Guest Blog Post: Commencement Address 2016

Rochelle Dicker, M.D.'95
Rochelle Dicker, M.D.’95

Commencement Speaker Rochelle Dicker, M.D.’95, returned to her alma mater to address the Class of 2016 in Ira Allen Chapel May 22, 2016. This blog post is her commencement address in its entirety.

University of Vermont College of Medicine Class of 2016, family, friends, fellow alumni, community: It is a great privilege to address you this afternoon and to come back to my alma mater – the seventh oldest medical school in the country – a medical school that has never sacrificed the heart and soul of the country doctor while maintaining aptitude and cutting edge progress.

Over the next 10 minutes I want to talk to you a bit about allowing in the special moments in the practice of medicine, some thoughts on hope and advocacy in a seemingly limitless field, and finally, something about celebration.

I’m going to start with a story, a moment: Jamal is a young man who grew up in San Francisco and at 20 years old, was shot a couple blocks from his home. He was brought in on a stretcher. We took him right to the OR where we leaned down and transferred him onto the OR table. He needed dozens of transfusions during the operation, and four hours later, we leaned down again and transferred him onto a bed and brought him to the ICU. Our team performed tirelessly. Jamal needed four more operations: Remaining supine; onto the OR table, back to the bed, down to CATscan…repeat.

For weeks this was the pattern until one day I got a call from a nurse on the ward.

“Dr. Dicker, can you come over to Jamal’s room?”

My response: “Is it urgent?”

“Well, Jamal’s asking for you…”

When I arrived at his bedside, he was sitting on the side of the bed, his hands on a walker – head down. Then, with a little help from the nurses and a med student, and a declaration from him – “Watch this Dr. D!’” – he lifted himself up and took a couple steps towards me, beaming. All the days of leaning down and moving him from one bed to the next were over. Now it was he who was towering over the bed, and over the rest of us – turns out he’s 6 foot 4! Jamal is now walking the campus as a student at San Francisco City College. Jamal knew that we had hope, and on that day it was clear to us that he did too. It is so amazing to see a healing patient show off!

Hope is the epitome of our profession, and now you get to be the ambassadors of it.

Vaclav Havel, former president of the Czech Republic once said: “Hope is a state of mind, not of the world. Either we have hope or we don’t; it is a dimension of the soul. It is an ability to work for something because it is good, not just because it stands a chance to succeed.”

My soon to be fellow alumni, you are about to enter a field rich with these moments because you have on this day earned the trust inherent in that white coat you began to don as first year medical students. You will not only bear witness to amazing moments in people’s lives, but because of that trust, you will play an integral role. Those are moments that are critical to the people we serve, and often define our professional lives. They drive us to want more of them. You’ve probably had some of these moments already, and there will be lots more if you stay focused, deliberate, and humble. There is no doubt that some moments will be very hard, and the moments when patients are getting better are like little gems. Let them wash over you and you will remain activists in the pursuit of good health, and life-long learners of the dynamic science and art of medicine. You will be change agents, and these moments can make you a better healer.

In the spirit of delivering the best possible care, think holistically and understand that your white coat can make you a great advocate. During your tenure here at UVM you have been exposed to not only the anatomic and physiologic basis for health and pathology, you have also been perhaps uniquely exposed to other drivers of health that provide you with a foundation to understand your future patients more comprehensively than we traditionally have done.

Healing is a broad term, and so think broadly about the resources available to deliver it. Thinking broadly is increasingly important as we contemplate an uncertain world of climate change, political instability, and even food insecurity still in 2016. These global ailments often manifest in a struggle for individual health, and our job is to meet people whenever they come to us (some of you kindred spirits will go to them), and explore the opportunities to help individuals and populations.

It’s not just a white blood cell count that we can consider modifiable as you perform your history and physical. We don’t write “getting a good education” on a prescription pad, but it might be a better treatment than a medication for certain public health issues. It’s exciting to think that we CAN help affect that kind of change if we hold onto that holistic, creative, hopeful, limitless way of thinking that you have learned here. There are very few boundaries to what constitutes good medicine as long as we understand the resources and treatments available to us, and to our patients, both inside and outside the walls of a hospital or clinic. Thinking that way is a deep demonstration of hope. That way of doctoring and healing will certainly bring some very special doctor/patient moments.

We have the capacity to provide a voice for our most vulnerable patients, and thereby open doors to health that they may not have otherwise known. I urge you to stay curious and creative: Going to the laboratory, taking on administrative duties at your hospital or university, speaking out at town hall or city hall or to Congress – or simply making a call to the clinical lab and asking that something be run stat – people want to hear from you. Bring those moments at the bedside with you to these places. It’s that drive and that hope that keeps this field truly good.

I have one more short story I’d like to share with you: Last Sunday, I was spending my last day of the week as the intensive care unit attending. Mr. S is a young man who loves to play soccer and came to America looking for a better life. We’ve been treating him for a life-threatening illness for three months with all the latest modalities and management strategies of critical care, and he is slowly recovering. We advocated strongly – okay, cajoled – physical therapy to work with him on a Sunday. On morning rounds, I told him that I couldn’t help him anymore. He looked at me kind of funny, as did my medical students. I told him that I’ve reached my limit of what I could do – now it’s up to him and that overworked physical therapist who’s arm we twisted to work with him on a Sunday.

During his PT session later, I heard him cursing and yelling. I heard frustration and anxiety. I went in and asked him if he wanted to kick a soccer ball again. He half smiled and said yes.

I said: “Then you will. Start building back today with this PT expert helping you.”

He took my hand and put it on his forehead and said: “I like you. You care about me. You believe in me.”

Your expression of doctoring may take a form one day of making a diagnosis, another perhaps performing a complex procedure or writing a critical prescription, another day a referral for counseling or home health care, and sometimes a hug or a shoulder grasp. Staying humble and driven can allow you to be excellent at each of these components and know the right times to apply them.

But as you launch into an almost limitless field, pay attention to your own individual human limits. There will be pressure for you to have all the answers, but you won’t. Seek others’ advice and expertise. A patient doesn’t care if you or the nurse or the endocrinologist comes up with a good idea, just be sure to act on the best idea the team has. That’s good medicine and good leadership. You may have to toughen up a little to cope with what you see, but don’t get too tough. That’s a hard balance. You’ll be busy and tired, but don’t forget to teach and learn. Educate your patients, their families, your medical students. Despite all your demands, take a moment to focus on the person who has come to see you, to really listen and look away from the computer. Learn from THEM and remember that the basis of all of medicine is still that doctor-patient relationship.

Today, all these people are assembled to celebrate your incredible achievements. What you have accomplished is truly wonderful. This is also a celebration of everyone in the Chapel and those who could not be with us. Mentors, friends, family: I suspect their support has been essential to many of you. I remember my sister putting this mortarboard on my dad’s head outside this chapel after my commencement 21 years ago. My dad was not a giggler, but in that moment, he giggled.

Celebrate your classmates and thank them for studying with you, for blowing off steam with you, for explaining to you the concept of layering for a hike or that when it’s sunny in February, that does NOT imply that it’s warm out, for convincing you that it is possible to downhill ski on ice – you 20+ West Coasters, you especially know what I’m talking about. Hold onto those precious moments of the Class of 2016.

Celebrate your launch from a school that has given you a great holistic foundation for what lies ahead. Today you have earned the right to participate in a field rich with hope. You are now ambassadors and agents of the most basic human right – health care. May you thrive in the rich moments inherent in our profession and celebrate the chance to do something truly good. Congratulations.

What are your thoughts about this topic?