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Student Clinician's Ceremony July 3, 2006
Reid B. Blackwelder, M.D. Residency
Program Director / Associate Professor
ETSU Family Physicians of Kingsport
I am very honored to be invited to speak at this critical time in your training, and am so pleased you have chosen to mark it in this fashion. I applaud you for recognizing the importance of creating ceremony for these kinds of transitions. We have a strange country in many ways. You can transition overnight from not being able to drive on your own to driving independently. You can join the military to go fight and die for your country, yet cant legally drink, and girls become women, and sometimes mothers without benefit of school-based education - and all without clear and consistent rites of passage.
These rites of passage are powerful times. Other cultures approach these transition periods with seemingly more respect. You have elders, you have initiates. You should feel awe. You should also feel some fear. It is a time to respect those who have gone this path before you and to realize with trepidation the obligations you are taking on, now more than ever.
You each deserve to be here, but you are far from done with the journey. During the coming months, it is easy to forget that this is indeed a rite of passage. It is one that occurs over years compared with some that take a procedure or a short ritual. Yours takes years. It is easy to become frustrated or get bored or cynical as in many ways, as we have lost the magic of what we do amid the paperwork and protocols and change in expectations and responsibilities in our disease-care system. It is easy to fail to respect the power you have been entrusted to use wisely.
You are indeed the chosen. You are the healers of your tribe. This power can be misused however. You have likely seen it already - patients become a diagnosis only, or a 47 year old white female stripped completely of identity and personality. Patients are described as demanding, non-compliant, or drug seeking, or at least that is how we describe them in our stories about them to each other during rounds, in lectures, and after hours.
The mystical predawn time becomes a frantic rush to wake groggy ill people, direct quick questions, do either too much or not enough physical exam. During these times, you are rarely truly talking and hearing, or even touching with compassion. Instead, you are gathering the quick information you need to write essentially the same note each day, if not each patient and ordering tests, drugs and procedures. We forget the power of kindness and connection during these full moments. Unfortunately, we fill four years of medical school and your several years of residency with the same moments.
During these times, we direct the flow and the outcome of the stories we hear often changing them to fit the opinions of others on the team. The same patient can be interviewed by several different people and the outcome of the story can be totally different depending on what we heard or what we share. In some ways, rounds become sterile, devoid of the individual. Social history, instead of being the rich window into someones life becomes solely whether or not someone uses alcohol or tobacco. Cynicism can rule in this environment. The issue of work hours changes the concept of our calling and of this service profession.
So what can we do? Take control! Create ceremony in your life and ritual but yet understand the powers of symbols and the small things. Begin your day with affirmations, prayers, blessings or whatever you need to help remind yourself of why you are doing this. Start rounds with a reading so that you share and role model this with others, drink your coffee out of a ceramic mug instead of a Styrofoam cup. Take your time to really appreciate the smell, the taste, the feel, and the effects of that coffee.
Use the power of the transition periods, such as from dark to dawn as we always have through the centuries. Be kind, finds ways to create connections, be respectful, be thankful. Recognize the power of symbols and use them wisely. Make your power stronger by giving some of it up. Allow your patients to have control when you might otherwise normally impose something on them.
What you are about to do, we healers have done for generations. We are not much different now. I told you a story last year that I would like to repeat now. Consider how we view other cultures and their approaches to health and healing. We often smile or laugh, or at least think we have Come so far when we consider the Shaman and old style medicine people.
But consider what we do. Begin the day with special rituals and potions, cleansing, donning the robes, gathering our tools and ritual instruments, greeting the dawn with strange words and actions, gathering in groups to recreate these approaches, writing secret formulae on paper in a language that only another priest can read, who then dispense unguents and potions of magic!!! Are we that different? I think only in that we dont embrace the inherent power in these rituals.
Ultimately, I encourage you to feel. It is okay to cry at death and exult at birth, share the journeys. Your patient comes seeking your aid at their worst and at their neediest. They rarely come to just say, Hey, thanks for being there! Instead, they come when they truly are afraid they may die. And they come to you because you said you were willing to be there for them. In these relationships and commitments, both of you have hard work to do on this healing journey. Done well, healing occurs but not necessarily cures.
Find and learn from the Jason Moores, the Steve Lloyds, the Mary Hooks, the Elizabeth Pryors, the Jackie Yorks, the Allen Dyers, and the many other outstanding mentors that you will find on your clinical path. But also recognize you are teaching as well. Many people are looking to you as the next generation of role models for the choices they may be making. Most of all, you are teaching yourself in this regard.
Gandhi has said, Be the change you want to see in the world. I challenge you to be the change you want to see in medicine. Be a healer, rather than a doctor or even physician, in thought word and deed. The words do mean different things, and are often lost in this society.
I would like to close with a quote from a remarkable book. I will also briefly tell the story of how I came across this quote. Nowadays, I dont read medical literature, so much as I read about leadership and management. Being the Senior Partner in a large practice such as a Residency, creates a number of challenges. I find the books I gravitate toward are those that help me learn how to stimulate disparate groups of people to share vision and move forward, when the participants changing constantly.
I also tend to visit bookstores wherever I go. So, when I was recently in Kansas City, I went to the management and leadership section, and out of the corner of my eye, saw a book called The Wizard and the Warrior. I was fascinated that this was in the management section, rather than the Dungeons and Dragons section! When I looked at it, I saw strategically placed symbols and what seemed a real appreciation for some of the little known yet very important aspects of leadership. So I got the book. I am now reading it and am impressed with the stories of leaders in industry who have utilized the traits and characteristics of wizards and warriors as part of their transformation of a company. This week, I found a very powerful quote from a book that I also own. I enjoy going to the original source so that I can appreciate the context, so I pulled out Crow and Weasel by Barry Lopez. It is a book from a Native American perspective telling the tale of two young men, Crow and weasel who embark on a rite of passage for their people. They meet others on their path, including Inuits. Later they are invited to spend the night with Badger, who asks them to relate their adventures. When Weasel starts to talk, she interrupts him with questions to redirect his tale. This is very similar to what will happen when you try to present to us we will interrupt, redirect, and reshape what you say to our expectations. It can be very frustrating!
After a few such interruptions, Weasel is getting frustrated, but Crow sees what is happening. He says to badger that she is trying to help him create a rhythm and a flow, to increase the power of the telling, to recreate what he has seen for others. Weasel and Crow both benefit from this teaching. When they prepare to leave, Badger has one final thing to give them. It is what I will leave you with:
I would ask you to remember only this one thing. The stories people tell have a way of taking care of them. If stories come to you care for them. And learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive. That is why we put these stories in each others memory. This is how people care for themselves. One day you will be good storytellers. Never forget these obligations.
Go hear your patients stories. Cherish them, protect them, nurture them, make them yours. Share them with love and respect. Ultimately, hope to return them to your patients in a form that helps them become better story-tellers of their own life and passages. Enjoy the journey. Dont forget you created this reality out of a desire to help people. Congratulations for getting to this point.