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Page 11 text:
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Baltimore, the 12th largest city in the U.S., dates its beginnings to 1729. Outstanding attractions include Harborplace, historic markets, and the Orioles.
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Page 12 text:
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The Journey We started out, certain that our ignorance of medicine would be remedied by hard work — either ours or the faculty’s. Now we graduate, less ignorant, but keenly aware of what we do not know and how to look it up at 3 A.M., when the library, and our eyelids, are closed. We have grown up. Even if we could buy our own beer as freshmen, we have changed to meet the demands of medical teamwork. The eternal mysteries of man and woman, birth and death, have been revealed to us without fanfare as we listened with our stethoscopes and our own hearts to our patients. We have snatched patients from Death’s door — with a little help from residents, attending physicians, nurses, and dieticians. We have occasionally cured somebody’s particular illness while hardly making a dent in the ills of society and none whatsoever on the AIDS juggernaut. We have orchestrated million-dollar miracles and sent patients home with unfilled prescriptions and loose change in their pockets. Small victories, perhaps Pyrrhic, but victories nevertheless, and considerably better than selling pork futures. A few of us had some other experiences, like marriage or a trip to Vail. But unlike the proverbial honeymoon night or first time on skis, medical school is par excellence the experience to write home about. So our families have had the best time of it (along with the commercial banks). For example: Athlete’s Dad: “My son just ran a marathon in under three hours.” Med Student’s Dad: “So what? My son just held three retractors and an air saw for six hours while reciting the blood supplies to the diarthrodial joints.” Athlete’s Dad: “Well, my son had a broken leg.” Med Student’s Dad: “My son could fix YOUR son’s broken leg.” As one of my friends put it: “I am proud of the University and my classmates except those whose names begin with S, since they shared my anatomy table and made my life miserable. I’d like to forget my first semester — as well as the other seven. But I am waxing nostalgic at the thought that I will NEVER EVER BE A MEDICAL STUDENT AGAIN.” Yet in retrospect, when his annual income minus his malpractice premiums equals the cost of a secondhand ski bib, he will call these the best years of his life — when he met his closest friends and worst bugbears, finally understood why people use Dial, and why they go to such great lengths to “unwind.” Now we are warned that future M.D.’s will practice in goldfish bowls. I disagree. Goldfish are isolated except for their periodic manna from above. Medicine will be more like water- skiing in polluted waters behind a boat whose propellers are fouled with red tape, surrounded by piranhas waiting for the slightest falter. It is metaphorical, though I am fairly sure whom the piranhas represent. But I am not sure if the patient is piloting the boat. These days, every medical newsletter has an article which, stripped of polish, laments, “Medicine ain’t no fun anymore.” Well, I hope it ain’t so, since we have worked this hard and that long to see our pictures here. We won’t change careers now (except for one colleague who has intrusive thoughts of becom- ing a fruitmonger), but it would numb our expectations to step out in mortarboard, clipboard, and gown to a chorus of “NEVER MIND.” Ours is a noble profession. Health is the foundation, the sine qua non, of anyone’s life plan. The term “health care provider” is irksome, but physicians are providers in a most general sense. We maintain and restore people to be whatever they want to be. Unrestrained, our grandness of purpose can inflate to grandiosity, as sometimes happens on morning rounds. But health remains as a basic human need like quiche, clothing, and shelter — and that three letter word, “$$$.” We have also learned to let go — when the healing arts can no longer heal and Nature must take its course, as it inevitably does anyway. At such times, we may have turned away from our “defeats” to address some new case with renewed vigor, anxious to catch some fleeting, no doubt eponymic, sign or symptom an hour earlier so we could apply the definitive treat- ment and save a life. To save lives, yes. More often, to provide comfort; to help an asthmatic or emphysematous person to breathe; to start a life without handicap and let it end, when it must, with dignity and self-determination; to relieve pain and often helplessly stand by because we cannot confront its cause. Patient care (taking “patient” as adjective or noun) is now our focus but we should not neglect the scientific knowledge which is the especial legacy of our medical faculty. To paraphrase Newton, if we have seen farther than other men, it is because we have stood on the shoulders of these giants. (And also because we have listened to WOMEN). We consoled ourselves early on by believing that medicine, like beauty or dermatology, was dazzling but only skin-deep. We have since learned that dermatology treats a spectrum of systemic disease, and the physician is like a Master of All Trades, not a mere Jack or Jill. Put crudely, medicine is a game of intellectual hardball, won or lost by a footnote. And when we lose, we lose big and it hurts. An old taunt says that physicians are the only people who get paid for practicing. If by that we mean the assimilation of new knowledge until it is perfectly applied, then w e shall certainly be practicing our entire lives. Those eternal mysteries of human nature may be old wine, but like generic drugs, they keep appearing in new bottles. By graduating, we have passed a major milestone. But the overall journey towards better patient care and personal com- petence is never-ending. My best wishes to all of you on that journey. Pete Novalis 10
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