Lucy Kalanithi: 2017 Commencement Address at UC Irvine School of Medicine

now my distinct honor and privilege to welcome dr. Kalon a--they as the 2017 guest commencement speaker at the Lucy Kalon ethey MD FAC P is the widow of the late dr. Paul Kalon a--they author of the number one New York Times best-selling memoir when breath becomes air for which he wrote the epilogue Lucy is an internal medicine physician and faculty member at Stanford School of Medicine in Palo Alto California she completed her medical degree at Yale where she was inducted into the Alpha Omega Alpha National Medical Honor Society she completed her residency at the University of California San Francisco and a postdoctoral fellowship training in health care delivery innovation at Stanford's Clinical Excellence Research Center at the cross section of her career as a medical professional and her personal experience standing alongside her husband during his life diagnosis treatment and death dr. klahn a--they has special interests in health care value a meaning in medicine patient-centered care and end-of-life care she has appeared on PBS Newshour NPR Morning Edition and Yahoo News with Katie Couric and been interviewed four people NPR in the New York Times she lives in the San Francisco Bay Area with her daughter Elizabeth Acadia and she's just a delightful person you're going to enjoy her talk I'm certain so please welcome good morning and thank you Thank You Chancellor Gilman vice chancellor Federoff and dean Stamos thank you to Dean chewy in the class of 2017 for inviting me here I'm just delighted to be here on this exciting day ten years ago my husband Paul and I were graduating for medical school as newlyweds we met as first-year students and we were basically the Jessica Gandy and Brian Labadie of our class and ten years ago this month pollen eyes sat where you sit hearing the word doctor in front of our names for the first time let me tell you quickly about Paul I fell in love with Paul because he kept a gorilla suit in the trunk of his car he used to say it's for a emergencies only he later said he fell in love with me when he saw me cry over a practice EKG I'm going to take this off of v-fib degenerating to asystole it was the first time I had seen a heart ceased beating a few years after graduation I had become an internist and Paul was a chief resident in neurosurgery when he started to lose weight he developed excruciating back pain and a cough and the diagnosis came when we looked at his CT scan together Stage four lung cancer over the next 22 months before Paul died in 2015 he finished his residency and wrote a memoir about his transformation from doctor to patient he called it when breath becomes air and in its pages he reflected on living and on his lifelong quest as he put it to keep following the question of what makes human life meaningful even in the face of death and decay in practicing medicine he discovered much of that meaning but his passion for medicine and mine was not without its complications as we all learned sooner or later and one of the ways Paul first faced those complications says a lot about him you all have a medical student ID and you'll probably never wear it again right just like you'll never have to wear a short white coat again congratulations at least unless you're going somewhere like Johns Hopkins maybe sorry Christopher PI G and Jessica do well when Paul stepped up to have his student ID photo taken on the first day of medical school he stood in front of the camera and pulled out of his pocket a fake mustache a big bushy unmissable fake mustache and slapped it onto his face Paul had been a comedy writer in college but he understood well the seriousness of medical culture he worried that the system would eventually suck the humor out of him that it might change him in fundamental ways and yes that photo ended up on our class face sheet and three years later the moustache stared back at every neurosurgery attending who was writing Paul a recommendation letter for residency but in the meantime that ID photo with the moustache was an amulet that Paul used to protect himself from some nascent fear of losing his humanity he recognized the possible danger so he fashioned an amulet to protect himself Ernest Hemingway wrote the world breaks everyone and afterward many are strong at the broken places he actually meant it more darkly than that sounds but the idea stands Paul and I found that practicing medicine made us weaker and stronger it enriched us in ways we couldn't have imagined although at times we felt broken Paul's amulet was so important if Hemingway's right and the world breaks all of us then that amulet made him even stronger at the broken places and you will need ambulance of your own I can't give them to you and not all of you can pull off a mustache like Paul did but what I can do is share some of the challenges we faced as physicians and how we made sense of them so if you're taking notes our first breaking point hard work parents I suggest you cover your ears for this story cover your ears during my residency I had to drive 30 miles home after every overnight call at the end of a thirty hour shift I was exhausted as you well know so a friend of ours taught me to wedge a lock of my hair in the sunroof of the car so I wouldn't be able to drop my head and fall asleep while I was driving it worked go for the record I do not recommend that arrangement okay parents you can come back now and doctors that little trick should probably stay between us Paul wrote this about medicine people often ask if it's a calling and my answer is always yes you can't see it as a job because if it's a job it's one of the worst jobs there is it is a calling and we do the hard work especially in the early years as we're training to become competent and confident and the work may ease up but we put our patients needs above our own and we work intensely to impact science and our communities and we do that hard work and service of something great after Paul was diagnosed with terminal cancer he struggled not just with his mortality but with his identity he was slowly regaining strengths on a novel EGFR tyrosine kinase inhibitor but he lacked purpose writing about that time he said I woke up in pain facing another day no project beyond breakfast seemed tenable I can't go on I thought and immediately it's antiphon responded completing samuel beckett's seven words I'll go on I can't go on I'll go on that morning I made a decision I would push myself to return to the Oh our why because I could because that's who I was because even if I'm dying until I actually die I'm still living why would someone work that hard endure the incredibly difficult work of residency and then return to it given the limitations of a terminal diagnosis it wasn't because Paul was a gunner it's because he was a doctor he also wrote I don't think I ever spent a minute of any day wondering why I did this work or whether it was worth it the call to protect life and not merely life but another's identity it's perhaps not too much to say another soul was obvious in its sacredness breaking point number two witnessing pain when I was a medicine intern I took care of a veteran a young veteran with AIDS and CNS lymphoma and he was so severely neurologically compromised he couldn't get out of bed and then he became unable to communicate I was completely overwhelmed by witnessing it our work requires that we enter into the pain of other people physical pain psychological pain existential pain bearing witness and choosing to accept the pain and uncertainty that our patients face and sometimes we forget that the act of bearing witness is its own kind of burden as a resident I went through an episode of depression and got help from a therapist I was afraid to tell anybody about it at first I thought I was the only one I worried my career with over but it wasn't and during one session when my therapist saw me struggling with really strong emotions she got up and wrote on a whiteboard this simple formula pain plus non acceptance of pain equals suffering at first I didn't get it I thought to myself but I don't want this pain of course I don't accept it but slowly I learned that resisting pain can make it harder to bear and even keep us from experiencing our lives fully the true danger lies in resisting it that lesson crystallized for me five years later in a conversation with Paul we had always planned to have children toward the end of Paul's residency but obviously was not part of our plan for Paul to become terminally ill at that time soon after he was diagnosed we broached the idea of having a child while he had advanced lung cancer each of us worried about the other and I asked him don't you think having to say goodbye to a child will make dying more painful for you and his answer astounded me he said wouldn't it be great if it did we were learning that living fully means accepting pain that life isn't about choosing the easiest path