A graduation address for the COVID-19 era

If you watched your child graduate this year, as I did my older son’s junior high school ceremony at the end of May, you most probably did so online. The same for my participation in the virtual graduation liturgy for Georgetown University School of Medicine’s Class of 2020, which included 17 family physicians who start their internships in July. Two years ago, I was inspired to write about Dr. Atul Gawande’s moving graduation address to UCLA’s newest specialists. This time, I turn the clock back to 2012, when Dr. Don Berwick addressed Harvard Medical School’s graduating students; his speech later appeared as an paper in JAMA’s A Piece of My Mind.Dr. Berwick, as longtime books of Common Sense Family Doctor know, is one of my heroes. I ultimately had the opportunity to meet him in person in early March, when he handed the Georgetown University School of Nursing& Health Studies Values Based Lecture. He recently captured the essence of that talk about the “Moral Determinants of Health” in another JAMA essay that is well worth reading, but in this post I will focus on “To Isaiah, ” his Harvard graduation address from eight years ago.Isaiah is the name of one of Dr. Berwick’s past patients, a Black teenager from the Roxbury neighborhood of Boston who developed acute lymphoblastic leukemia and received the “the best of care … the glory of biomedical science, ” including chemotherapy and a curative bone marrow transplant. But biomedical science – then and now – proved to be no pair for privation and anguish: Isaiah inhaled his first drug at age 5. He got his first shot before 10, and, by 12, he had committed his first armed robbery; he was on crack at 14. Even on chemotherapy, he was in and out of police custody. For months after his displace he tricked me into additional drugs for drugs, which he hoarded and probably sold. Two of his five friends were in jail–one for slaughter; and, two years into Isaiah’s treatment, a third brother was shot dead–a handgun explode through the breast door–in a drug dispute . … His world was the street corner and his range was only one day apart. He hated it, but he saw no way out. He formerly told me that he fantasized his leukemia was a blessing, because at least while he was in the hospital, he couldn’t be on the streets. And Isaiah died. One night, 18 times after his leukemia was antidote, at 37 years of age, they found him on a street corner, breathing but brain-dead from a lengthy tumult from uncontrolled diabetes and even more uncontrolled despair . … Isaiah, my case. Cured of leukemia. Killed by hopelessness.Dr. Berwick went on to tell HM’Ss Class of 2012 that Isaiah’s story demonstrated that they had two offices as new specialists. One, to “go to the mat” for their patients, always putting their needs firstly and proposing for health care to be recognized as a subject of human rights in the United District. The second function was “more subtle – but no less important”: Maybe this second is not a imperative that you meant to embrace; you may not welcome it. It is to cure , is not merely the killer leukemia; it is to cure the killer abuse . … One million American children are homeless. More people are good in the United Commonwealth today than at any other time in our nation’s history; 1.5 million American households, with 2.8 million children, live here on less than$ 2 per person per day.I am not blind to Isaiah’s responsibilities; nor was he. He was mortified by his lacks; he fought against his addictions, his disarray, and his lures. He tried. I know that he tried. To say that the cards were stacked against him is too glib; others might have been able to play his hand better. I know that; and he knew that.But to ignore Isaiah’s condition not of his select, the glean of intolerance, the imperfection of the safety net, the vulnerability of the poorest of the poor, is simply wrong. His survival depended not only on proper chemotherapy, but, equally, on a merciful culture . … Isaiah, in his legions, needs those in power–you–to say to others in influence that a nation that fails to attend to the needs of those less fortunate among us threats its person. That is your duty too.Our nation’s health care professionals have been “going to the mat” to treat patients with COVID-1 9 for the past four months. In doing so, hundreds have already lost their lives. To their approval, the Congress and the President rapidly enacted legislation to reduce obstacles to coronavirus testing and care created by our patchwork health care system, where at least 27 million are uninsured and tens of millions with insurance still cannot afford to see a doctor or pay for indispensable remedies. Thus far, there has been no similar national initiative to eradicate injustice, even as millions have quietly protested incidents of police violence and parties of all hastens, from all places, have signaled support for the Black Lives Matter movement.Doctors have participated in numerous asserts, guiding some to description them hypocrites because of the real possibility that the protests could intensify COVID-1 9 society spread( though early receives from Washington State show that their contribution has been minor as compared to indoor social gatherings without disguises ). Thus far, the Washington, DC metro area is one of few in the two countries that has seen a sustained decline in cases despite vast protests and tear gassing of protestors. But as imposing a public health problem COVID-1 9 remains, it pales in comparison to the morbidity and death toll of intolerance, social sin, institutionalized prejudice, and poverty – all factors which have fed the pandemic and contributed to the disproportionate devastation the virus has caused in communities of color. To respond to Dr. Berwick’s “second duty, ” it is absolutely right and appropriate for all physicians to take a knee against injustice, and to use the power of our medical measures to move our political representatives “go to the mat” for the most vulnerable Americans.

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