Frank H Netter MD School of Medicine Commencement 2019 ~ Dr. Wible

Graduates selected Dr. Wible to deliver final inspiring words before becoming physicians. View speech, download MP3, or read full transcript below: (the audio podcast is BEST because you can hear all the laughter & audience reaction) . . .

In less than 30 minutes you will all finally be physicians! (cheering) And this summer you’ll be set loose on your very own patients. (laughter) How exciting is that? Maybe a little nerve-racking.

During your career (depending on specialty and work ethic) you may care for more than 100,000 patients—only a few will live in your heart forever. You will join them on a sacred journey for two. Trust them. They will guide you from nervous new doctor and teach you how to be a healer.

As a new intern, I was assigned to Emily. She had idiopathic bronchiectasis (a fatal lung disease) and refused to take her meds so the transplant team signed off on her case. They abandoned us. We were both 25. Sobbing uncontrollably with her oximiter alarm shrilling, she looked to me for help. I didn’t know how to help her die. So I snuck my dog, “Happy,” into her room for midnight excursions. With her portable oxygen tank rolling behind us, we’d hold hands and disappear across the hospital parking lot into a blanket of grass and gaze at the stars where she’d share her grief of never giving birth or finding her soul mate. Emily and I became soul sisters on an adventure of a lifetime. . . until the day, in her bedroom sitting beside her body wrapped in a Mickey Mouse blanket, I signed her over to the morgue.

Emily has never left my side.

Patients like Emily will hold your hand and lead you to places where there is no algorithm, no attending, where you have no earthly idea what you’re doing. All you’ve got is each other.

After Emily, Harold stumbled awkwardly into my heart. A loner who distrusted technology (and doctors), he lived in the woods caretaking a wildlife sanctuary with no electricity. No phone or car. But he had great health insurance (through his employer). His ex-girlfriend recommended me. So he’d hitchhike to my office—3 hours each way. One day he came in, his back covered in nodules. I excised one, sewed him up, gave him a kiss on the forehead, a slip for a chest X-ray, and an appointment to return next week. It was metastatic lung cancer. He chose chemo, moved to the city, got a cell phone, and quickly spiraled to his death. I got him back to his cabin. He died the next day. His ashes now food for the forest he so loved—where I visit him each fall.

I think Emily kind of helped me with Harold. You’re never really alone. Some patients follow you forever.

It’s weird that I only remember one patient from med school—Veronica—end-stage kidney disease. I still see her alone in her crib in that dark hospital room where I’d lift her up and sing her to sleep in a rocking chair. My peds attending walked by (and this landed in my permanent record) and he said, “Dr. Wible, you are a doctor when your patients need a doctor and a mother when they need a mother.”

I’m proof you don’t need to maintain professional distance. I prescribe professional closeness. You can be a doctor—and be the real you. Is it legal to kiss dying patients? I don’t care. I do what’s right for patients. You will stray from evidence-based guidelines to do the same—because what patients truly need has no ICD or CPT codes and never requires a prior authorization. As an intern do something so epic it can’t fit into an EMR.

Our biggest threat to patient relationships is what I call “assembly-line medicine.” I’m a womb-to-tomb, till-death-do-us-part physician. My dream of being a small-town family doc doing house calls was way too big for my little cubicle. If your dream is bigger than your cubicle, leave your cubicle. You can practice medicine your way—as an employee, a business owner, or an entrepreneur.

If you’re freaking out over your debt or end up hating residency, don’t despair. You can launch your own practice with one or two years of post-graduate training—and if you register it as a nonprofit, you can totally get your loans forgiven! (laughter) Doctors I know are doing this now!

As a physician employee in a big-box clinic, I was so miserable—even suicidal. Then I did something really crazy—I asked my patients for help. I invited them to design their own ideal clinic. I invited them to write my job description for me. And I promised to do whatever they wanted (as long as it was basically legal). They shared 100 pages of their most creative ideas. We adopted 90% of their feedback and opened our community clinic one month later without any outside funding—where I’ve never turned any patient away for the last 14 years for lack of money (clapping) and this is the first ideal clinic designed entirely by patients.

My patients saved my career—and my life (’cause I was thinking of working at Starbucks and doing something totally different—but I probably wouldn’t have gotten the job because I was overqualified). Luckily my patients came to my rescue and I want to assure you that your relationships with patients will  save you from lawsuits. (Patients don’t sue doctors they love.) I’ve been running a physician suicide hotline since surviving my own close call. Several docs told me their suicides were actually averted by a patient thank you card! Keep your thank you cards. Read them often. On your worst night, those letters may save your life.

