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SUNY Downstate Medical Center

2017 Commencement

Speeches Menu

College of Medicine, School of Graduate Studies, School of Public Health

President Wayne J. Riley

Greetings

Good afternoon: Chairman McCall, Honored Guests, Deans and distinguished members of the Faculty, Families, Friends, and of course, our Graduates.

Members of the Class of 2017, you have worked extremely hard to achieve this milestone in your lives, and I want you to know that you have earned the admiration of your professors and colleagues at SUNY Downstate.

This is the first two months for me as President of SUNY Downstate Medical Center. Although I have not been at Downstate for your entire experience, I am extremely pleased to celebrate with you and your families in this beautiful hall with its rich traditions that date back to 1890 … but did you know that Downstate's history goes back much farther -- to 1860, before there was a Brooklyn Bridge, before there was anesthesia or antibiotics?

Graduates: Commencement represents the culmination of your journey as students seeking knowledge to enter your respective fields. You are about to embark upon careers that are intensely challenging, always changing, and personally rewarding.Graduates, today is your day. You have each accomplished a great deal, and I salute you for the many successes. I know that as you journey forward much more will be accomplished bringing great acclaim to Downstate.

Today we also reflect with great pride. Downstate's contributions to medicine, science, and public health over the years have been remarkable – from pioneering open heart surgery and MRI to uncovering the genetic underpinnings of alcoholism. We look also to the future, knowing that Downstate – and you, our graduates – will continue to make history.

I know that for many of you, the road to graduation has not been easy. Each of you have made unique sacrifices to be here today. Please know that we are enormously proud of every one of you and applaud your accomplishments. You have worked hard to achieve this goal, and I want you to know that you have earned the admiration of your professors and your colleagues at SUNY Downstate.

We are joined today by several distinguished guests, and I would like each to rise or raise your hand as I say your name.

First, I want to recognize the best doctor in my house, my wife and mother of my children, Dr. Charlene Dewey, who is with us in the audience. Charlene is Assistant Dean, President of the faculty senate and Professor of Medicine at Vanderbilt in Nashville.

Next, on stage: The Honorable H. Carl McCall is Chairman of the State University of New York Board of Trustees and a great champion of Downstate. I am honored to welcome him today.

Dr. David Alexander Bennahum, who will deliver today's Commencement Address, is an ethicist and scholar in residence at the Institute for Ethics at the University of New Mexico.

Dr. James Ranck, who I will award an honorary doctor of science, is distinguished teaching professor emeritus of physiology and pharmacology at Downstate and one of our foremost scientists.

Dr. Ruth Browne, who will receive the President's Award, is the president and chief executive officer of Ronald McDonald House New York.

Dr. Michael Lucchesi, who is also receiving a President's Award, is professor and chairman of the Department of Emergency Medicine at Downstate, as well as our chief medical officer.

Class of 2017: When you look back on your time at Downstate, I hope you will remember us fondly. YOU WILL continue to hear great things about your alma mater, and we will continue to take pride in your accomplishments ahead. Keep in touch, and let us know how you are doing.

You are about to embark on a career that is intensely challenging, ever-changing, and personally rewarding. I am confident you will meet the challenges facing you, and want you to know that the good wishes of all of us assembled for this happy occasion are with you.

Congratulations.

Farewell Remarks

Members of the Class of 2017, it is my pleasure this afternoon to welcome you officially to the ranks of medicine, science, and public health. Looking back, doesn't it seem easy?

It is traditional at the conclusion of these ceremonies for the President to address a few final remarks to the graduates. First, though, on behalf of everyone here, I would like to thank Dr. Bennahum for his thoughtful address. I also wish to thank Chairman McCall, Trustee Burke, Dr. Ranck, Dr. Browne, and Dr. Lucchesi for being present to share this happy milestone in our students' lives.

I would also like to thank and congratulate the families and friends of today's graduates. Your support has been important – not only to the graduates themselves, but also to their teachers and to the thousands of people whose lives they will touch throughout their careers.

Members of the Class of 2017, you are embarking on your professional lives at a time when medical research and the practice of medicine in our society have changed in profound ways.

New knowledge and new technologies are transforming medicine as we currently know it – and as I learned it, years ago. The boundaries between science and medicine – and between disciplines – will continue to blur, as translational medicine and new discoveries change the way medicine is practiced…and the way we need to teach it.

Yet even as we look forward to the future, the problems of today are likely to remain with us for years to come.

We face great uncertainty. Access to healthcare has become the stuff of political fodder. Physicians and healthcare professionals in all disciplines are frustrated by increasing levels of paperwork that leave less and less time for hands-on care. Patients are concerned about whether they will be able to purchase health care at all, much less at an affordable cost and whether – if they are among the 25 percent of Americans with a pre-existing condition – if they will be lucky enough to see a physician who will be able to offer cutting-edge health solutions.

