Leave 'em with a swear

I recently returned from a trip to Australia on a transoceanic flight from sydney to LA. And on the 13 hour flight, as I was contemplating an appropriate way to summarize our collective medical journey with an appropriately moving symbolic metaphor... for some reason, all I could think of was the television show Lost.
which coincidentally also begins with trans-oceanic flight from syndey to LA.

Lost, you know...

a bunch of strangers from all different backgrounds embark on a long slow journey (ie medical school), they survive a horrific plane crash (whcih could be the boards, or the match, or our surgery rotation- however you want to look at it) and then some of them (the ones that don't die horrible painful deaths) up on a mysterious tropical island (aka residency) having to face all sorts of eerie terrors and jungle smoke monsters.... yada yada yada.

And so apparently, after 4 years of medical school and a 1 year pathology student fellowship I am only capable of thinking in terms of TV analogies. I don't know what that says about OHSU.

Perhaps a more appropriate, and much more reasonable analogy would be a story, say, about climbing a mountain. For example, one of the residents that I worked with in the emergency department recently climbed Mt. Everest. He literally climbed Mt. Everest.

Unfortunately, I don't have a story like that. Instead i'd like to share with a you a brief story about not climbing

The summer after our first year at OHSU, when many of my illustrious colleagues did things like pursue research opportunities, or go on medical rescue missions in poverty-stricken nations, or invent life-saving medical techniques or cure cancer ... i decided to go on vacation. So I traveled around Australia with my sister, and found myself, one clear day, looking up at a staggeringly enormous bright red rock, towering out of the middle of the outback desert.

Ayers rock. which is a geologic marvel, once thought to be the largest single piece of rock in the world. Its amazing. According to the aboriginal people it is Uluru, a sacred place where they have gathered worshiped for thousands of years. And because it is sacred, they do not climb it. And they ask the tourists not to climb it. There's this picture I took, with this sign that says "please do not climb" and behind, a long line of white tourists clambering up the side, using the metal spikes that have been driven into the rock to make their way. And I thought to myself, why? Why is everyone climbing it? For the sense of accomplishment? For the amazing view? Perhaps for the obligatory "I climbed ayer's rock t-shirt?"

I think our tendency to want to climb to the top of things means something.

Medical school is a kind of climb. Completing medical school at OHSU is indeed a fantastic accomplishment, indicative of a climb that was mentally, physically, and emotionally challenging. It is an accomplishment that we should all be truly proud of - one that probably does deserve a really nice t-shirt.

But we need to continue to ask ourselves: why did we do this? Why did we embark on this journey? For the sense of accomplishment? For the view that we can get from the top of our new-found positions in society? For the satisfaction of a contribution to the greater good?

Each of us has our own reasons for pursuing a career in medicine. Maybe, as for Sir William Osler, it was a calling.

"The practice of medicine is an art, not a trade," he said. "A calling, not a business; a calling in which your heart will be exercised equally with your head."

But along with this calling comes leadership, and with leadership comes responsibility. And choices.

We owe it to ourselves and to those who have helped us in our education thus far, to be conscious of our actions, of our great effect on others, of our power, really. So my charge to you is "Don't just get in line. Think about where you are climbing to, and why."

In case you were wondering, my sister and I did not climb Ayers rock. Instead, we hiked around it and then had lunch.

And now, on behalf of the class of 2007, I would like to say thank you. Thank you to OHSU, for allowing us these opportunities. Thank you to the deans for guiding our way. A great thank you to all those in the dean's office without whom we would have wandered away in confusion years ago.

Thank you to all of our teachers and mentors. To the wonderful and talented faculty of OHSU, our esteemed attendings, who taught us so very much. To our residents and interns, who quite possibly taught us even more. Survival skills. And thank you to our other teachers, our nurses, who often displayed the patience of angels.

I would also like this opportunity to thank the those who taught us the most of all, and yet who are not on the payroll: our patients.

And, to all OHSU pts, on behalf of the class of 2007 I would like to say thank you, and also that we are really... really.. sorry.
Sorry for waking you up every morning at 4:45 to ask you if you've passed gas, sorry for our cold and tentative hands, for our awkward and repeated questioning, for our incompetent and pinchy pelvic exams... Sorry for having a roomful of total strangers stare and then prod at various exposed parts of your naked body, and then stand around you and talk in incomprehensible acronyms about things like Ranson's criteria and EtOH and hepatic encephalopathy.
We're very sorry for telling you things that later turned out to be completely untrue. For all these things, and many more, dear patients, we aplogize and we thank you.

Last, and most important of all, thank you to all of you. To our loved ones, our families and friends, our parents and children, our significant others... for all of your support and encouragement and unending patience

on behalf of the OHSU school of medicine class of 2007 I would like to express our deepest gratitude. Thank you so very much.

And to my fellow classmates and colleagues, I wish to all of you the best of luck, wherever your paths may take you, whatever climbs or non-climbs lie ahead.

And as we all scatter across the country to begin our respective residencies, I would like to leave you with a reminder from one of our great teachers, who shares the stage with me today. In the inspirational words of Dr. Marc Gosselin, "the d-dimer is the devil's asshole."