2004 Commencement Speech

The following speech was given at the School of Medicine graduation on Thursday, May 20, 2004 by Edward D. Miller, M.D,. Dean of the Medical Faculty, CEO of Johns Hopkins Medicine.

I would like to welcome you to the Meyerhoff for the graduation of the class of 2004. This has been a long journey for many of you and today is your today, so enjoy it.

When I was thinking about what I was to say tonight, I remembered I gave my first set of remarks to the graduates of Hopkins eight years ago. Think back eight years and remember where you were, finishing high school perhaps or just beginning college. Now look at where you are: one of the most significant days of your life. The effort that you have put into your education will be rewarded - not only in a monetary way but more importantly, the skills that you have been given will help mankind. Whether you are treating patients, doing research or teaching, you will make a difference. The road ahead will not always be easy, but you have been given a gift and you will need to use it wisely. While today is your day it must be shared. Look around at your classmates and the families that are here tonight. Look at your professors and others who have supported your efforts. Without that support, you would not be here.

Let me leave you with a few words to think about after you depart here tonight.

First, integrity - a word often used but a word that signifies the core value of an individual. Integrity is earned not given. You will have many choices in your life. You need to do the right thing. Think and make wise choices in all that you do.

Second: collegiality - we talk about this a lot at Hopkins. I believe it is one of the attributes that sets Hopkins apart from other institutions. It has allowed us to make discoveries that would not have been made. Let me give you an example of that: I had the opportunity to go to Sweden this past year when Peter Agre accepted his nobel prize. On Monday of that week, Peter delivered his nobel prize lecture. One could not but be struck with awe of the science. Such an important discovery, namely, how water moves into and out of cells - but the simplicity of how that discovery was made still amazes me. Peter and his lab had found an unexpected protein and they did not know what it did. He went to his friend, Bill Guggino, who had an oocyte model. They inserted the protein into the oocyte and before their eyes the oocytes started to pop just like popcorn. They knew immediately that water was moving into the cell.

This part of the story is only one piece, however. Admittedly Peter worked in one department, Bill Guggino in another, but because of the open, collegial atmosphere this discovery was made possible. I can say, however, that the discovery may have stayed in the lab. It didn't. One of the things that I learned in Stockholm about the nobel prize is what goes behind the selection. Many discoveries are made each year - why one versus another? In talking with people on the nobel prize committee it was apparent that the discovery alone did not do it. The discovery and its impact had to be known by many.
What Peter Agre did is that he worked with people all over the world to look at various aspects of this discovery. In his lecture, he noted multiple groups of investigators that he and his lab had interacted with in various aspects of this discovery. At a reception and dinner that night hosted by Hopkins, it was a montage of people from throughout the world that came to Stockholm to celebrate with Peter. Peter Agre represents the very best of Hopkins and he is a role model for the word "collegiality."

Third: teaching: you have had the opportunity to be taught by some of the best. Sometimes it is in a classroom, other times in is in small group discussions. Sometimes your best teaching may come from residents, interns, postdocs or attendings. But the commitment to teaching and learning is a core value of this institution and one that you should adopt.

You are undoubtedly aware of the multiple pressures that the faculty are under these days as they try to do research and practice medicine. The number of regulations and unfunded mandates makes life much more difficult than ever before. You are aware of the 80 hour work week rule. We have had our troubles with this. We want to comply and we are complying but over and over again I hear that I will not abandon my patient because of a work rule. Yes, there can be abuses but these work rules need to have more flexibility so that patients are not harmed. Another rule that has caused difficulty is effort reporting, namely, how many hours or actually what percent of our time does one spend on clinical care, research or teaching. As faculty try to allocate their time it becomes more and more difficult to justify unfunded teaching time but if there is one thing that i as the dean of the school of medicine is immensely proud of is that our faculty continue to find that time to teach, want to teach and look for ways to improve their teaching efforts. You as a graduate have a duty and obligation to teach the next generation. Make sure teaching is part of your life. You will also find that by teaching you will continue to refresh your own knowledge base. Medicine is a lifelong occupation. Make sure that teaching is a part of it.

Fourth: compassion: i receive many letters throughout the year about the medical care that someone has received at Hopkins. Often times Hopkins is seen as the court of last resort. Sometimes there is nothing we can do to help a person medically. Over and over again I am struck with the words that talk about the compassion one has received here. Let me read you a letter that Irecently received:

"Dear Dr. Miller,

I have cancer. I came to Hopkins for a final opinion on whether I needed radiation. I had arrangements to stay at the McElderry house Friday night because of extra testing that would be performed on Saturday. I ate all my meals, five in total, in the hospital cafeteria beginning with lunch on Friday. I was at the sandwich bar, trying to decide what to eat. I have a very restricted diet and sometimes it's overwhelming to put together a meal. A nice young woman who had been working at the cash register approached me and asked me if I needed help. I explained to her what I could and couldn't eat and she helped me put together a meal.

I went to the cafeteria again for dinner, breakfast and lunch. When I returned for dinner on Saturday, I just finished seeing my doctor. I went to the area where the warm food was served and I saw the same young lady who had assisted me with lunch the previous day. I guess she must have remembered me because when it was my turn, she asked me how things went with the doctor. At that point, I absolutely lost it and started sobbing. She came around the counter and looked at her watch and said, 'it's time for my break.' She gave me a hug and guided me to a table. I guess the news I received upset me more than I thought. I must have gone through thirty napkins.

We connected very easily. It was at this point that i learned her name - Denise Barbara Mason. We talked for a while. When her break was up, she said, 'I want you to have something —something special.' I started to cry again as she removed the cross from around her neck and put it around my neck. She fixed me a meal tray and went back to work.

I ate and went to say good bye to her. Once again she showed me kindness, compassion and caring. There were very few people in the cafeteria and she asked me if I had seen the statue. I asked her, 'what statue?' She said, 'come with me.' She took me to the Christ statue and it blew me away. I started to cry again.

After I regained my composure and prepared to leave, she volunteered to walk me to the front entrance of the hospital so I could catch my cab. She told me things would work out and I should leave it to the Lord. Her calming voice made all the difference in the world. Riding back on the train, I wasn't thinking about my illness, prognosis or treatment options. I kept thinking about Ms. Mason's kindness and compassion. I don't think i would have made it through the trip as well as I did. I have never had an experience like this in my life. I am a nurse with over thirty years of experience. I haven't met many people who work at a hospital other than nurses and other clinicians that have compassion and a commitment to patients. I don't think I've ever met anyone like Ms. Mason.

I thank God that I met Ms. Mason when I did. I'm not sure she realized how much of an impact she had. I sent her a card to thank her, but I wanted everyone to know how special she is and what a difference she made in my visit to Hopkins and my life. She deserves to be recognized."

(name withheld for reasons of patient privacy)

The purpose of this letter is to show you that compassionate care comes from all involved whether it is from kitchen staff in the cafeteria, the guard at the front of the hospital or a nurse on the floor. You as a physician, however, have a special duty. You need to set the tone. We too often get lost in the science of the disease. It really is not another M.I., another obstructed bowel, or sepsis but rather a person who has hopes and fears, a person who has a family and loved ones who have turned to us for help. We are indeed priviledged to be trained to help others.

Let us not forget though that one ounce of compassion may be better than a pound of pills.

In closing, I want to sincerely congratulate you for what you have accomplished. You are part of the Hopkins family forever. Remember integrity, collegiality, teaching and compassion are what makes Hopkins different and it will make you different as you go out into the world.