boy meets world

Cal started fourth grade about a month ago, which would usually be my cue to say, "Can you believe it?" but every time I say something like that I think about that Tig Notaro bit and feel a little bit stupid.

Anyway, fourth grade. It's going pretty well so far, at least academically, but I think we've entered the age where we really need to start watching his friends and keeping on top of their activities and interactions. And while this all would likely be true regardless of the existence of Minecraft, it sure doesn't help.

For those of you blissfully unaware (meaning you know no kids between the ages of, oh, say 5 and 21), Minecraft is a video game, and to call it a generational obsession would be understating things somewhat, like calling Pol Pot a pretty mean guy. I agreed to get the game for Cal because it seemed innocent enough--basically an open-world action adventure game, building things with blocks, resource management, that sort of thing--and more to the point I didn't want him to be some sort of out-of-the-loop freak if every single other kid in his class was playing this game and he wasn't. I know, I know, if all your friends jumped off a bridge, etcetera etcetera, but since he's a year or two younger than his classmates we try to be particularly sensitive about allowing him the social tools to be one of the gang more easily. Because if we didn't let him play Minecraft? He'd be, like, THE ONLY ONE. And I just hate to think about him being the pop culture equivalent of the kid whose parents don't let him eat sugar, and brings, like, unsweetened carob cakes in for his birthday, you know?

So anyway, we let him play Minecraft (which he's only allowed to play on the weekends--we still have rules and standards up in here after all), he plays it, he loves it, everyone is happy. And every time I pick him up from school all he wants to talk about is MINECRAFT and everyone's special strategies in MINECRAFT did you hear about the newest thing in MINECRAFT? And William? Told me that there's a mod? That you can put Star Wars skins on your MINECRAFT server? And also one time? Thomas was building a house and two creepers snuck up on him but then he used his leather armor and threw a sheep at them and then he fell into a trap in the nether? And it was SO FUNNY!

(I'd like to think the game makes more sense than this but suspect that it doesn't.)

Except one day I walked by when he was playing Minecraft and I noticed that there was this scrolling chat box open at the bottom of the screen, with these other randos talking to each other while they were all playing. (I'm no video game enthusiast, but I think there are similar things in most video games that you play cooperatively with people online, games like "Call of Duty" and of that ilk). Those of you familiar with such games probably won't be surprised to hear this, but the back and forth taking place in this chat box? Awful. Terrible. Slurs! Swearing! INCORRECT SPELLING.

"Cal," I spluttered, "what is all this going on at the bottom of the screen?"

"Huh?" He looked down. "Oh, I didn't see that. I'm not really sure. I think that's other people that are playing on this server. It's my friend Archibald's* server, he invited me to join when we were sitting together at lunch last week."

"OK, but who are these other people? Do you know them? And why are they saying all these terrible things?" For lack of any other better solution, I just covered the chat box with my hand.

"Oh, I don't know. I guess they're Archibald's friends. Or other people that joined his server anyway. I haven't really been looking at it. What are they saying?"

"NOTHING. They're saying NOTHING. But can you turn this screen off? Hide it in some way? Or better yet, why do you have to play on someone's server at all? Can't you just play by yourself? Play by yourself and do something peaceful, like build a diamond...zombie...hut...or something?"

So anyway, Cal turned the chat function off, and then we had a talk about not playing with people online unless he really really knows them personally and he's preferably in the same room as them. I also said he was never allowed to have the chat function on again, ever, because: INAPPROPRIATE.

He's still young and relatively naive, so I know this is just the beginning. And while I'm obviously not going to be a super-paranoic about the use of the internet and social media (see: this page you're reading right now, and the existence thereof) I am a little apprehensive, despite the fact that we have a pretty tight lid on his screen time and computer habits and who he spends his time with outside of school. Because what's it going to be next year? Or the next? Or even forget the computer--what are he and his friends talking about in person at recess? In carpool line? At their sleepover parties?

(Yes, you're right--they're probably talking about Minecraft. Because Hayden? Said one time? He got a pile of gold? But then a zombie came and fell into this lava moat that he made around his house? And then someone hacked into his server and stole his diamond armor! It was epic!)

Cal is eight years old now, which is the age that most kids start to form stronger and stronger ties with people outside of their families. So I have to let him do that, but it's hard not to worry, because even though we know his friends and know their parents, that act of sending your child out there into the world can feel like feeding a lamb to the wolves. Because we can't always be there, and we can't always filter, and can't always catch the chat box before they see it and cover it with our hand. We just can't. That's what raising a child is: getting them ready so that they will be OK without you.

