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A Speech to the Graduating Medical Student

This speech was originally delivered to the 2010 graduating medical school class at the University of Pennsylvania in Philadelphia.

Four short years ago I sat in an auditorium not unlike this one for our white coat ceremony. At that time, the classmate sitting directly to my left was a Rhoad's scholar, and the classmate sitting directly to my right was an Olympic quality athlete. Naturally, my ego quickly burst into flames, at which point I thought, "You're really up the proverbial creek without a paddle!"

Then classes started and I realized that not only did I have a paddle, I had 150 of them; all in the form of some of the most amazing, compassionate, and intelligent classmates a student could hope for.

Since then you guys have continued to produce. You've published medical articles in some of the most prestigious journals in the world. Others have volunteered their precious spare time at many of the free medical clinics in Philadelphia. Others have obtained advanced degrees in business, bioethics, and epidemiology. Several students have even earned a second doctorate; they are effectively graduating today as "doctor doctors"!

These men and women will continue to push medicine into new realms. They will develop treatment options to cure disease once thought incurable, and help draft national healthcare policy; some will become global leaders in medicine.


People have often asked me what its like to be in medical school. And for a long time I never had a great answer, until I heard the starfish story. This story starts after a storm washed thousands of starfish onto a beach. At one end is an old man tossing starfish one by one back into the ocean. At the other end, a young man finally yells out, "Sir, how could what you're doing, tossing starfish one by one back into the ocean possibly matter? There are too many, you cannot save them all!" At which point the old man, as he picked up a starfish and tossed it back into the ocean, yelled back, "Mattered to that one!".


Medical school is a little like being both the old, and young man. Some days you wake up and think, how could what I'm doing possibly make a difference? There are too many lives to save, too many people to help. Other days you wake up, clench the diagnosis and provide the proper treatment. You've effectively tossed another starfish...

The first year and a half of medical school is books, books, and, well, more books. We've studied physiology, pharmacology, and pathology. We've learned symptoms, diagnosis, prognosis, and treatment of thousands of different diseases. We've even watched our anatomy instructor impersonate a uterus so that we would better understand the anatomy of the broad ligament.

And then, like starfish, we are tossed into the ocean that is the hospital. Our two months on medicine are like drinking from a sea of knowledge. We've seen heart failure, kidney failure, and liver failure; and we've filled our short white coats with manuals and guides galore. On our family medicine rotation we've seen the beauty of the long term doctor-patient relationship.

Then its on to surgery, where there are only two ways to cut a suture - too long or too short. We've seen organs harvested and transplanted; we've contaminated sterile fields; and while being used as human retractors, many of us have even managed to fall asleep, standing up!

Then its obstetrics and gynecology... (And no, medical science has still not figured out how something that large pops through a hole that small)! We've delivered life into this world with nothing more than the watchful eye of an attending behind us. We've learned to perform invasive exams and ask very personal questions with the utmost respect and dignity.

Then we are transported into the world of psychiatry, where the term "crazy" is not taken too lightly. We've studied the inner workings of the mind and have witnessed battle hardened soldiers at the VA brake down in tears because of post traumatic stress disorder.

Then, neurology, where thanks to Dr. Galetta, we've learned that the brain is nothing more than a watermelon sitting on top of a cantaloupe. We've seen devastating strokes, and have diagnosed Parkinson's. Some of us have even held the hand of a patient dying from ALS.

In the emergency rooms we've seen the horrible effects of drug abuse and domestic violence. After a long night in the ED we've even done the 3:00am McDonalds run... (Yes, docs do occasionally indulge in a Big Mac and fries).

And last, but not least, pediatrics, where no, they are not just "little adults". At the Children's Hospital of Philadelphia we've seen some of the rarest diseases in the world, and perhaps more importantly have watched pioneering physicians develop unique, ground-breaking treatment options.


At the end of this long journey we've erred countless times, but more importantly with the help of our mentors: faculty, residents, and fellow classmates we've persevered. We've gone from sweaty-handed, shaky-voiced students into compassionate, confident physicians.

However, it is the people here today; the mothers, fathers, sisters, brothers, spouses, and significant others who sacrifice as much, if not more in this pursuit of ours. And they deserve particular recognition today.


One final note - the next chapter in our education begins today. Residency will push us harder and further than we ever thought possible. Yet, with each starfish we toss, the rewards are priceless... We've made a difference in the world.

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