Dear Graduates

Dear Graduates,

Thank you for granting me this privilege to share with you today.

When I was initially asked to share this advice, my first thought went straight to, “Me? How am I qualified to impart any new words of wisdom to this class?” This instant fear of inadequacy brought me back to earlier times of my life: my first day of internship as a night float, starting my PGY-2 year in the MICU, and when I got my certificate of residency completion. I don’t think these feelings are unique or even new. They’ve put a name to it now. Imposter syndrome.

I suspect you all know the feeling, and likely are in the throes of uncertainty right now as you prepare to leave your familiar responsibilities and prepare to move on to the next phase of your careers. It seems that medicine, like life, is full of transitions.

Just when you get a handle on things, whether that is your continuity clinic inbox, your ICU patients’ vent settings, or your wards service, it is time to move on. It may seem like you never quite reach “there,” wherever “there” is because the next task is always calling for attention.

1. Life, and medicine, will take you on different pathways.

Some of you may have known from the get go what you wanted to be when you grew up. College, med school, residency, fellowship, and then practice. You had a timeline for relationships and for family, and guess what? Everything fell into place just as you planned. You are the lucky few. The rest of us have taken a more scenic path; either because we chose to stop and see some sights along the way, or because life threw some large boulders into our path and we had to take a detour. And you know what? Both paths eventually led to the exact same place.

That’s why Google maps gives you three options when you’re looking for directions. You’ll get there-it’s up to you to choose how and when.

Sometimes you can choose the path, sometimes it’s chosen for you. Either way, stay focused on your own journey.

2. Don’t forget to show up.

There is a quote from Glennon Doyle Melton that reads, “Be messy and complicated and afraid and show up anyways.” If this isn’t the perfect way to describe every day of residency training, I don’t know what is. I think the take home message though is the fact that things don’t suddenly get easier or cleaner just because you’ve finished residency.

There are always going to be responsibilities and demands on your time, unless you’ve managed to create a life where you live in a bubble just doing your own thing.

And if some of you have done that, please come talk to me later. I’d love to know the secret.

There will be days when you will question what impact you’re really making, if your presence is really making a difference. Don’t underestimate the power of just showing up. By showing up you are telling your patients you are invested in them, you let your colleagues know that you can be held accountable by your team, and you show your family and loved ones that you care. As we all know, actions speak louder than words.

3. Believe in something greater than yourself.

Because I know that there will be days that you will be tired, and resentful, and overworked and underpaid. But you won’t be able to quit. So you need to know what you’re doing this all for.

Believe in something bigger. This doesn’t need to be a religious practice, but an exercise in connectedness: to nature, to God, to the universe, or to humankind.

Look around. I suspect the people who are here to celebrate you are a large part of your “something greater.” And if you paid $50 for them to be here, you must really think a lot of them. So hold them close and make sure they earn their entrance fee! Knowing that you are a piece of a larger puzzle will give you a sense of

belonging and purpose and will allow you to understand the importance and magnitude of doing your part.

4. Never forget that united we stand, divided we fall.

With connectedness comes the understanding that we need to stand up and speak up for others. We have been trained to care for patients with compassion, but now, more than ever, we need to stay abreast of what is happening in the larger world of healthcare.

I hope you will all see it as part of the job to be advocates for social justice.

This may translate into identifying and speaking out against microaggressions in the hospital, to writing policy papers, participating in marches for a cause, or simply by having a greater understanding of the privilege that your job, race, gender, and ableness afford you.

One of the best signs I’ve seen bears a quote by Stephanie Sparkles, “I love when people who have been through hell walk out of the flames carrying buckets of water for those still consumed by the fire.” I hope you will all grip your buckets tightly as you leave our residency program and lead others by this example.

5. Humility never goes out of style.

You are never too old to say please and thank you. The lessons you learned in kindergarten are just as applicable today as they were when you were five.

Keep your hands to yourself. Don’t throw sand in other people’s eyes. Say sorry when you hurt someone. Share what and when you can. Wait your turn to speak. Keep your promises. Read, read, read. Don’t forget to go out and play. Invite all the kids in the class to your birthday party.

6. Don’t believe everything you see.

Back to that imposter syndrome I spoke about earlier. It’s easy to get caught up in the “I’m surely the only one feeling inadequate” space. Instagram tells you that Ashley with the 2.5 GPA in high school is now making six figures as a lifestyle blogger, your old med school classmate has a million followers just for being attractive because who cares if he takes good care of patients, and everyone else is going out about 10 times as often as you are.

Social media is great for a lot of things; boosting self-esteem is sometimes not one of them. Just remember, there are always stories behind the facade.

Ashley’s marriage may actually be falling apart. Did you know that your “drug seeking VA patient” was abused as a child at a military boarding school or that your angry non-compliant patient is barely making ends meet and is devastated that he can’t feed his family? Your hypochondriac “woman in bed 2?” Well, she just watched her mother’s body wither away, ravaged by cancer, and wonders when she’s going to be diagnosed with the same.

Ask the questions. Dig deeper.

The patient the ED diagnosed with pneumonia actually has CHF.

Don’t accept what you see on the surface, either in life or in medicine.

7. And don’t forget to throw yourself a party now and then.

Nothing too philosophical here. Just this. Life gets busy. Life is hard. Take a day now and then to just celebrate you. Everyone needs time to rejuvenate and to refuel their tank.

You’ve chosen a career where you will be giving a lot yourself to others day in and day out. You can’t pour from an empty cup.

Spend time on your own. Spend lots of time with the people who make you feel loved and happy.

It’s an exciting and yet scary spot to be where you are now. New adventures, more learning, new colleagues, and cities to explore. At the same time, it’s hard not to second guess your decision.

Have I picked the right path? Am I still going to be excited about this in three years? What if it doesn’t turn out the way I hoped it would?

It’s understandable to have doubts. Most will be unfounded. But the reassuring thing is, even if some or all of your worries come to pass, there is always an opportunity to change your path. The possibilities are myriad, and I’m a prime example of “it’s never too late to change.”

It is never too late to find the work that reignites your passion for medicine. Do what makes you happy, brings you joy, and gives you a sense of purpose, and don’t settle for anything less.

The field of medicine needs more people who care.

People who care enough about patients to demand access to healthcare for all, who care enough about colleagues to demand change in systems that are not working, who care enough about themselves to

remember who they are away from their lives in the clinic and hospital.

We all will depend on you to help make the future better as we face serious issues of physician shortages, physician burnout, and national policies that affect the lives of the patients we treat. And we have faith that you will, in fact, be the ones to help fix what has been broken.

I wish you all a future that is all that you deserve and have worked so hard for. I hope you don’t forget the people who supported you and sacrificed for you along the way.

I hope that you will remember to be grateful, humble, and thankful as you climb to great heights.

Please know that it is okay to stumble and lose your spark occasionally as you grow and learn. Use the words, “I don’t know,” “I’m having a rough time,” “I could use some help” without embarrassment, guilt, or shame.

At the same time, keep an eye out for those around you. Learn how to say and ask, “I see you,” “It looks like things aren’t going well for you”, ''What can I do to help?”

Gather who, and what, you need around you: family, friends, music, exercise, religion. Whatever keeps you going, don’t let it go.

Go out and conquer the world, knowing that there are a whole bunch of people here who are cheering you on every step of the way.