together.
Seek to gain their trust and understanding.
This, too, is a pillar of shared decision-making.
Number nine-- bring a balance to the old and the new.
Learn from your teachers.
Teach your teachers.
Learn from your peers.
Teach your peers.
Embrace the evidence space.
You're all incredibly smart, talented, and accomplished.
That's a given.
So how to move forward most effectively
with all of your talents, with all of your knowledge?
I suggest we remember that medicine is a team sport.
Collaborate.
Be a good teammate.
Argue and disagree respectively--
respectfully.
Dig in with your attendings.
Take advantage of their experience.
Ask questions.
Refine your thinking and practice.
Engage them thoughtfully.
And reach down and pull the next generation up.
Right the ship where it needs righting.
Retain the good.
Update what needs updating.
Number 10-- be aware of your blind spots and deficiencies.
Do what you do well, and do it often.
Work to improve what you do less well.
I think I grow even more aware of my flaws and deficiencies
as I get older.
This sometimes frustrates me.
At other times, though, I'm reminded that this is good--
really good, that it keeps me vigilant, on my toes, grounded.
Science discovery and medicine are moving so fast,
it's nigh impossible to keep up.
So ask a friend.
Ask your attendings.
Ask your senior residents.
Ask.
Number 11-- stay in your lane, but don't stay in your lane.
Read within your specialty.
Know and live your subject.
Become an expert.
But read the New England Journal of Medicine, Lancet, and JAMA,
too--
general journals.
Know and learn what your colleagues do.
Learn what their day is like, what they
can tell you, what vexes them.
They're your classmates.
They're now your colleagues.
They're your chums.
You need them.
They need you.
You need each other.
Stay abreast of the science, discovery,
and sociocultural issues that are
part of our work and mission.
And read for pleasure.
When the weight and gravity of your work and your eyelids
allows, be lifted by the words and art of others.
Let them and it inspire you when you're exhausted
and have nothing left in the tank.
I'm halfway through too many things on my bedside table.
Lately, I keep coming back to Obama's memoirs
of his first term, to be refreshed
by him and his courage and his leadership.
The only problem-- that I'm too fired up to sleep.
Find your heroes.
Learn about them.
Learn from them.
Learn about their strengths and their doubts
and their deficiencies.
Let their work, ideas, and words carry you forward.
Provide perspective.
Lighten your load and ease your journey.
Lastly, but importantly, give yourself a break.
Feel your emotions.
It's OK.
Titrate them genuinely and honestly into your work.
And practice self-care.
My generation had none of this, did none of this.
It wasn't part of our curriculum.
Some in my generation poke fun at it.
But make no mistake, it's crucial.
Physician, heal thyself.
Find a balance.
Note the uniqueness of your work and duties.
When you're on, your on.
Be fully present.
We need you there.
You will be your current attending's and teacher's
doctors.
You will be doctor to your parents' generation
and to their neighbors.
And you will be parents and partners and coaches
and so many things to so many others.
And you will need to be healthy and well
to play all of these roles, personal and professional.
So take care of yourselves.
When you're off, you're off.
Go on vacation.
Turn off your pager.
Don't check your email or inboxes.
Go.
Get lost.
Give yourself a break.
I'm not here today because part of my balance
included reconnecting with my family
as we navigate life, work, families, COVID,
and vaccinations.
We traveled this week of your graduation
to Vermont into the Adirondacks and its 46 peaks,
to poke around and see if we might find a track of land
where my four siblings and I and all of our kids
might gather together in the years to come.
We've been thinking about this for a long time.
Pipe dream?
Maybe, maybe not.
And while I hate to miss your graduation,
I thought that this was important--
part of my self-care, perhaps.
Keep your friends and families nearby.
Do your best to take care of each other--
your families, friends, classmates, colleagues,
and peers.
We've lost one of our own here at AMS this past year.
Let's keep the memory, and honor the graduation of wonderful,
kind, and vibrant Jack Ruddell.
And so to close, I promised I would be brief.
You will all be off to the races soon--
to internships, residences, research labs,
and transitional years, to hospitals and universities,
to new cities and states, some closer
to home, some more distant.
Whatever or wherever it is, it all
starts with this momentous occasion of graduation
from medical school.
And for that, I wish you all a hearty congratulations.
Go out.
Work hard.
Be well.
Take care of your patients.
Take care of yourselves.
Take care of your friends and families.
Look out for each other.
Do great things.
Help to make us all better.
Good luck, and the very best to all of you.