It is my unbelievable honor to be speaking
to the 2011 graduating class of the Stanford
University School of Medicine. A class of
intelligence, compassion, extreme good looks.
And now, a class of doctors. And, lest we
forget, we are an historic class at Stanford:
the final class to graduate without having
passed even one course in a distinguished
manner. Graduates of 2011, hold your heads
high, for we were the straw that finally broke
the camel’s gradeless back; the class that
found the thin line between pass and fail
and deeply explored its meaning. Although,
in truth, none of you ever needed a mark,
good or bad, to motivate you; you are people
whose native passion and internal motivation
will always far outstrip the reach of any
red pen. We are these people. And when the
administration of this worldclass medical
institution asked us to help shape the new
grading system, to provide feedback and assistance
from a student perspective, we responded like
the most noble of creatures in a structure
fire: by getting the hell out of the building.
Which is why we are all sitting here today,
preparing to go from the frying pan of medical
school to the ...armageddon of residency.
And if you remember the commotion about the
rapture a few weeks ago, well, it turns out
that they just got the date wrong: a correct
reading of all major religious texts predicts
a yearly bump in the number of souls on the
way to heaven every July 1st. But don’t
worry, you won’t be going anywhere when
it happens: you will be on call. They say
that when a new doctor is made, an angel gets
its wings, and now that I see just exactly
what we know at the end of medical school,
I realize that the phrase is meant literally.
Indeed, we are headed far and wide next year,
the newest footsoldiers in the war against
disease that leaves not one of us on this
planet untouched, a true world war in a pure
and timeless sense. And my classmates, though
your staggering debt load may prevent you
from sleeping on an actual bed, you can at
least sleep soundly knowing that you have
chosen to fight on the right side of this
war. We all know that there is profit to be
made, quickly and in abundance, in spreading
fear and ignorance, in promoting poor health,
in disregarding or denying the sorrow of another
human being. You have instead chosen to hold
a candle against these things, to enter into
a profession where even your daily commute
is a statement against suffering and a habitual
reaffirmation that good exists. And believe
me, this is the only way that a rusted 1993
Geo Metro driving at 6am will ever be considered
a sign of good in the world.
As interns, you will not set all of the care
plans, but you will be the constant presence
at the bedside, the face that appears in a
patient’s mind when they wake up at 2am
in pain and in need of “their doctor.”
In this part of the war against illness, you
will be the pointy tip of the Foley, the first
to respond and uh...relieve the situation.
It will be on you to show up, maybe tired,
maybe frustrated after a long day, at 2:05am
and bring to bear your skill and above all
your compassion, from trench to bedside.
You are an amazing and accomplished group
of colleagues, and it would take me all day
to list even those of your achievements that
I know off the top of my head. But we did
not get here alone; we were supported, mentored,
guided. We had help. From family, friends,
teachers, patients. Innumerable people chipped
in and sacrificed so that we might develop,
some in ways that we will never fully comprehend
or possibly even realize, and we would be
remiss not to spend some time thanking them.
With that in mind, here we go: ...thanks.
It is actually a peculiar deficiency in our
language that we only have the word “thanks”
to express gratitude. “Thanks” is what
you say to the guy who made your coffee; “thanks”
is what you say when somebody holds a door.
What do you say, then, to somebody who has,
for decades, given variously of their body,
their career, their savings, their thoughts,
and above all of their time to you? What do
you say when, to your shame, you were sometimes
less than grateful for these indescribable
gifts, when they had to be given out of nothing
but faith, determination, and a transcending
love that has inspired some of the best literature
and worst tattoos in the history of our species?
I guarantee you that there is not a person
in a robe here today who is not thinking about
their parents, biological or otherwise, and
I also guarantee you that we don’t know
what to say. It certainly is not just “thanks.”
Personally, I can only think to express my
gratitude in the way that I always have and
will always in the future: by calling home
once every two weeks and asking how the cat
is doing.
Our advisors. Drs. Blaschke, Knox, Salvatierra,
and Gesundheit. To say that you tolerated
our harebrained ideas and rants is both selling
you short and seriously underestimating the
intelligence of a hare. Thank you.
