Address to the Class of 2000, Harvard Medical
It was an Irishman who gave the
best advice I've heard regarding the delivery
of a commencement speech. Father Flynn was the
president of St. John's University, where a
young man was anxiously preparing to speak for
the first time. That young man, Mario Cuomo,
the future governor of New York, asked the priest
how he should approach it. "Commencement speakers,"
said Father Flynn, "should think of themselves
as the body at an old-fashioned Irish wake.
They need you in order to have the party, but
nobody expects you to say very much."
It's true that only so much can
be said in the 10 minutes or so that I have
on this special day, this day when we, the graduating
class, are being honored. But I hope that by
the end of these 10 minutes, I will have adequately
conveyed to you something that I learned over
the past few years that has become extremely
important to me.
But before I begin, as I look
across the faces of all the people gathered
here to honor us, I can't help but think that
these honors . . . are misdirected. Today, we
students spend much of our time talking excitedly
about the recent improvements in medicine or
the new services in our hospitals, but we don't
often realize that things haven't always been
this way. We also don't recognize the great
costs that have been borne by the physicians
before us . . . to make things the way they
One of America's best-known physicians
in the early 1900s, Dr. Richard C. Cabot, was
not only an exceptional medical scientist, but
also a champion for greater humanitarianism
within medicine. So deeply felt were his convictions,
that Dr. Cabot chose to leave medical science
altogether, to focus solely on patients' concerns.
Among many other achievements, he went on to
start the first hospital program for social
work in the country. At the time, many of Dr.
Cabot's colleagues vehemently disagreed with
his vision, some going so far as to say that
the hospital's concern ended . . . when the
patient went out the door. In 1912, Dr. Cabot
was passed over for the prestigious Jackson
Professor of Medicine, a Harvard Medical School
position that many would later come to believe
he clearly had deserved. Though he was rejected
in his own time, it is the generations after
him, those doctors who came before us, who accepted
Dr. Cabot's vision. In fact they not only accepted
it, they embraced it, working hard to institutionalize
it . . . before handing it down to us.
Today, every hospital in this
country incorporates social work as a key component
of patient care--because of them. . . And yet
the irony is, today is set aside to honor us.
Incredible sacrifices have not only been made
by those in the medical community; they have
also been made . . .by the people sitting right
behind us, the people all around us. The people
who have traveled from all over the world to
be here and honor us-- our loved ones.
It's our families and friends--
those who spent years putting food in our mouths,
and changing our diapers, cleaning up after
us and supporting us through thick and thin.
They were the ones who taught us the core values
that no one else really could; all the while
never expecting to be repaid for this.. . .
And yet the irony is, today is set aside, to
So how can we thank them for
this? How can we repay our teachers, our loved
ones for their decades . . . of changing the
world for us? Well I believe that there is a
way. And we can learn it . . . from them. We
can learn it by asking them . . . what their
professors gave to them, and what their parents
did for them. And by that tiny gleam you can
barely catch in their eyes, that distance you
can faintly hear in their voice, you begin to
understand how they are thanking their own professors
and parents-- through us. And it dawns on you,
that there is much more than just "us" and "them."
You realize that we are really just the next
chapter in a long, long story; we are really
a gift of gratitude from the generation before
us, to the generations past. And now we can
fully understand how it is that we can repay
them. We repay them by making this world a better
place . . . for our children, a better place
for our students . . . a better place for our
Now, as an HST student, I firmly
believe in the value of medical research, but
it isn't what I learned from science that I
want to share with you today. Nor is it everything
I learned as a medical student, or a "fledgling"
doctor. What I want to share with you is what
I learned . . . as a patient. And I would also
like to share with you my thoughts on how we
can further improve medicine, just as the generations
before us have.
