Work to be the best at what you do; this is about real people
Remarks by Peter D. Sullivan, M.D., Associate Professor of Medicine, OHSU School of Medicine
OHSU M.D. Hooding Ceremony
June 3, 2018 Oregon Convention Center
Work to be the best at what you do; this is about real people
It is an enormous honor to be chosen by this class to speak. We came up together you and I – you are the first class that I have known all four years – and neither of us really had a clue as to what we were doing. And we embraced it.
For those who don't know me, I am the clinical thread director, meaning I teach the doctoring skills of history-taking, patient communication and physical examination. This thread runs through all of the blocks as the students spend their first 18 months learning the various organ systems, and this thread has bound us together.
I was never very involved in the pre-clinical curriculum before the transformation in 2014, and when Dean Bumsted called me to tell me I got the job I wasn't even sure I wanted it. I almost turned it down. I had a good life before all of this! I had work-life balance;I got to see patients, teach students and residents on the wards, keep up with the main journals, read non-medical books, rock climb, practice yoga, and go on long bike rides… life was good.
But there's an adage in academic medicine that you can do it all, but you can't do it all all of the time. A new curriculum is an unforgiving taskmaster, and for the past four years I haven't had time for most of those things and I have an extra 20 pounds to show for it. But having the privilege of working with you has been the single most rewarding experience I have had in a career that's exceeded all of my dreams, and all of my family's expectations. I'm not sure there is a person in this crowd not bound by blood or ring who is prouder of you and what you've become. And as my first class, like first love, you will always have a special place in my heart – third left intercostal space, by Erb's point.
You've come a long way in these four years – think back to your first clinical rotation, Step 1, your first OSCE, your first day of medical school, or all the way back to the youthful innocence of Frenchman's Bend – you have grown exponentially.
I was telling a student how difficult this speech will be, to say the right words to this class of amazing characters and personalities that I love and respect so much, and how it reminds me of being asked to speak at a wedding. She asked, "how many students are graduating?" 140 I think – to which she said, "No you're speaking at 140 weddings." Thanks Caroline Stephens, no pressure.
So how does one prepare for this?
I did what every commencement speaker has done in the past decade, I listened to David Foster Wallace's Kenyon address, This is Water, about a dozen times until I curled up into a fetal position because I can never come close to his brilliance.
I watched videos of the great orators – MLK, JFK, Emma Gonzales, and Naomi Waddler. I watched the speech that Dr. Alisha Moreland-Capuia gave last year, and it was brilliant and thoughtful and delivered with such heart. But I just can't channel Whitney Houston the way she can.
I asked my daughter, one of the wisest women I know, and she suggested I just talk about wolves, have everyone think I'm using them as a metaphor, waiting breathlessly to turn it back to your medical training but no, just stick with wolves.
Finally, I decided to use the formula of offering the advice I wished I had gotten when I was graduating, and sprinkling in a few quotes from Irish poets.
Let me start by describing for the family and friends the character of this class. They are the pioneers in this new curriculum. They are activists and dreamers, writers and jokers, singers and scientists, iconoclasts and comedians, mentors and survivors, a group so full of tenacity, heart and cool I'm humbled that they ever let me hang with them.
You were willing to be the first students in a new and unproven curriculum, the trailblazers. You helped guide this plane, drove changes to the curriculum, mentored the students who came after you, excelled in your clinical years, completed a four-year scholarly project and you have all landed as outstanding graduates, in excellent residency programs.
I wish I could take some credit for this, but you were born this way. Your future patients will be incredibly fortunate to have you on their sides.
And now, the real adventure begins. As with medical school, every year gets better and more challenging. Your life is a journey, and you are the hero of this epic poem.
Joseph Campbell described the hero's journey as occurring in 12 stages. At first, you were living an ordinary life, and then you were called to adventure. Perhaps you resisted the call, or like me, a dozen medical school admissions committees decided you weren't quite ready to go on this adventure the first year you applied. Maybe you met a mentor, and crossed the threshold into the special mythical world. You crossed one when you entered medical school, and now you're crossing another into residency.
Ahead you will face tests, you will approach the inner cave, face an ordeal, obtain your reward, journey home, undergo resurrection and finally return with an elixir, which at OHSU is usually Gleevec.
So what do I wish I knew when I started on my epic journey?
I really didn't know that being a physician would be so rewarding. We blend the best of science and humanism as we unravel the problems that have beset our patients and help them heal. We are so privileged. To call it a job or work is misleading. Cheapens it. You are in a profession where you are constantly stimulated – emotionally and intellectually – and you will learn new things about diseases and society and suffering and love and strength every day.
