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Commencement: Thoughts

Today, I became a doctor, officially. Thanks to an Executive Order from the Governor, medical schools across New York State are conferring degrees onto their students more than a month earlier than planned so that a fresh wave of newly minted healthcare providers can rise to meet this first wave of COVID-19. Today is also the 40th day since the state confirmed its first case of SARS-CoV-2 – in other words, at least in length, today marks a traditional “quarantine,” a word that derives from the Italian for a forty-day period.


Quarantines harken back to the 40 days and nights of Noah’s flood, the 40 days of Exodus, and the 40 days of Lent, a period of time associated with purification. Here in New York City, we still have a lot of work to do. Though we may have started our precarious descent down from the apex of the curve, hundreds of people – mainly the most financially and physically vulnerable among us – are dying. The current “epicenter of the epicenter” for this strain of coronavirus is just down the road from me in, of all places, Corona.


There’s plenty of symbolism to go around. I could talk about how today is Good Friday, along with the religious implications of self-sacrifice, but I won’t go there. It’s not really my field. And I won’t talk either about how, in the absence of an official ceremony, my graduation cap and gown may consist instead of PPE – the most appropriate outfit I can think of at the moment, not to mention the most desirable. I do want to talk about what it means to graduate from medical school and become a doctor – and not just any doctor, but an Emergency Medicine doctor – at the exact moment when I’m needed most, and what that honor means to me.


For the past week or so, in my neighborhood of apartment buildings just a mile or two away from the giant steel globe at the heart of Corona Park, people have been joining areas around the world in cheering, honking, whistling, and banging pots and pans to root for the healthcare workers who, amidst a shortage of PPE, have literally put their health on the line. Just as they’ve been stretching out the lifespans of their masks – magically, like the oil of the Hanukkah miracle, what was meant for just one day now suddenly lasts for eight! – by all accounts healthcare in general has been doing more with less over the past few years, seeing more patients per hour, inching closer to 100% capacity even on slow days, assigning more beds to fewer nurses.


I suppose one definition of service is to do what is hard and what, for that very reason, is not often done for the sake of others. Perhaps it should be hard to become a doctor. Perhaps we want the people taking care of us to have fought for that privilege. But perhaps we also just need more people taking care of us. I’m divided on it. This is my second attempt at becoming a doctor. During my first attempt, as a pre-med student at Harvard in the class of 2004, I felt as though my organic chemistry professors were trying to weed me out, and they succeeded. The B’s and C’s I earned were too low to apply to traditional M.D. programs, and there was little to no formal advising on applying to medical schools. In fact, I wrote an article on the issue in my school newspaper. (And if I’m honest, all the time I spent writing articles in that newspaper probably contributed to the B’s and C’s.)


In lieu of applying to medical school, I rode on ambulances, joined the American Red Cross, and volunteered for the Massachusetts Commission for the Blind. I majored in English instead of a science, then spun off on a trajectory that landed me in publishing, then in China, then in Thailand, then in finance. I think I was grasping for something that in retrospect a career in Medicine might have fulfilled. I think I was trying to convince myself that proofreading contracts for authors, teaching English, and editing equity research were variations of service that could give my life meaning. But in retrospect, I hadn’t been ready for Medicine in college, not really. It was the grasping that made me ready.


In 2014, the first day I volunteered in an Emergency Department was the first day that Ebola hit America. It was a frenetic night, and I felt that the team at Mount Sinai Beth Israel, on the Lower East Side of Manhattan, was preparing to put out a fire by tamping it down with an old jacket – the jacket would be singed, maybe the curtains, too, but with enough energy they could smother the flames. I felt part of a group of people who each wanted to be part of something greater than themselves. It was as though I hadn’t known how hungry I was until I started eating.


My second attempt started that night in 2014, and I was discouraged from pursuing Medicine in other ways – told I was too old (I’ll be 38 by the time I start residency), that a doctor’s lifestyle was not actually that great and that suicide rates among doctors were pretty high, that it wasn’t financially viable to leave a career in finance for one in Medicine. Some of my classmates and, I’d bet, a large number of people who never make it to medical school, might argue that it doesn’t need to be this hard to become a doctor. In times of dire physician shortages – times like these – medical schools and the government have found ways of making doctors quickly.


For example, during the 1918 influenza pandemic, and again in World War II, medical student education changed dramatically to respond to dire needs. Medical schools designed three-year accelerated courses, expanded class sizes, accepted prospective students with as little as two years of undergraduate education, and truncated the requirements for graduation to boost the number of physicians. I don’t know if those measures are what’s needed now. But it might be worthwhile for someone more qualified than I am to consider whether some of the academic and financial barriers to becoming a doctor are meaningful ways to cultivate competent, compassionate, and hard-working physicians. It might be time to update the Flexner report. I can’t remember the last time I actually used organic chemistry except as a proxy for how well I can regurgitate other information I don’t routinely use.


But I digress. My point is that it takes more time to make a doctor than it does to make a mask, a ventilator, a hospital, or a vaccine, and it takes some doctors more time than others. If you reflect, no time is wasted. Ceremony or not; cap and gown, or cap plus gown plus mask plus goggles; I think there has never been a better time for me to become a physician. This week, the American Medical Association (AMA) called the COVID-19 crisis an “all-hands-on-deck moment,” noting that governors in New York, California, and Illinois have called for physicians to come out of retirement to help with the response. The AMA is also working with the federal government to expedite visa approval for foreign-born graduates of medical schools abroad. For its part, New York City is importing active physicians from across the country to further strengthen the bulwark against this pandemic.


There is a square-shaped hole in New York City right now, and healthcare workers are square-shaped pegs. I’m so excited to join them on the front lines, to earn the goodwill that I hear pouring out of apartment windows at 7pm every evening. With lives ending and lives on pause, what we need more than anything right now, in any shape or form, alone or together, on stage or through Zoom, is a Commencement. Let’s commence.

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