After speaking to thousands of suicidal physicians who survived, I noticed one trait they share (very unusual among doctors)—they asked for help. The most common phrase I hear: “I would have been one of your statistics, but you called me back right away.” They’re shocked that I called them back. I ask, “When you’re on call, do you respond right away? Why not do that for each other?”

In your last few minutes as a medical student, take a good look at the person to your right and left. Hold hands for a minute please (aw so cute! – laughter) I’m asking you to please be on call for each other.

Look, listen, and feel—notice when a doctor is struggling. Look up at all your beautiful, proud parents celebrating you today. Promise to watch over each other so no parent ever gets a call from the police telling them their child has died in residency.

I was tasked with delivering a few uplifting words today—and they’re coming! (laughter) For now though you might want to keep holding hands. This is tough to hear, but so important for your future.

A med student in the Army Reserve told me she was less stressed in Afghanistan during active sniper fire (than med school!). Here’s why: She had total trust in her comrades. She knew if killed by enemy fire, she would be brought home, covered in an American flag, and honored with a proper burial. They had her back. In med school, she never knew who would stab her in the back. Trying to change that culture here starting with your generation.

We are brothers and sisters in medicine. Protect and defend each other. If a resident is being pimped with esoteric questions, say, “I don’t think any of us know the answer. Let’s look it up together.” Please do that.

When in doubt, hold hands.

Be like the preschoolers on the wooded path by my house each morning. There’s so cute. Almost makes me want to have kids, but not really (laughter). It’s much easier to have you as my kids, already diaper-trained and everything, you’re already know how to bathe, tie your shoes. I’ve just never really been into the young kid thing. Looks really difficult. Anyway, I don’t know if you’ve heard of this, getting rope trained. There’s a rope they hold on to and they each put one hand on the rope so they learn how to walk in a line equally spaced and they are the cutest thing in Oregon with all their tiny colorful rain coats and little tiny rain boots. When one kid slows down to look at a mushroom, they all stop to look.

That’s what we should be doing. Stick together. Hold hands.

I’ve taken hundreds of doctors on hot springs retreats, soaking together in the bubbling Lithium-infused water under the stars in the ancient Oregon forest where Harold once lived (where his ashes are). We go out on a cliff overlooking the Breitenbush River—so amazing! Wild how Harold’s kind of helping me heal doctors now. Weirdly, more than once a doctor at the retreat has told me, “I don’t know why I’m here. I don’t even like doctors.” I think that was Harold’s opening line during our first office visit. Took me years to deconstruct that comment from a physician.

Why do doctors dislike doctors? Hurt people hurt people. Wounded healers wound each other. Most people don’t bond over codes, crash carts, and stillborns. Bonding over trauma creates trauma bonds (leading to maladaptive drug and alcohol use to numb the pain). Befriend each other by doing stuff normal people do. Go on a hike and cook dinner together. As interns, the best way to prevent trauma bonds is to first bond over your hopes and dreams.

Now to celebrate . . .

My #1 recommendation—always keep your umbilical cord plugged into your dream.

Reflect back on medical school. Remember how you felt on your favorite rotation or with that attending who inspired you to go for your dreams. Maybe you have a patient like Emily or Harold or Veronica who touched your heart. Go back to those precious moments, and ask yourself these 3 questions: 1) Do you ever feel so excited you can’t wait to get to work Monday morning? 2) Are you having so much fun at work you would do it for free? 3) Do you love your job so much you never want to retire?

Raise your hand if you answered yes to any of these questions. Oh good! Your dreams are still alive. (Turning to the professors) “You kept their dreams alive! What a great crew of teachers.” 

To those of you who raised your hands. Seemed to be the majority. I want you to realize you are very fortunate to still have passion for your career (which you should have when you graduate medical school).

During a keynote in Vegas, I asked those same questions to 4,000 doctors. Everyone was laughing (to hide the pain of losing their dreams). I can still answer yes to all 3 questions—and so could about 20 doctors (out of 4,000). May you be one of those 20 doctors to create such an amazing life in medicine, you’ll never need a vacation.

