Tuesday, January 18, 2011

Yale Medical School Graduation Address

A friend of mine sent me an email with a light blue hyper-link at the bottom. The email itself was short: "Do yourself a favor and watch this lecture. It won't take long... 15 minutes max. I promise it will inspire you. I would not send something that wouldn't!"

I deeply trust and respect this friend, so in an effort to try to nurture myself as much as I nurture my students, I closed my grade book, put down my red pen, and followed the link to a videotaped keynote address given at a medical conference in Southern California by Dr. Donald M. Berwick, President and CEO for the Institute for Healthcare Improvement (IHI).

First impressions - this guy was not going to win any "charisma awards" anytime soon ... he was monotone, circuitous, and flat; I began to doubt my friend and started eying the stack of senior essays neatly piled on my desk.

About six minutes into the video clip, Dr. Berwick finally got to the good stuff. He explained that for the conference keynote address he would actually be "redelivering" his graduation address to the Yale Medical School class of 2010. His whole demeanour changed; I sat back and gave him my attention.

Anyone who has been very ill, or loved someone who has been very ill, should watch this video. If you prefer to read it - you can find the text HERE. Personally, I found it more moving to hear Dr. Berwick deliver it himself (despite the bumpy start) which you can find HERE.

His remarks were largely focused around an email he got from a woman, Mrs. Gruzenski, who wrote to him advocating for an administrative change to hospital visiting hour policies. Her email explained the cruelty of being strictly limited to only seeing her husband, Dr. Gruzenski, to four times a day for 30 minutes during the last few days of his life in the ICU. A small portion of Dr. Berwick's remarks appear below:

"...We will have to imagine ourselves there. 'My husband and I loved each other very deeply,' she writes to me, 'and we wanted to share our last days and moments together. We both knew the gravity of his illness, and my husband wanted quality of life, not quantity.'

What might a husband and wife of 19 years, aware of the short time left together, wish to talk about - wish to do- in the last days? I don't know for Dr. and Mrs. Gruzenski. But, I do know for me.

I would talk about our children. I would talk about the best trip we ever took together, and even argue, smiling about whose idea it was. I would remember the black bear we met in a clearing in the Wrangell - St. Elias Range; the cabin at Assiniboine; the Jotenheim mountains of Norway. I would remember being lost in Kyoto and lost in Prague and lost on Mount Washington, and always found again. Mushroom soup at Cafe Budapest. And seeing Jessica born, and Ben, and Dan, and Becca.

We would have so much to talk about. So much. The nurses would pad in and out of the hospital room, checking i.v.s and measuring pulses and planning their dinners and weekends. And none of what the nurses and doctors did would matter to us at all; we wouldn't even notice them. We would know exactly who the visitors were - they, the doctors and nurses. They, they would be the visitors in this tiny corner of our whole lives together - they, not us. In the John Denver song it goes this way, '... and all the time that you're with me, we will be at home.'

Someone stole all of that from Dr. and Mrs. Gruzenski. A nameless someone. I suspect an unknowing someone. Someone who did not understand who was at home and who was the guest - who was the intruder. Someone who forgot about the black bear and the best mushroom soup we ever had - the jewels of shared experience that glimmer with meaning in our lives. Someone who put the i.v. first, and the soul second.

...In return for your years of learning and your dedication to a life of service and your willingness to take an oath to that duty, society will give you access and rights that it gives to no one else. Society will allow you to hear secrets from frightened human beings that they are too scared to tell anyone else. Society will permit you to use drugs and instruments that can do great harm as well as great good, and that in the hands of others would be weapons. Society will give you special titles and spaces of privilege, as if you were priests. Society will let you build walls and write rules.

And in that role, with that power, you will meet Dr. and Mrs. Gurzenski over, and over, and over again. You will meet them every day - every hour. They will be in disguise.

...Decide. You can read the rules. Or, you can say, 'Pardon me'. 'Pardon this unwelcome interruption in your lives. Thank you for inviting me to help. Thank you for letting me visit. I am your guest, and I know it. Now, please, Mrs. Gruzenski, Dr. Gruzenski, what may I do for you?'

...You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity - of the dignity in each and every soul. When you take off that white coat in the sacred presence of those for whom you will care - in the sacred presence of people just like you - when you take off that white coat, and, tower not over them, but join those you serve, you become a healer in a world of fear and fragmentation, an 'aching' world as your Chaplain put it this morning, that has never needed healing more."


Thank you to all my doctors who were and continue to be truly part of my healing - and always put Gary and I before the cancer. Dr. Nash, Dr. Wagreich, Dr. Maloney Patel - thank you for taking your white coats off and helping me every step of the way in my fight against this disease, instead of forcing me into battle alone. I can never thank you enough.

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