In my mind Cal is kind of a low-maintenence child, in that's he's old enough now to fend for himself and his personality is generally allergic to trouble-making. (He's actually kind of a people-pleaser to an almost unfortunate degree, in that even the hint that he's transgressed in some way makes him start to get teary and apologize--at school, anyway.) But nonetheless, I'm glad that I'm going to have a little more time to spend with him now, not just in spite of the fact that he's older and becoming more independent, but because of it.

-----
* Not his real name, OBVIOUSLY. I actually have not ever met this kid before but I have encouraged Cal not to play on his server anymore because aside from the obvious reasons I detailed above, apparently he regularly stays up until midnight playing Minecraft on school nights and what parent lets their nine year-old kid do that? 

the chamber of secrets

Cal did two weeks of "Danger Camp" this summer (basically a summer day camp program based on this book) and came away with it not only with the requisite mosquito bites and tie-dye T-shirt, but also with an enduring passion for spying, ciphers, espionage, and general subterfuge. It's all highly contagious, and while Mack will deny this to his last breath he idolizes Cal beyond all measure so whatever interests Thing 1 has rapidly become the interests of Thing 2.

Separate and mostly unrelated: we currently live in a three bedroom house, which while by New York standards is an embarrassment of bedrooms (and square footage), means that under current occupancy patterns, we have neither a guest room nor a room for Nina to decamp.

THEREFORE (and this is where the two threads come together) we are working towards the goal of consolidating both boys into the same room. We already have a bunk bed in Cal's room so we're halfway there (it's even a twin over a full so that Mack will be, what, 50% less likely to end up on the floor?) but even so, it's a transition that is sure to be met with some resistance, at least initially. So we're selling the idea by billing these new shared quarters as the SUPER-DUPER BOYZ HANGOUT ROOM. Jazz hands! And one of the ways that we thought we could make the room cooler? By building a secret clubhouse inside of it.

Cal's room has three small closets, the middle closet of which has a lofted crawlspace, about two and a half feet wide, thirteen feet long, and maybe four feet high. We'd been using this space to keep a variety of larger items that we had nowhere else to store (as we have neither garage, basement nor attic space); things like our Christmas decorations, moving boxes, an old set of doors from the laundry room, what have you. We still have no place to store these things, and in fact, all these things are kind of sitting out in the family room now until we find a better place to put them. But lack of storage aside we figured screw it, let's just empty out the crawl space and turn it into a clubhouse. A SUPER SECRET RAD CLUBHOUSE FOR BOYS. No Homers allowed!

The first thing we had to do, after we emptied the closet out, was change the light fixture. Being a closet, all it had was a single bare bulb hanging from the ceiling with a pull-chain cord, which was obviously hazardous, what with the risk of anyone walking into the burning bulb with their face. So we took out the light fixture, capped it off, and put in an outlet instead. (I say "we" but when I say "we" I really mean the electricians did it and I watched, encouraging them with the thumbs up sign and offering beverages for their troubles at annoyingly frequent intervals.) After the electrical work was done, we vacuumed and washed the floors (and I apologize for the lack of any really good "before" photos because you have to understand, it's basically a railroad car-shaped space, there's really no room to get a good shot) and got to work decorating.

One thing that Joe really wanted to put in there was a full-wall panel of dry-erase board. A dry erase board that size (about four feet by six feet) would easily cost more than a hundred bucks, but we did it on the cheap by going to Home Depot and getting a panel of fiberboard with one side of white shiny coating (not sure what the coating is but it is smooth and slick, like melamine) and getting it cut to 48 inches, which was the length of the wall on one side of the clubhouse door. The whole panel of fiberboard cost something like $12.99, and after getting it cut, we ended up with two fairly large pieces of whiteboard material--I still have to find a home for the second piece, because I guess I'm too much of a cheapskate to throw it away. The only drawback to this is that the dry-erase board isn't magnetic like some of the more expensive "real" whiteboard options, but in the big scheme of things and especially given the price differential, I don't think it's a big deal.