This year marks the 49th Anniversary of the death of Dr. Martin Luther King Junior. It was Dr. King who reminded us in 1966 that of all the forms of inequality, injustice in health is the most shocking and the most inhumane.

In Brooklyn, we see the great challenges posed by inequities. At Downstate, the majority of our patients are on Medicaid or Medicare – and many, for lack of a better term, are on what's called "Self Pay." For far too many of our patients, health challenges go beyond access to health insurance. It's also having access to the best care. To timely care. To care that's available on a schedule that doesn't force them to take a full day off from work. Far too many of our patients have to make decisions about whether to pay for medications – or pay for food. And far too many see a hospital bed as a better alternative to a bed in an apartment without heat.

The majority of Downstate's patients come from under-represented populations. We know that health inequities are rampant in these populations.

At Downstate, we see patients with high levels of obesity, diabetes, stroke, and cardiac disease. With high levels of environmentally- induced asthma. And with serious complications because our patients too often come in too late, when their illness is advanced and much more difficult to treat.

Downstate represents a shining light in our community. We offer terrific, compassionate care, in the broadest spectrum of specialties to all who cross our door – no matter what their race, their ethnic or cultural background, their religion, their sexual preference. You, our students, represent what the best of Brooklyn is all about – acceptance of differences, acceptance of diversity, and acceptance of cultures and all ethnicities in one blended, beautiful whole.

But Class of 2017 we need you – I need you – all of you – whether you are graduating from the College of Medicine, or the School of Public Health, or the School of Graduate Studies, to take what you have learned at Downstate and bring it to your community.

I encourage you to stay involved. address the rampant disparities that render too large a portion of the population of our great country unable to enjoy their lives… their communities… and their full potential as fellow citizens.

These are great challenges that will demand both your ability and your energy as healers, researchers, public health advocates, and citizens. I challenge you to be forceful, comprehensive, directed, motivated, and passionate. I challenge you to live your life to the fullest AND to live it in the service of others.

We can and must do better… because we know better.

Members of the Class of 2017, you are well prepared to become leaders in your field. The practice of health care – today and tomorrow – is in your hands.


Dr. David Bennahum

The Importance of the Humanities to the Art and Science of Medicine

I have been thinking about what makes a good physician and by inference any excellent health care professional. Medicine is both an art and a science, what the Greeks called Techne. And at one time they were one and the same thing. But as science comes to encompass so much of our modern lives we risk losing the art of medicine: the ability to listen, to recognize the signs and symptoms of each disease, to empathize, to care, to touch, to be ethical and to be present. In effect is there a risk that you could be distanced from your moral compass?It is in the humanities, not the sciences that we find our moral ground and I would argue that we must remain committed and return frequently to the humanities for emotional and intellectual healing and nourishment. The care of patients is not a risk free process. In the care of patients if we are to give of our selves we cannot but become wounded healers. A paradox indeed: to care, to be compassionate is to take on the suffering of the patient, but without caring how can we heal both others and ourselves?

A number of historians and scientists such as Yoval Harari and Edmund O. Wilson believe that we are in a paradigm shift as the new digital world replaces the past. I have been trying to imagine what your new world of big data, medical science and practice will be like. Will Americans finally agree that health care should be a universal right? Will we finally recognize that prevention is something worth fighting for? Will you experience moral distress as you try to take care of patients in this new world where time is so constrained? Moral distress occurs when what you should do such as sit down and listen to a patient or a colleague, conflicts with what you are asked to do which is to be efficient. How will you maintain control of your personal and professional lives? How will you assure that your patients are respected and retain control of their lives and decisions?

As Adam Kirsch noted in an article in the New Yorker last September, we are "acutely aware", of our modernity and the extreme and rapid changes that science is bringing into our lives. Change is disorienting.

Whatever extraordinary and often marvelous inventions the new medicine of computers, algorithms, robotics and genomics will bring, patients will still be patients and healers must still be healers. Mortality is our destiny and our new science cannot change that. But medical science can alleviate suffering and to relieve suffering is the first duty of the physician. The great physician humanist, Edmund Pellegrino, founder of the Center for Biomedical Ethics at Georgetown University defined the duties of the physician as two: Competence and Compassion. He also welcomed the educated practitioner or scientist whose range and references included literature, philosophy and art. A century ago, Sir William Osler said that a physician must always have equanimity. He or she must remain calm. But of course we cannot expect every one to be suited to medicine. The composer Hector Berlioz was sent to medical school in Paris on the insistence of his physician father. On his first day in the anatomy lab, the sights and smells of the laboratory in summer time caused him to leap from a ground floor window and flee, for our great benefit, to the Music Conservatory never to return.