Inspired by a Zen poet, I’ll conclude with this: Physicians who are masters in the art of medicine make little distinction between their work and their play, their labor and their leisure, their mind and their body, their education and their recreation, their love and their religion. They hardly know which is which and simply pursue whatever they do with excellence and grace, leaving others to decide whether they are working or playing. To them they are always doing both.

May you be blessed on your journey.

Congratulations!

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9 comments on “Frank H Netter MD School of Medicine Commencement 2019 ~ Dr. Wible
  1. Mark Thompson says:

    Hello Pamela: Touching, heartfelt, uplifting and inspirational commencement speech presented to the Quinnipiac University Frank H. Netter Scholl of Medicine in early May 2019. Beautifully delivered message that all doctors, young and old, should listen to on a regularly basis. It is a poetic and palpable reminder why most doctors heeded the call to practice medicine. Thank you for everything that you do! Mark Thompson, Executive Director, Fairfield County Medical Association

    • Pamela Wible MD says:

      Thanks for letting me practice on you on our car ride after the Fairfield County Medical Association event 🙂 Your input was very helpful and was so great to have the hour together in the car (I think Leslie fell asleep so pass this post on to her) . . .

      • Chantal Nouvellon says:

        hi

        I think your message is great. I wish that the training directors of medical school and the medical director of the hospitals would understand that. The medical world is based on an abusive system of learning and unless the laws are in place to change it , I don’t see it changing any time soon.

  2. Rebecca Ulrey says:

    Please can I travel to where ever you are I desperately need a physician like you. My story is long and very sad. I’m stuck in this quagmire of bias, profiling and honestly sick, demented and cruel treatment. I don’t know why they just didn’t kill me in the operating room, but that would have been 2 easy. How dare a assertive empowered woman speak up against local politician corruption. Yes I pushed back, and I did it in writing to the State Attorney General, Local commonwealth Attorney et al. It’s my right as a citizen or so I thought. The surgeon butchered me and left me a piece of a woman unable to function without excuriating pain. Simple civil court cases are twisted, violating laws and left my record as a scumbag, against the “scumbag”. I have lost my home my indepencence. But they left me with a mind as clear as a smooth fresh lake at sunrise. Able to research, document and understand clearly factually why and how all these ” people of power and influence did and still do drain the ever liven life out of this courageous, honest, compassionate, loving proud single mother.

    It’s become a battle for me to stay the course, determined not no matter how bad my life gets to change who I am and become “mad” like the world around me. I’m tiring, my body is tiring. I have nothing left, I live in a hotel, all I want is a home. To be a family with my 17 year old daughter and our loveable friendly golden retriever. I ask myself why God would allow this to happen to me .Answer I would have never believed it could.
    I want to make sure it never happens to anyone again. Friday I’m leaving alone and searching for an answer, a friend someone who cares about goodness.
    How will my story end, I’m scared to death but have nothing to loose. No matter what, I did make a difference in this life, my conscious is clear whenever I lay my head down. I wanted so much more out of life, I worked so hard to achieve all that I did. I taught my daughter by my leadership, love, kindness and generosity how to live life with pride, morals and virtues. And I taught her how to fight and stand up to aggression and rightneous. I want to be free again, and see the beauty of this great country. Me and my Liberty Belle. Wish me luck. Justice comes to all one day🤔.
    I wish at times I was as psychotic as this letter portrays me to be.
    But I’m not.
    God Bless America.
    God Bless the Good guys in this crazy world.
    I would like to meet a few before I go….

  3. Thank you for swimming against the Tide, Doctor Wible. Healers have long been burdened with the expectation of infallibility from sufferers. Seems that is magnified and multiplied with the galloping advance of technologies. Those are miraculous, but many miracles will always beckon from a ways beyond our understanding, and Even Miracles can be mis-used.

    You do an excellent job of reminding us that healing is – and must ALWAYS BE – as much of the Spirit as it is of the corporeal aspect of our lives.

    Without delving into the arguments as to whether there is a spiritual dimension to our existence, it does seem that absolutist denials of the possibility leaves a person without any buttress against the darkness. It’s a challenge to imagine how a doctor – in isolation from peers, without supportive friends and grateful patients, and some sense that this is not just a pitiless clockwork universe – can find sustenance even in a successful practice.