You see I started having SZ's
over 2 years ago. And I soon found out, that
they were due to cancer . . . an oligodendroglioma,
or a type of malignant brain tumor. What's more,
the MRI showed that it was too big to fully
remove, so surgeons here at the Brigham Hospital
just took out as much of it as they could. Unfortunately,
the tumor continued to grow, and soon I was
having 3 SZ's a day, even while taking over
20 pills of medications. So I underwent chemoTx
for the next year. And what happened since then?
Well, the chemo certainly helped, but unfortunately
I still have SZ's. I keep track of them every
day, and since the beginning, I've had well
over a thousand. And because of them, I had
to give up driving completely, long over a year
ago. I also just had another surgery 5 months
ago, getting this electronic anti-SZ prosthesis,
a pacemaker-like device, implanted in my chest,
pulsing my Vagal nerve every 5 minutes. One
of its side effects is an alteration of my voice,
through the recurrent laryngeal nerve. So when
you hear me get "something stuck in my throat,"
which is what I tell people, it's not because
I really have something stuck in my throat.
If you were to look at your watch, you'd see
me get something stuck in my throat again, exactly
5 minutes later. Fortunately, it appears that
some combination of the device and the medications,
has led to a decrease in my rate of SZ's, and
for that I am thankful. But as for the tumor
itself, it's still there. When I look at it,
in my latest MRI, it looks right back at me.
It's estimated, that there is a 30% chance of
fatality.Upon hearing this, a close family friend
smiled and said to me, "You know, things could
be worse. It could've been a 30% chance of survival."
And you know what? I think he's absolutely right.
So there are some things I can
share with you; one thing really, that I learned
through being a patient. And what is that? What
is the important component of medicine that
I learned through being a patient? Could it
be the MRI, which enables us to see my tumor?
Or maybe it's the chemotherapy, an approach
that appears to have slowed the tumor's advancement.
Or perhaps it's the incredible surgery--brain
surgery I underwent while kept awake. Which
of these do I feel is most important?
I would have to say this: as
truly valuable as they all are, it really is
none of them. You see it turns out that because
of the nature and size of my tumor, the question
of even undergoing surgery was not at all agreed
upon. One highly respected neurosurgeon I saw
recommended surgery, while another one felt
strongly that we should not proceed.
I had to choose one, and I chose
to proceed--not out of any false hope, or any
study, or because of the incredible reputation
of the doctor . . . but because of the look
in his eyes. I chose to get my head shaved,
my skull opened, and part of my brain -- my
very mind -- taken away. All . . . because .
. . he, Dr. Peter Black, truly cared.
Now medicine has come an incredibly
long way over the years. And because of our
doctors and professors and even Dr. Richard
Cabot, not only has the science of medicine
advanced, but the very thinking of medicine
itself has changed. And yet, the most important
aspect of medicine, that which we talk about
so little, hasn't changed at all. Caring for
your patients . . . just caring . . . IS the
most important part of medicine.
It's ironic, because compared
to all the complicated aspects of medicine,
the stuff that we've spent so much time on these
past several years in medical school--things
as complex as the MRI, or chemotherapy, or neurosurgery--compared
to all of this, caring is really the simplest
thing of all. And, of course, the ultimate irony
is that it's the one thing you can't be taught.
And that's because understanding the MRI or
chemotherapy or neurosurgery--that all comes
from your head. But caring, truly caring, that
comes from someplace else. And I don't think
you need a brain tumor to know that.
And yet, therein may lie the
problem. Because of its almost un-intellectual
origin, caring just isn't treated the same way
as most other aspects of medicine. Caring isn't
given the same level of respect, isn't emphasized
to the same degree. What textbook did we read
that taught us how to befriend our patients?
What class did we take that taught us how to
inspire those we cared for? Does that sound
crazy? Possibly. But then again, is it sensible
that we remember a patient's cholesterol level,
but not his name? And why is it that today,
while we can cure more diseases than we ever
could before, more patients are turning away,
. . . turning to different kinds of medicine
than they ever did before.