As you must already know, to remain calm in the chaotic and demanding environment of the modern hospital and clinic is not easy. Whenever I walk into an emergency room I am always conscious of the nurses who seem to keep it all together in the tradition of Florence Nightingale. When Nightingale came to the Crimean War in 1853, conditions of the wounded at a hospital in Scutari in Turkey were horrendous as were the death rates. She, with a small group of English nurses cleaned up the patients and the hospital, and brought order and a plunging death rate. So too did the great barber surgeon of the sixteenth century, Ambroise Paré, when at the age of 26 and on his first campaign, on the Renaissance battlefield, had the serendipity to stop using boiling oil to cauterize wounds and recognize that euthanasia of the mortally wounded may have been the kindest act to perform. In his autobiography Pare, looking back on a career of forty years of battlefield surgery he humbly said : I bandage, God heals.

So it would seem that bringing order to situations of confusion, fear and anxiety are the duties of every health professional: the duties of competence and compassion.

Medicine also has much to do with justice and injustice as the Hippocratic oath tells us. The ancient Hippocratic writings remind the physician to First Do No Harm. May I suggest in the hope that they will guide you, as they have generations of health professionals, the principles of Competence and Compassion, of Justice, of Equanimity, the duty to avoid harm, and the obligation to respond to suffering. We must always take care of patients in the context of hope. Even at the end of life there must be hope, not necessarily for cure and recovery, but perhaps for an easy memory or an easy death. Every patient hopes to remain in control. Everyone needs dignity; but loss of control and of dignity are too common when we fall ill and as we age.

In my first week as an intern some fifty years ago at Roosevelt Hospital, I was assigned to an attending Doctor Henry Schaffeld. I found him in a patient's room. The patient was sitting up in bed, looking emaciated and very uncomfortable as he struggled for air. Doctor Schaffeld introduced me and I learned that the patient had won a silver star in the Pacific War against Japan and that he was the mayor of a city in Connecticut. Outside the room the attending told me that the patient was dying of a widespread lymphoma and in great distress and he taught me a lesson that I never forgot. He said in such a case you order as much morphine as needed and at the frequency necessary to stop all discomfort unless respirations fall to less than six per minute. This was my first introduction to terminal sedation. Over the years, and especially during the AIDS epidemic in the 1980's and 1990's, I would come to learn that there are situations in which the physician may have to do more than terminal sedation to ease a patient's suffering.

Some years later a colleague from the English Department at my university asked me to take over his care. Franklin was a renowned Shakespearean scholar; but he also had a pancreatic cancer and he was dying; but he wanted to return to Europe and to Paris for one last visit to cities, cathedrals and museums that he had loved. I was worried that on his travels and far from home that he would be in pain, although we had arranged for him to receive chemotherapy at the Pasteur Institute in` Paris. Before he left I gave him a bottle of 150 Demerol Tablets, an opiate that we often prescribed at the time. He returned a month later, but first stopping off in Chicago to visit the Chicago Art Institute and after a short stay in our hospital, went home and died two weeks later. Remember that this was before Hospice, Palliative Care and Biomedical Ethics Committees were common. His wife then called me to say, "David, please come and take away his left over medicine." I returned to their home and found the original bottle of Demerol. How many tablets do you think were left of the original 150? Yes, 150. He had never used a single one. Why? Because when people are trusted they have control. And control is necessary and essential for each person's Dignity. It has long been my impression that patients who have the means to end their own lives peacefully are much less likely to do so than patients who have no easy means.

I have needed the arts and humanities to function as a physician. I also needed to make the time to run or swim each day. These days my wife and I just walk. Each one of you must find his or her own solution, your own healing private space. Whether it will be in philosophy, art, history, literature, dance or music, yoga, baseball, fishing or whatever, you must find that space for enriching your imagination with stories and experiences that resonate with those of your patients. That will help you to be a better physician or scientist.

So let me end with a story in a lighter vein, one that you might even remember.

You may have heard that those who live in the mountains live much longer lives than the general population. Editors at a New York paper wanted to learn more about healthy aging so they sent a reporter to Appalachia, as there are few high mountains near New York City. The reporter spent days driving up and down mountain roads visiting villages and hamlets until he found the most elderly, old man sitting in a rocking chair on a cabin porch. "Good sir", he said, "may I ask you how you came to live to such a grand old age"? "To tell the truth", he replied, "I smoke three packs of cigarettes a day, I drink a bottle of whiskey every afternoon and I have sex every night". " My but that is extraordinary! Can you tell me how old you are"? "Well" he replied " I am twenty-six!"

I wish you all the best, good luck and above all to enjoy your wonderful new future!



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