  4. Emily Paterson says:

    Hurrah to all the new doctors, and what a positive, actionable commencement speech. As a mom who has a child with a preventable adverse event, my sense is that “assembly line medicine” can be dangerous. In my heavily consolidated healthcare state, malpractice attorneys may see over 150 cases of harm and take one case which will be in court 3 to 5 years. I’ve often thought that my child’s doctor, and my child, didn’t get treated right in the most expensive healthcare system in the world.
    I love that Dr. Wible has tips of how healthcare can evolve. Let’s keep making this system better! I don’t think it’s right for healthcare administrators and malpractice companies to hand out so many multi-million dollar top level salaries while those of us in the trenches (doctors and patients) get harmed far too often. When the US ranks high in patient safety, high in provider satisfaction, and low in doctor suicide, let the multi-million dollar salaries fly. Doctors and patients share a desire for a better system!

  5. Michelle Marsonette says:

    Thank you for bridging the gaps in medicine and challenging us to expand our own beliefs to create the systems we want to participate in. This is brilliant on all levels of healing.

  6. This commencement speech is a message of hope from my personal superhero, Pamela Wible MD. You really are The Doctor’s Guardian Ángel. Thank you for saving the lives of American doctors and doctors everywhere. I celebrate the day I first read your book Pet Goats and Pap Smears. Since then I have begun a whole new journey to the life I always wanted. I have left drive by psychiatry clinics and big box medicine behind forever. Serving patients with joy, my dream, once crushed by the burden, trauma and sheer torture of medical education has been revived at last, and is now alive and well again. Serving patients with joy as their psychiatrist is what I was born to do. Thank you Pamela for reviving my dream that I thought had been killed off forever. I join forces with you in the fight for freedom and dignity for all healers everywhere. An end to physician suicide is a starts with a revival of The Dream, a commitment to relieving pain and suffering for our patients and for ourselves. A dream of balance, enlightenment and time to spend with our loved ones, our personal healers such as cats and dogs, to talk and listen to our friends, and tome to wander quietly in the woods. A dream of hope for patients and doctors everywhere. Thank you Pamela for bringing us back to our starting point. Our wonder and our love for healing.

  7. ES says:

    Good Morning Dr. Wible,

    A few more things to reflect on.
    When you say….”when in doubt, hold hands” that makes perfect sense.

    When I was running my nursing unit at the hospital, every Wednesday night I had coffee, tea and cake at the nurses station, (I was probably breaking every infection control regs at the time) many of the physicians stopped by to sit, chit chat with the staff or among themselves, and have something to eat, many did not have a patient on my unit, they just came….

    I would tend to play classical music, mostly Mozart, Beethoven, Wagner. There was one physician in particular that I would always find after his rounds, sitting in the charting area totally immersed in “conducting” the music using two pencils. He had pure joy from that.

    I had a physician come to one morning, 6:30am-ish, and exclaimed…”Elaine, I can’t explain to you how great I feel, I took a sleeping pill for the first time in my life last night and I actually had the best night sleep I have ever had!”

    There were many times as staff and physicians had difficult or terminal cases that died….. we cried together.

    When I would see a surgeon come to the unit after I knew they were in the OR for hours (of course I had the OR schedule and knew what they just finished) they would stack their charts up to make rounds on the unit patients. After they went down the hall to round, I would place a cup of coffee and a sandwich by their stack of charts for them upon their return to chart…… no words were needed there, just a glance and weary smile.

    There was a patient that required extensive daily abdominal post surgical dressing changes that the physician would perform. (open and close extensively invasive gyn-cancer) They were painful for the patient and were very extensive. I always had the patient prepped and pre-medicated for the daily dressing change at the same time. I would always gown up, set up and assist the same physician every day. I knew his every move and process. We worked well together.
    After some time of silence day after day during the dressing changes, the patient started to recite a different chapter of Scheherazade to us from memory. We started to look forward to that. So that went on for a few weeks…. the physician, me and the patient story telling during the dressing changes.
    Then it stopped, the patient finally died from the inoperable invasive gyn-cancer they had. The next day when there were no dressing changes, no story telling, the physician and I just looked at each other…… in silence

    I had a patient with sudden extreme abdominal pain, turned out to be a superior mesenteric artery infarct. I called the resident on call, I called the patients surgeon, the patient was in the OR in record time. The next morning the physician came to my unit and hugged me.

    Yes….. we held hands, on many levels and for many reasons.
    And now once you say it that way, I understand ……. the reality of being mere mortals dedicated to doing the impossible every day and coming back for more.

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