but you already know that your doctors and you've entered into a different and deeper relationship with pain and suffering being a witness to pain is not ancillary it's a core vital part of what we do and we get to see the human condition on full display for me and Paul it made our lives richer and it made us more resilient because of that because life and hardship are unshakably bound together and because of the boldest and best decision Paul and I ever made our daughter Katie is about to turn three she's over there with my dad [Applause] freaking point number three pursuit of perfection I think you can all relate to this one you wouldn't have made it this far if you didn't already have a pretty close relationship with the pursuit of perfection when you enter medicine you stop being motivated by grades or achievement and instead by a profound desire to heal other people but that's hard too and in some ways it's harder I get to quote Paul again here which is good because quoting Paulus basically my favorite thing to do he wrote good intentions were not enough when not when so much depended on my skills when the difference between tragedy and triumph was defined by one or two millimeters the in electable failures brought me nearly unbearable guilt in picking up another's cross one must sometimes get crushed by the weight you've already sensed this immense responsibility and driven yourself to study and work and try and try and try all in the pursuit of perfection and this is as it should be you will hold in your hands the lives of your patients you should continue to pursue perfection with your hearts full measure but don't subscribe to the belief that you might ever or should ever achieve it I'll borrow Paul's words once again yet death always wins even if you are perfect the world isn't the secret is to know that the deck is stacked that you will lose that your hands or judgment will slip and yet still struggle to win for your patients you can't ever reach perfection but you can believe in an asymptote toward which you are ceaselessly striving and to me that concept of the asymptotes isn't just an expression of unattainable 'ti it's an acknowledgement of forever needing to leave a space to recognize our patients and our own humanity and phal ability and to give ourselves and each other the permission to strive for but not the pressure to be perfect so there we are three major challenges for new physicians three possible breaking points hard work witnessing pain and the pursuit of perfection those challenges won't go away they're part and parcel of what we do they're some of the worst parts of medicine but they're also some of the best but there's one more challenge that I really worry about and it's not just an individual challenge it's a collective responsibility Dean fedorov mentioned it it's one of the worst things we face as physicians and that's burnout people enter medical school with better well-being than their peers but somewhere along the line something happens more than half of physicians in the US are burned out twice as high a rate as in the general population and that includes half of residents dr. Christina Maslach is a leader on burnout at UC Berkeley and she called it erosion of the soul it's different from stress it's a constellation of exhaustion ineffectiveness and cynicism burnout affected me and it affected paltu who described it like this I feared I was becoming Tolstoy stereotype of a doctor focused on the rote treatment of disease and utterly missing the larger human significance burnout effected our marriage and it can lead to substance abuse and depression and job turnover and loss of meaning and the worst part we physicians also have twice the risk of suicide as the general population suicide takes the lives of 400 US physicians every year and one of Paul's most dear friends a brilliant surgeon was among them it's roughly twice the number of physicians here today I worry a lot about burnout as you can tell for myself and my mentors and for new physicians like you and the key thing we need to realize about burnout is it comes at us from two directions our ability as individuals to cope and our work environment burnout isn't just an individual problem it's a system problem dr. Tate ran afoul of Mayo Clinic studies the key drivers of burnout and their system factors like unrealistic workload and inefficiency and loss of autonomy and meaningful work but many health systems treat burnout and professional satisfaction as solely the responsibility of the individual physician so solutions tend to focus on promoting wellness but that's incomplete it's a mistake it sends the message that if you are burned out there's something wrong with you physician burnout is a shared responsibility of individual physicians and the health system and solutions need to reflect that being a physician is a calling but we need to make sure that the job is sustainable that's how we can take the best care of our patients there's a moral case and a business case for mitigating burnout thankfully we're shifting the paradigm for one the ACGME which oversees residency and fellowship programs is recognizing burnout as a system issue and as the paradigm shifts we do need to take care of ourselves as individuals for me coping as a physician and a caregiver and a widow and now a mom means prioritizing exercise and sleep and mindfulness meditation which I'm obsessed with and social connection and seeking help when I needed it you know among physicians who've had suicidal ideation a majority were reluctant to seek help because they were scared it would influence their medical licenses I remember having that fear but that stigma is crumbling too and if I could tell myself then I know now I'd say it's okay to seek help in fact it's crucial and you will feel so much better I promise but thriving as physicians does take more than our own resilience and grit which you already have in spades because you've made it this far we need those systemic changes too and your leadership will be part of that I heard something recently that summed up really well the need to attack burnout from both sides the quote if there's a canary in the coal mine you can't just teach the canary to meditate funny right there's a common view that physicians burn out or leave medicine because of those individual challenges I mentioned before like the suffering we witness or the call to perfection but I don't think that's true my instinct is that those challenges reflect some of what we care most about in taking care of our patients and those challenges are the reason that we stay the good news is this if we can support each other and like Hemingway said make each other strong at the broken places then those challenges become deeply meaningful and sustaining practicing medicine is a little like a marriage which means today is your wedding day through the gown is a little different and this was way way more expensive but married people today can affect can attest to the fact that you don't live a marriage in the big moments you live it in the day today you wake up every morning choosing their relationship again choosing it over and over and when problems come be they depression or burnout or even cancer you work through them together I used to think the most romantic part of a wedding was the kiss but now I think it's everything that comes after I'd like to leave you with a short poem it's called good bones by Maggie Smith it's really dark but it's also kind of funny life is short though I keep this from my children life is short and I've shortened mine in a thousand delicious ill-advised weighs a thousand deliciously ill-advised ways I'll keep for my children the world is at least 50% terrible and that's a conservative estimate though I keep that for my children for every bird there is a stone thrown at a bird for every loved child a child broken bagged sunk in a lake life is short and the world is at least half terrible and for every kind stranger there is one who would break you so I keep this from my children I am trying to sell them the world any decent realtor walking you through a real chirps on about good bones this place could be beautiful right you could make this place beautiful I didn't share that poem because medicine is perfect of course it's really not perfect but I would choose it again and I would choose to marry polygon too even knowing that I'd lose him as for Paul his identity as a physician was why I believe he died not leaving everything he wanted but having everything he wanted and despite medicines imperfections that asymptotes that Paul wrote about that's our responsibility to heal patients in the fullest sense of that word to believe in an asymptote of what we can be both as physicians and as a profession and to ceaselessly strive toward it I believe you'll do it well and I'm thrilled to call myself your colleague thank you again for the privilege of speaking to you now go make this place beautiful [Applause]