So what advice do I have for you?
Don't trust anyone. Your patients' lives are too valuable to rely upon hearsay and conjecture. You need to verify their history, do your own exam and follow up on all of their tests yourself.
Don't assume that others are right just because they have been around longer or are seen as experts. As Mark Twain said, "It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so." Except Mark Twain never actually wrote nor spoke those words, which proves his point.
Be humble. Arrogance is a fatal flaw in medicine – nobody talks about the healing power of arrogance because there isn't one, it's a poison. Remember when you enter a patient's room that it's not your stage anymore it's theirs, and that now you are a supporting cast member in their epic and they are the hero. Keep them as the center of your attention.
Be curious. Discoveries are made when we are curious, not just scientific discoveries, but insights into our patient's lives that can help them heal.
Use your words carefully because words have power. A patient being admitted to you isn't a hit, an IV drug user or a vasculopath, they are a son or daughter, mother or brother. People aren't defined by their diseases, so don't name them by their diseases. When you stop seeing your patients as people you lose your own humanity – I know because I've been there.
Read not in the casual way that you peruse People magazine, but read to master the material, because this is about real people. Read with the focus that you would for a big test, as you would an Anki card, because this is the biggest test, but this test isn't on pen and ink, or keyboard and monitor, or in a simulation lab, this is a test on flesh and blood, and heart and soul, and your preparedness may determine the difference between life and death.
So read, and observe, and find a good mentor who can coach you on your journey, and give you corrective feedback. I was fortunate to have many mentors, Faith Fitzgerald at UC Davis; Lynn Loriaux, Jack McAnulty and others here at OHSU.
Teach, not just because it is our duty as doctors, but because it will test whether you actually have mastery over a subject, and because it will feed your soul. The best teachers don't merely impart knowledge, they inspire. WB Yeats, another Irish poet said "Education is not the filling of a pail, but the lighting of a fire." Be that spark.
Master the art of listening, one of the most powerful therapeutic skills we have. You may think you don't have time, but if you just slow down, time slows down with you. Sometimes as little as five minutes of unhurried time with a patient can seem like an eternity, if you slow down and give them your complete, undivided attention, and I mean that in a good way.
Now, I want you to remember that this is a team sport. It takes everyone, not just the interns/residents/attendings, but also the nurses, therapists, aids, food servers and the janitorial staff.
One of the people with the most therapeutic bedside manners I've ever seen is Salim, a nearly seven-foot-tall, shaved-head food server from Kenya who spoke 18 languages and made everyone feel as though he was an old friend visiting from their own neighborhood, conversing on their front porch. This is what most patients want, connection with a real human. So get to know your team, and show them the respect they deserve; you might learn from them.
As a team sport, know that it doesn't all come down to you. Despite the best care, many of your patients will die or have complications – reflect on them and learn what you can to be better next time. Avoid assigning blame, to others and to yourselves, as blame is destructive, especially for those who care the most.
Your hours will be long, and you will be physically and emotionally challenged, and you need to take care of yourself. Follow the advice you would give to anyone one else, about sleep and exercise and diet and about being kind to yourself.
Sometimes the intensity and otherness of our experiences can be isolating, but remember this life was not meant to be lived alone.
Wolves are meant to live in packs, and the lone wolf can't survive in times of deprivation. Develop a community where you work, stay in touch with your classmates, and nurture the relationships that you have outside of work – don't drift away from your old friends, family and partners. When you say you're leaving now and will be home soon, be home soon. And when you do get home, save some of that life and charm for those who are waiting for and supporting you. Share your difficult experiences, with your colleagues, friends, family and when needed, a professional. I have been there, too.
So, in the end, what I want for you is what I want for my own child: that you will find happiness and fulfillment, more than to do well but to be well.
Remember when I said this isn't just a job? Well, maybe sometimes it is. I told you, don't trust anybody. Medicine isn't your whole life, you are more than this. Take care of yourself, and take care of each other. And this thing that we have? It doesn't end here. First love is eternal, and this thread that binds us is unbreakable.
Read our full coverage of the 2018 OHSU Convocation and School of Medicine Hooding Ceremonies.Pictured:
Giving advice: Dr. Sullivan addressing the M.D. class of 2018.
Lauded: Dr. Sullivan receiving one of four awards for teaching and mentoring during the 2018 SoM Honors and Awards Ceremony. Associate Dean for Undergraduate Medical Education Tracy Bumsted, M.D., M.P.H., presented the awards.