You see, it's because we're only
doing "half of it." We're doing the "science
of medicine" part, but we've forgotten the "care
of medicine" part. That's why I brought in this
patient's chart. I brought it not to show you
all the important things that truly are in there,
but more to show you all the important things
that are not. You see this patient is me. And
I am only here with you today,because I was
lucky enough to receive the "medical treatment"
that doesn't appear in this chart.
I'm lucky in that MY doctors,
with my family and friends, have been working
hard not only to lower my seizures, but also
to raise my spirits. And they've not only been
fighting to kill off my tumor, but also to keep
alive my hope. But here in my chart, which coldly
follows our "official approach to medicine,"
you can't see all of that. Oh, you can can certainly
read plenty about my seizures and my tumor,
. . .but what does it say about my spirits and
my hope? Nothing. But I'm standing here with
you today, only because of both science AND
So to repay the generations before
us, let's give this gift to the next generation.
Let's teach them how to truly care for their
patients. And we can do this only by teaching
them to give care the same degree of respect
that we give the MRI or surgery or medical science
in general. How do we do that? How can we make
I think this first step would
be to stop penalizing a physician for spending
more time with his patients. Today, because
of our advances, our patients' cases are more
complex than ever before. But today's doctor
is not only NOT encouraged to spend more time
with his patients, he's actually penalized for
doing so. In fact, we could go even further.
Rather than just have insurance companies dictate
the entire basis for a doctor's compensation,
we could let the patient thank his doctor, by
letting the patients reward their doctors through
the insurance companies. By asking each patient
to express how well they've been treated by
answering some simple questions, we could base
a small portion of the insurance bill on what
the patient said. For the first time this would
let the patient have a say in the value of a
Now what have some people said
about taking such a different approach? Many
are reluctant to have the system of finances
enter into the world of inter-personal care.
I've heard doctors saying things like: "this
is not a proper role for the medical community"
or even that this excessive level of interaction
"should be handled by charities and not by medical
staff." But this is actually kind of ironic.
It's ironic because these things weren't just
said today, they were also said almost a century
ago, said to Dr. Cabot. They were said, as he
implored that . . . caring for patients after
they left the hospital shouldn't be done simply
out of charity. Rather they should make it a
part of their system, a system of social work.
But it wasn't until the next generation of doctors
came along, that this was finally accepted.
So just like nearly a century
ago, it may not be obvious at first pass how
this small change might begin to alter our whole
approach, change our patients' lives, even change
medicine itself. It would undoubtedly change
our own lives, because now, for the first time
we would be judged on our ability to communicate.
We would see, clear as day, how well we are
speaking with our patients. And it could change
our patients' lives, as now for the first time
they would be told that what they feel, what
they think, really does matter. But possibly
even more than patients or doctors, such a shift
would change the lives . . of patients' loved
ones. A subtle message would begin to reverberate
through out the health care system, even . .
. from the hospital bills. What loved ones would
be seeing, is that patient care gets billed
along with everything else -- lab tests, radiologic
studies -- everything. But what they'd be realizing,
and slowly internalizing, is that the compassion
the patient receives--that thing which is often
all the loved can really offer them -- is every
bit as valuable as what doctors provide. While
this may not sound like much, I can assure you,
as a patient . . . that even this small sense
of empowerment to both patients and their loved
ones . . . is truly life-sustaining. That alone
. . . should be reason enough for us to do this.
But enough dwelling on the future
and the past, today is a day to celebrate the
On this special day, we the Harvard
Medical School class of 2000, are surrounded
by the generation before us. We are gathered
with our teachers and our families, gathered
to honor and celebrate one another. We honor
our professors, who taught our minds to practice
medicine. While we honor our families, who taught
our hearts to care for patients. And today,
we, the students, are honored, both for completing
one journey, and for beginning another. For
accepting the challenge that lies ahead of us,
the same challenge that lay ahead of every generation
that has come before us. And that challenge
is to continue in the work that those before
us have so nobly carried out, and today, is
so faithfully entrusted to us.