My big contribution was the lighting. Mainly the concern was safety. Joe had wanted to install one of those recessed can lights up in the ceiling, but I just kept having visions of the kids burning their heads or their hands on the bulbs, as the ceiling really is very low in there--Cal can't even stand up straight without his head grazing the ceiling. Another issue is that as a closet, the ventilation in the clubhouse space isn't very good. We already put a fan by the door to move some air in there and I have talked to the boys about leaving the outer closet door open, because as an anesthesiologist I am somewhat paranoid about CO2 rebreathing. (That scene from "Apollo 13" where the astronauts have to make that new CO2 filter out of, like, a sock and some duct tape? THE STUFF OF NIGHTMARES.) Anyway, my point to the lights is that anything incandescent would heat up the space quickly. I originally thought about a string of low wattage Christmas lights, but then I found these:

Tape lights! (Not "tap lights". TAPE lights.) They're LED and energy efficient, bright, cool to the touch, and super-easy to affix, as they are literally backed with 3M tape so you can just stick them up wherever you want. And best of all?

They change color! They even have flashing and strobe effects, which is not my favorite setting (I kept waiting for someone to start seizing in there) but the kids certainly enjoyed pushing all the buttons. I mean, no kidding, right? THERE ARE BUTTONS? WE MUST PUSH THEM. Anyway, we got two sets of 16 feet each, which was enough to go around the entire clubhouse once with a few feet to spare. We actually like these lights so much we ordered another two sets to rim the bunkbed with, so the kids could use them as reading lights in bed. (See also: the awesome factor.)

We rounded out the room with a berber carpet remnant we had lying around from carpeting the bedrooms when we first moved in (coincidentally the one strip we had was almost exactly the dimensions of the clubhouse space--we just had to lop off a few inches in width to make it fit), two beanbags from Target, a few superhero posters, and a world map from National Geographic. Et voilà.

The name of the secret club, by the way, is SECRET CLUB MOM AND DAD NOT ALLOWED (S.C.M.D.N.A. for, uh, "short") and after surveying the finished product, Cal and Mack promptly kicked me out, which I consider a successful end-result.

Hope you're having a happy Labor Day weekend!

straddling

I had to take our minivan to the dealership for a physical (I don't know--what do you call it when you have to take your car in for a visit to the car doctor? A well-car check? I plead ignorance and this parenthetical is now threatening now to take over the whole intro) and at the dealership they have honest to god carrels in a room off the waiting area, like a damn library. On one hand--how great! A quiet area with a desk and a chair and a power outlet to get some actual work done! And on the other hand--how long do you expect that I'm going to be sitting here, exactly?

Well, nothing like a stretch of captivity to force you to update your foundering blog. Ahoy hoy.

Last week was my last week of working full-time. My first "official" week of working at a 60% schedule is actually the week of Labor Day, but I had this week fortuitously scheduled as a week off from almost a year ago, like I planned it this way the whole time, for transition. It's not so much a vacation as purely a maintenance period for our family (MAINTENANCE! That's the kind of car visit I'm at now! Le mot juste!) meaning yesterday I took Mack to the dentist and tomorrow I'm taking Nina for her one year well-child check and now I'm here looking at a wonderful hubcap display and wondering if I should get purple under-light effects to make our suburban splendor-mobile that much more splendid. I mean, it seems excessive and yet this pamphlet makes such a compelling case for them...

I am so excited to enter this next phase of being more engaged or at the very least present for my out-of-hospital responsibilities, but I acknowledge that various internalized cultural attitudes have been a little difficult for me to shake. Namely, I find that I really have to check myself from being too defensive when people talk to me about my part-time status. 

JOE

(As we are engaged in high-level strategy talks about managing yet another week of juggling 

call schedules, OR and clinic times, childcare, meal timing, and after school activities)

Man, this is hard. I can't wait until you start slacking off at work a little bit.

MICHELLE

SLACKING OFF?

JOE

I mean...not slacking...I mean...you know what I mean! Working less! Working less at the hospital!

MICHELLE

THERE IS NO SLACKING INVOLVED HERE. NO SLACK. 

ALWAYS WORKING! HARD WORKER ME!

Or possibly this:

CO-WORKER

So, you're going part-time, huh? Sounds nice.

MICHELLE

(Cautiously)

Yes...

CO-WORKER

Gotta go be mom. I get it. I wish I could do that.

MICHELLE

DO YOU THINK THIS WAS AN EASY DECISION OR SOMETHING?

BECAUSE IT WASN'T! NOTHING EASY! EVERYTHING HARD!