Channel: Lucy Kalanithi

Views: 26,902

Rating: 4.9587631 out of 5

Keywords:

Id: 7XumNVKvRns

Length: 22min 15sec (1335 seconds)

Published: Sat Jun 17 2017

Reddit Comments

[u/[deleted]]

Dude on the left with the sideways cap, thug life

[u/this_isnt_nesseria]

The med school picture she talks about in the beginning.

https://s3.amazonaws.com/botm-media/magazine/images/Post51_AirMoustache_663x400.jpg

[u/postcomlexdepression]

"Now go, make this place beautiful." This was really good! Thank you for sharing.

[u/GolfTheBall]

When Breath Becomes Air is an awesome book! Lucy offers some pretty cool reminders and challenges in this address, enjoyed it! Thanks for the share

[u/futuremd2017]

damn. She put her hair in her sunroof so she wouldn't fall asleep driving home! That's nuts. Great speech.

[u/[deleted]]

Why the fuck are people in this thread objectifying her just because she is a woman?

I have my utmost respect for Dr Kalanithi and I absolutely HATE what is going on in this thread.

[u/chipmunkfacies]

Great speech. Should get more attention than stupid shit like Will Ferrell singing Whitney Houston.

[u/koalabeard]

Just finished reading When Breath Becomes Air. Incredible speech. She is so strong. Just puts my faith back in people and in this profession. There's so much negativity going on all the time with medical people. We need reminders every once in awhile why we're here. We have the privilege to help people, to know all this incredible science, to make this terrible fucking world a little better.

[u/wtpwtpwtp]

Jesus Christ these comments...