Good evening Colleagues, Friends, Family, and the entering John A. Burns School of Medicine Class of 2017.
It is truly my honor and privilege to speak to you tonight. When I received the Leonard Tow Award* earlier this year, I had no idea (1) what it was and (2) that it meant I would have to give this keynote address. I really wasn't sure what I was going to say, so my friend told me to use this opening line: “I just flew in all the way from Hilo and boy are my arms tired!”
The Leonard Tow Humanism in Medicine Award** was established by the Arnold P. Gold Foundation, whose motto is “Working to keep the CARE in healthcare.” And really, caring for people is the foundation of our profession.
As I stand here looking at all of you tonight, I can remember all the emotions that you are feeling right now: excitement, pride, and perhaps a wee bit of nervousness. The medical field is most certainly challenging. There is so much to learn: anatomy, diseases, pathophysiology, pharmacology, diagnostic skills, clinical skills, treatment plans, how to remember all the names of medications, their dosages, and what they are used for. Treatments and guidelines are always changing. Insurance companies and paperwork are a total nightmare. There is SO MUCH to learn. Your four years here will fly by and you will feel like you have not had enough time to learn everything that you need to, then you will be thrown into residency where you will continue to learn and grow, but it will still not seem like enough. Then you are suddenly thrust into the real world where the lives of patients are literally in your hands. Their lives will depend on your fund of knowledge, the skills you learn and practice, and the advice you give. It is a huge and stressful responsibility. Now the wee bit of nervousness you felt has probably just escalated into a full-blown panic attack, which, by the way, is not an uncommon feeling as a first year med student. Somewhere in your four years of medical school, you will probably diagnose yourselves with diseases that fit your symptoms of mental cloudiness, fatigue, and generalized weakness. I think 50% of people in my class thought they had lupus or multiple sclerosis. But I digress… There is so much to learn. The great thing about medicine, though, is that you never stop learning. You will be a lifelong learner, and this is a very valuable skill.
In your journey of learning, you will have many great teachers. Your faculty at JABSOM will educate you and guide you. Your classmates and colleagues are irreplaceable: you will teach each other, learn from each other, support each other through tough times and challenges, and celebrate triumphs together. Nurses, ward clerks, respiratory therapists, lab personnel: right now, they all know more than you, so learn from them, be humble and be kind, offer them food, because if they do not like you they will make your life a living hell.
Of all the great teachers you will encounter, however, your best teachers will be your patients. I have been out of medical school for 15 years now and not a single day has gone by that I haven't learned something new or valuable from a patient.
A number of 3rd year medical students have done their family medicine rotations with me in Hilo, and one of them asked me, “What was your ‘A-Ha’ moment?” I was like, “Huh?” and he said, “You know, that moment when you knew why you went into medicine and that you made the right choice.”
My A-Ha moment. Hmm. I remember it clear as day. I had just started my 3rd year at JABSOM and was super excited to finally be working at the hospital and doing hands-on work with actual patients, so I was going to go for it, sign up for the hardest rotations, get pummeled and learn as much as I could. So for my very first rotation of 3rd year, I signed up to do surgery at Queen's. Back then we didn't have limitations on our hours or the amount of overnight call we did, so the three of us who were assigned to Queen's were scrubbed into surgery all day, and every third night we were up all night on trauma call. It was tiring and overwhelming, but I was learning and it was really fun in a masochistic sort of way. On the 2nd day of our rotation, we were assigned to scrub into the big surgical cases of the day. I was totally stoked because I was going to scrub into a Whipple procedure (the granddaddy of all big surgeries, a potential treatment for pancreatic cancer) with the chief resident and the director of surgery at Queen's. The first thing you have to do is a pre-operative history and physical. So I walked into this particular patient's room, bright and early on the first “real” day of my surgery rotation. The patient looks at me and says, “And who the hell are you? And what the hell do you want?” “Ai carumba,” I thought to myself as a bead of sweat started to roll down my forehead. So I tried my best to explain that I was the medical student assigned to his case and that I would be in the OR but by no means would I be doing any cutting or stitching whatsoever, and I managed to get a fairly decent H&P from him and his wife. A few hours later, we wheeled him back for surgery. I had prepared myself for what is usually a 5-8 hour surgery, but unfortunately, when we opened him up, he had metastatic tumors scattered all over his omentum and bowel. The Whipple procedure had turned into a bypass procedure to keep him comfortable and keep him from getting more jaundiced. After the surgery, I was present when patient and his family were given the bad news. I didn't know what to say or do so I went to the bathroom afterwards and cried.
During our surgery rotation, we had to round on the patient twice a day: once before 6am rounds, and again in the afternoon before we left. Med students have to do rounds before the intern, who needs to round before the upper level, who needs to round before the chief, who reports to the attending. So I would round on this poor patient at 4:30 every morning. Every morning he would say, “What, you waking me up again, sheesh, the vampires (lab guys) just left!” In the afternoons, he was usually awake and his family was there so we would talk story for a bit and I would try to answer their questions, always emphasizing that I was only the student but, in true PBL fashion, I could look it up and get back to them. One morning I walked into his room in the dark, and surprisingly, he was awake. “I've been waiting for you,” he said. “Try go over there by the foot of the bed. My wife and I have something for you.” There, on the table, stood a small blue Tiffany bag. “Well, open it,” he tells me. I open the bag and pull out a beautiful blue glass heart-shaped paperweight. I just stood there with my mouth open and he told me, “You know, all day long people come in and out of this room, waking me up, asking questions, poking, prodding, etc, etc. And of all those people who come in and out of this room, you are the only one who really takes the time to talk story, really ask me how I am feeling and seem to give a crap about it, listen to me grumble, and try to answer questions even though I'm really not sure you know what you're talking about. You have a very hard job ahead of you. It will be stressful and it will wear you down. It might make you depressed and jaded and uncaring. But when you look at this heart paper weight, you remember that you have heart, and your patients need to see this. This is your gift. This is why you went into this field. DO NOT EVER LOSE HEART.” I met Mr. Lee on the second day of my surgical rotation. He passed away on the second to the last day of my rotation. Sixteen and a half years later, his wife still sends me a Christmas card. I have learned many things from great teachers, but this by far, was the one lesson I have never forgotten.
Being a physician is not only about making the right diagnosis and prescribing the right treatments for your patients. Part of your job as a physician is to remember that your patients are human beings, not just numbers or statistics or a diagnosis. As physicians, your patients and your community will always respect you, but when you truly care and reach out to them with a compassionate hand and heart, they will embrace you. And when this happens, you will feel that you have indeed made a difference in their lives, and you, too, will have your “A-Ha” moment.
Stand tall, student doctors: you have made it this far. Keep standing strong: your journey is just beginning. Congratulations, class of 2017.
Footnotes
Dr. Arakaki was nominated and selected by the students (Class of 2013) and their advisors.
The Mission of the Arnold P. Gold Foundation is “to perpetuate the tradition of the caring doctor by emphasizing the importance of the relationship between the practitioner and the patient. Our objective is to help physicians-in-training become doctors who combine the high tech skills of cutting edge medicine with the high touch skills of effective communication, empathy and compassion.”
“Our (the Foundation's) inspiration emanates from the leadership of Dr. Arnold P. Gold, role model physician, mentor and the guiding force of our work. Arnold's vision places people and relationships at the center of every healthcare interaction. Toward that end, he believes that given proper instruction, a clear set of expectations, personalized mentoring and recognition and rewards, doctors in training will acquire the ‘habit of humanism’ and thereby improve patient care and healthcare outcomes.”