Our medical administration and deans. While
we may not have always agreed on policy, your
doors were always open, and working with you
was always a tremendous privilege, both when
the white coats were off and especially when
they were on. In a world where people are
often content to ignore you if not work intentionally
against your best interests, I have never
doubted that you had ours in mind constantly.
You are role models for ascetic, civic-minded
self-sacrifice, to the degree that, should
I ever be in a position of leadership in the
future, I hope dearly that I will prove far
more effective than all of you at using my
power to enrich and glorify myself. You have
a strong and definite vision for the future
of medical education, bringing us both an
innovative new clinical evaluation system
called “grades” and a beautiful new building
full of equipment so expensive that experts
estimate its sale at auction would generate
enough money to pay up to half of one student’s
medical tuition next year.
You have given us other bold new programs,
too, such as Educators4Care. An initiative
that has identified some of the most skilled
and dignified physician educators in our institution
and put them to work for a project whose name
is based on a number pun. In its naming, Educators4Care
finally elevates Stanford to the lofty ranks
inhabited by such cultural institutions as
the musicians of 2 Live Crew, the videogame
Left 4 Dead, and of course the 2003 cinematic
masterpiece featuring Ludacris, 2 Fast 2 Furious.
Thank you for that.
And for the future, you have ensured that
we will never forget medical education, largely
because you have ensured that we will be paying
for ours until the heat death of the universe,
when physicists tell us that all motion and
life will stop, but several government loan
agencies remind us that we will still be responsible
for all of our borrowed money. Interestingly,
the idea of free medical education has become
more trendy recently. I think that this is
a fantastic idea, but I will block it with
my life if its provisions are not also retroactive.
And don’t worry, deans, I mean that for
you, too: I will see to it personally that
you are fully refunded the three-hundred dollars
that you paid directly to Dr. Osler himself
for your medical educations in the time before
the great flood.
At this point, I should note that I thought
that I would be receiving my diploma before
this speech.
And so we transition. My classmates, Stanford
made us colleagues, but we made ourselves
friends. And if ever you become nostalgic
and miss the last four to eleven years of
your life, you need only to load an online
medical lecture at 200% of the normal speed,
and you will be home again. But still it is
with a huge amount of sadness that I watch
all of you ready to disperse; we have just
barely become doctors, and already we’re
itching to leave the room too fast. You’re
set to go to so many amazing and influential
cities, such as Boston, New York, Los Angeles,
and...other. And undoubtedly you will make
a difference for the better in innumerable
lives, as I know you already have. In truth,
after spending the last several years with
you, I can say honestly that medical school
has only made you doctors in the way that
a microphone makes somebody a singer. The
letters “MD” will magnify your impact
and open doors for you, will let you reach
into more and darker corners of the world
and spread hope and comfort there. That is
true. However, those letters work only like
a microphone, only amplifying what you put
into them. And a microphone will never make
you a singer, just as an MD will never make
you a doctor. It is now just as it has always
been: you have to bring your own voice, and
it is, in the end, the only thing that matters.
I’d like to close now by ripping off a more
experienced speaker. Everybody here who is
affiliated with Stanford medicine knows that
our community suffered an unfathomable loss
this year with the death of Dr. Gregory Feldman,
a surgeon and teacher whose profound, protean
talent was matched only by the degree to which
he was beloved. I know for a fact that his
influence directed many of the graduates here
today, and he is and always will be instantly
and permanently missed. What you may not realize,
however, is that some years ago, Dr. Feldman
gave a commencement address for his graduating
class at some medical school in Boston that
I have never heard of. And this speech was
so good that it ended up on youtube, where
I will be stealing from it for the rest of
my life. Birthdays, bar mitzvahs, my own wedding
vows, all of it. I’d like to end now as
he ended then:
“In medicine, as in life, it’s far more
important to be lucky than to be good. My
friends and classmates, we’ve spent the
last 4, 5, or in some cases, 37 years of our
lives studying to get good, and not one of
us graduating today can effectively treat
lower back pain. So as we move forward into
our residencies, let us resolve to take the
focus off getting good and concentrate instead
on getting lucky. Thank you.”
