Respect the rituals of medicine, Verghese tells graduating students

Abraham Verghese, champion of hands-on medicine and best-selling author, exhorts medical school graduates to make time for personal connection with patients.

- By Tracie White

Dean Lloyd Minor, far left, presents Guy Haskin Fernald, accompanied by his four children, with his PhD diploma.
Norbert von der Groeben

The only quote author and physician Abraham Verghese, MD, keeps framed in his bedroom is from a 16th-century physician named Paracelsus: “This is my vow: to love the sick, each and all of them, more than if my own body were at stake.”

As the keynote speaker at the School of Medicine commencement on June 14, Verghese, addressing a crowd gathered under a large white tent on Alumni Lawn, asked the graduates to respect the timeless rituals of medicine. A champion of hands-on medicine, he cautioned graduates against letting technology push them too far from the patient’s bedside. Look to the time-honored role of the physician-patient connection, and learn from this relationship, he advised.

“Whenever you enter a [patient’s] room, be conscious of that legacy, of this unbroken chain extending back centuries — how in standing before a patient, you stand there as the latest incarnation of this lineage, and you have behind you generations of physicians ... from Paracelsus, Osler, Curie, Shumway,” said Verghese, who is also the senior associate chair for the theory and practice of medicine in the Department of Medicine.

Dressed in caps and gowns, the graduates celebrated the occasion by applauding their own years of hard work, thanking family, friends and faculty, hugging their classmates and, for some, accepting diplomas in one hand while holding a baby in the other. 

Family affair

Guy Haskin Fernald, who earned a PhD, drew laughs and applause as he crossed the stage to accept his diploma with four children in tow.

“Way to go, Dr. Leon!” someone yelled from the crowd as Leon Castaneda, who earned an MD, cheerfully accepted his diploma.

In the 2013-14 academic year, 71 students earned PhDs, 84 earned MDs, 54 earned master’s degrees, and one earned a joint MD/MS degree.

The ceremony began with Dean Lloyd Minor, MD, introducing Verghese, the Linda R. Meier and Joan F. Lane Provostial Professor, as a physician and scholar who emphasizes the importance of listening to patients and seeing them as individuals.

“Have the courage to follow unmarked paths,” Minor said. “Listen to your patients. They are trying to tell you the diagnosis. ... Above all else, listen to your heart.” 

Medical school commencement took place under a tent on Alumni Lawn.
Norbert von der Groeben

Following words of congratulations and encouragement from graduating students Jonathan Lynch, PhD, and Johana Oviedo, MD, Verghese stepped to the podium. He began his remarks with words of warning, noting that soon-to-be-published research shows that medical students spend as much as five to six hours per day in front of the computer during their clerkships.

“That just astonishes me and worries me, and you are not doing it by choice, but because that has become the nature of our work,” he said. “You will need courage and determination to push back when things detrimental to your time and your care of the patient are being thrust at you. Electronic medical records don’t take care of patients: You and our amazing colleagues in nursing and the other health-care professions care for patients.

People take care of other people,” he said to loud and long applause from the audience.

The importance of ritual

Both heritage and rituals, like the ritual of commencement, play an important role in the career of a physician, he said.

“You are also participating in a timeless ritual ... when you get to examine a patient. You are in a ceremonial white gown. They are in a ceremonial paper gown. You stand there not as yourself, but as the doctor. As part of that ritual they will allow you the privilege of touching their body, something that in any other walk of life would be considered assault. …

 “The ritual properly performed earns you a bond with the patient. ... The ritual is timeless, and it matters.”

Gandhy Pierre-Louis received his doctoral degree at the ceremony.
Norbert von der Groeben

Verghese also said that he had learned innumerable lessons from his patients, and he went on to share one.

“I had a patient who was a hemophiliac. He was a college teacher in his 30s when I met him. He walked with a stiff gait, his arms swinging at an odd angle at his side, the result of many episodes of bleeding into his joints when he was a child. As a child he had more hospital admissions than most children had ice cream.”

The patient survived childhood, only to be infected by the AIDS virus in the 1980s from his many blood transfusions.

“He was uncommonly brave and dealt with AIDS matter-of-factly. Once, toward the end of his life, I put him in hospital — he hated to be admitted. I had no treatment that would reverse things, we had nothing to offer him that night, no way to minister to him. In fact, he was ministering to me, he was instructing me.”

The patient told Verghese that as a little boy, he would sometimes wake up in the night with pain in a joint. He knew that he was bleeding into the joint, but he also knew that his parents badly needed their sleep — they were each working two jobs, working weekends. If he woke them, they would dutifully get up and sit with him, put icepacks on his joints and take him in the morning to the hospital.

Maria Oviedo hugs her daughter, medical school graduate Johana Oviedo.
Norbert von der Groeben

Sustained by joy

So he did his best not to wake them, to wait till morning so they could get some sleep.

 “And his way of toughing it out was to put a record on his toy record player, a hymn called Joy Comes in the Morning,” Verghese said. “He would play that again and again until dawn broke. That was his way of coping, his mantra for carrying on. He is long dead, but in my toughest times, that is what I fall back on, my memory of him, his courage, his stoicism, and telling myself to hang in there, because joy comes in the morning.

Graduates of the Class of 2014, may you celebrate the rituals of medicine, recognizing their importance to both you and the patient. ... May you find courage to face your own personal trials by learning from your patients’ courage. ...

 “When you come on rounds to see your patients, may your presence bring joy in the morning. It has been a privilege to watch you on your journey. Good luck and Godspeed.”

After the ceremony, graduates hugged family members and friends, then discarded their ceremonial robes in the “regalia return bin” and headed to lunch on the Dean’s Lawn.

“I’m just really excited,” said Hiwot Araya, a new MD, who invited 20 members of her family from Ethiopia, all of whom were excited to see Verghese, a native of Ethiopia himself who writes often about the country.

“This graduation is different than undergrad. More intense. Many of us start work on Monday,” said Araya, who will begin an internship in internal medicine at UCLA.

“Dr. Verghese is an amazing speaker,” said Jaimie Henderson, MD, a professor of neurosurgery and of neurology and neurological sciences, chatting with a woman in a wheelchair after the ceremony. “Listening to him it’s like, ‘Yeah, that’s why I’m a doctor.’”

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