I think this is the introduction you were talking about...
Fellow faculty, parents, guests, and young colleagues: I am greatly honored to have been invited to be the guest speaker on the occasion of your initiation into our special fraternity. In case it crossed your mind, our president has very properly vetoed any semblance of hazing for admission to this fraternity, and you will not be asked as part of the ceremony to swallow a live crawdad as sophomores have been lobbying for, spend the night on a slab in the gross anatomy lab, or sing Vesti la Giuba in karaoke, which the faculty thought would be entertaining.
At this ceremony, which is about coats, I am reminded of the Irishman who went up to the clerk in the Mens Department at Macys in New York City looking to find a bargain in a suit. He said, Show me the cheapest suit in the store, and the fella said, Youre wearing it.
And, brothers and sisters, in a little while, you, too, will be wearing something, and it may not be made of the finest and most expensive fabricit may be made of ordinary and inexpensive cotton, but it is functional and easy to clean and it symbolizes something of great value. I like to think of it as a garment, which, when donned in the right spirit, changes the person who wears it forever. An analogy would be like that of a piece of cloth cut in a rectangle. Its just a piece of cloth. But when it is adorned with stars and stripes in red, white, and blue, it can never again be just a piece of cloth. Forevermore, it will be our National ensignthe American flag. Similarly, putting on the garment of a physician should be more than ceremony; it should change the very fiber of the young man or woman called to become a doctor. It is your decision, freely made, to take upon yourself the responsibility of the life and well-being of your fellow man. And, if this is not your motivationif you are doing this to please your father or your motherget out!
Many of you come from families rife with high achievers, and it has been expected from the childhood long lost in your subconscious that you, too, will become a successful professional. Your parents saw to it, often at great sacrifice to themselves, that you attended the finest schools in your area, and they demanded excellence from you. In some instances those demands were rather subtly expressed, such as disappointment in your grade of A-minus instead of an A. In others, more overt pressure was applied, and there were severe consequences for mediocrity or bad grades. In the healthiest of circumstances, your parents told you that they would be satisfied with any grade you made if they knew you had done your best. It is almost instinctive in us parents to want our children to succeed, and the love we have for you is indescribable. When you look into the eyes of your own children one day, you will experience what we mean. You are extensions of our very selves, and you are our badges of self worth. We can hardly help wanting you to shine above the rest because then we can shine above the rest, too. When you were kids it might have been in music or dance or in baseball, football, soccer, swimming, golf, or tennis. Your every triumph somehow made us feel superior to other parents and gave some of us that certain confident air and condescending tone. When our eyes were not riveted on you, we might benevolently grant an audience to parents of kids who were not stars, dropping them a few bones of disingenuous encouragement, faint praise, and advice. A few of us have even been quite vicious in our competitiveness by anyones standards, and, unintentionally, we may have passed that unfortunate trait on to you. In youth sports, you may have at first cringed when you heard us holler at the ref and then you learned to do it yourself. But it was all about you. As college got closer, we still cared about your sports and so on, but it was your grades in the high school AP courses and your score on the SAT that now mattered most. We were beside ourselves at your success in these areas, and we just couldnt stop talking about you to our friends. While pretending to listen intently as they talked about their children, we heard not a word and were just waiting for an opening to start in again about you. College sports focused and sharpened that competitive energy and in some, brought out downright hostility. But after the tumult and the shouting and the beer, it was back to the books to put your competitive nature to a more useful purpose. Now it was your GPA or your score on the MCAT that for us filled awkward silences and small talk at cocktail parties. No matter how hard we try, where you are concerned, we just cant put a sock in it. Please forgive us if we have been a little too enthusiastic in our promotion of you. Whether our motives have been reasonable or questionable, all we ever wanted is for you to be a success.
And succeed you did. Your real friends were happy for your academic triumphs. Your fair-weather friends were happy for you too, especially if their grade was slightly higher than yours, but they would never ask. Your acquaintances, however, were full of friendly inquiries like, Howd ya do?or Whatd ya get? Their one and only concern was that they scored higher than you. Gore Vidal was pretty insightful, (wasnt he?) when he said, Every time a friend succeeds, I die a little.
Im reminded of the story about the two guys out in the middle of nowhere on a mountainous trail; they spot a hungry mountain lion running hard after them about a quarter of a mile off. After panicking at first and trying desperately to escape while the mountain lion is steadily gaining on them, one of them stops, sits down on a tree stump, and takes out a pair of running shoes from his backpack and puts them on. His buddy says, What are you putting those shoes on for? You cant outrun that mountain lion! The other guy says, I know, but I dont have to outrun him. All I have to do is outrun you.
And you all outran a lot of people to get to sit in that chair today. And you just got here, and youre thinking that now you really need to turn it on because you need to outrun about 180 more to land that premier residency you may want three or four years from now. And after you get to Yale or the Mass General or to Stanford for your postgraduate training, youll be the best, wont you? And think of the conversational mileage we parents will get out of your accomplishments at other cocktail parties or in that two-page family update we send to all our relatives and people we barely know along with our holiday greeting cards. And as for you, you will have been trained by some clinicians and scientists who have written 500 or more scientific articles and who have 20 or 30 groupies hanging on them at all the big meetings laughing at all their jokes and hoping for a sentence or even a glance directed their way. Theyll teach you and inspire you to be just like them because thats what academic medicine is all about. Isnt it? Admiration? Praise? Recognition?
Or if a career in a teaching institution isnt your cup of tea, youll certainly feel you are more than prepared to enter private practice, and, with your hard-fought credentials, how can you miss being part of the best group practice in any city you choose? You should be able to write your own ticket and be able to pay back all those loans quickly and get your wife or husband out of the rat race theyve been in putting you through all your training. With your competitive edge over the rest of them and hard-work ethic, you ought to easily be able get that house with the pool, pay the $35,000 initiation fee at the country club, get that silver Jag youve always wanted, and put a large down payment on your house at the beach or in the mountains. Furthermore, youll have your children perfectly timed and ready for you to live vicariously in them just like we did in you.
Have you noticed what the missing element in all this competitive success Ive just described is? Yes, its the patient. It is the patient who has been left in your wake as you jet ski by.
In the academic medical center there really are some of us physicians (hopefully very few) who use medical knowledge about patients more to publish in esteemed periodicals primarily for self-aggrandizement. Most of the physicians in an academic medical center, whether faculty or house staff, are salaried. If one is salaried, it is only human nature to desire to be well paid while not having to work too hard. Such an attitude is common and usually pretty benign. However, this particular attitudinal tumor can become quite malignant and life-threatening. It can be diagnosed in ones self easily. Later in your career, if you actually find yourself feeling that you dont want to see a patient for any reason at any time unless you absolutely have to, you have the full-blown cancer. In other physicians, the symptoms and signs are less obvious. They may be short with you or with the nurses over the phone or critical of the care given to the patients by you or other physicians. They commonly want to transfer patients to other physicians. Translation: They really dont want to be bothered. Expect the tumor to metastasize around the medical school hospital if doctors with a true calling to help sick people are few in number, inundated with more patients than they can carefully evaluate, or not in key supervisory positions. If those other brand of physicians and trainees become plentiful or gain a good foothold, medical emergencies, hospital admissions, or calls in the middle of the night become viewed as negative interruptions. A good day on-call to these physicians is Mexican food delivered to the hospital and getting to watch television while the beeper and phone remain silent.