CO-WORKER

Uh...

(Starts backing away, feeling for the doorknob)

And also:

RANDOM PERSON

Hello--

MICHELLE

(Pointing)

AND YOU! I'LL HAVE YOU KNOW THAT I HAVE AN EXCELLENT WORK ETHIC.

RANDOM PERSON

Aha. Huh. Well, as I was saying, "Hello, and welcome to Target."

Anyway, sorry world. Obviously I am having feelings. It's like I'm all messed up on my Erikson's stages. Instead of "Generativity vs. Stagnation" I've regressed back to "Identity vs. Confusion." (Also, can we all acknowledge that the fact that I even remember any of this from second year med school psych is pretty fucking impressive? OK, not so impressive, but notable at least.)

I don't know why I default to the defensive--maybe I need to prove to myself and everyone that I'm not "slacking off" or "opting out" or taking some slow boat to Shangri-La. Not that anyone has implied that, I think it's pretty clear that going part-time at work amounts more to scaling back on one type of (rewarding, highly-paid) work and scaling up on another type of work which is both unpaid and elicits a less direct, calculable form of appreciation. Not that I need my head patted constantly, but I think many of us have experienced the Moebius strip that is the endless cycle of keeping a three-kid household running smoothly, and how the loss of old workday landmarks can make things both easier and harder.

I know I'm probably stomping all over the landmines with this but just hear me out, I'm sitting in the backroom of a Toyota dealership waiting for them to finish checking my brake fluid or god knows what else so this is a bit of a rush job. I realize that my defensiveness is just part of my natural adjustment to our new situation (see also: guilt at bringing home less bacon than I was before, particularly after many years of being the primary or equal bacon...herder) but this all makes me happy that I have the option to partially scale back as opposed to having to make a binary choice to be all in or all out. The identity loss I'd have without some career focus would definitely be traumatic, and I think that this option, the part-time option, might allow me the best of both worlds. That's the theory anyway, and hopefully once I see that, I'll stop alternately taking everyone's head off and showily doing one-armed push-ups to prove that I'm JUST AS POWERFUL AS I EVER WAS.

(Psychological problems! I has them!)

*          *          *

I was going to write some more stuff here, but in the interest of just getting this up and saying BLOG UPDATE: MISSION ACCOMPLISHED I'm going to save that for next time. My goal in general, by the way, is for there to be a next time more consistently, and to do a little more writing in addition to the other thousand things that I've been neglecting in the past year. And now I have no idea how to end this  entry so I guess I'll just put in this video of Nina lurching around because didn't you hear, she's a toddler now.  Unreal.

recalibrating

I know there's a touch of irony in adding this disclaimer given that I haven't updated this blog in, like, half a year, but: LONG ENTRY AHEAD.

There's a snippet of a cartoon I remember from my childhood--I can't remember if it was "Tom and Jerry" but if it wasn't it was in a similar vein--where a mouse is reclining in a hot tub. He's sitting back with his arms along the rim of the tub, maxing and relaxing as cartoon mice do, wearing that look of smug satisfaction he was prone to. (As an aside: I never liked Jerry. I always thought he was a real jerk to Tom, a cat who was just fulfilling his evolutionary imperative after all. Ditto Road Runner. Ditto those capering harpy kids that keep taking the Trix away from the rabbit. JUST GIVE HIM A BOWL, YOU ASSHOLES.)

So anyway, the mouse. He's enjoying the hot tub. He's relishing the water, the heat. But the water starts to get a little bit hotter. And a little bit hotter still. Suddenly it's not so comfortable anymore. Not hot enough that he wants to get out of the tub or anything, but just...hotter. He starts sweating. His fur starts getting a little frizzy (from the humidity, you understand). Then, finally, he turns around and notices the cat behind him, slicing onions and carrots to add into the now boiling water. (My memory of this part is not quite as clear, but the cat may have been wearing a chef's toque.)

I've thought of that cartoon clip a lot in the last year.

But let me back up for a second.

If you've ever followed this blog with regularity in the past (though I'm sure with my sporadic updates I've winnowed that number down to only the die-hardest of die-hards) you've probably noticed that I haven't had the time to write much of substance since I went back to work after my maternity leave last September, and that I haven't updated basically at all since December. The reasons are all those that you could probably expect: busy job, three kids, and the responsibilities and duties associated therein. The explanations are always boring because everyone's reasons for being busy are pretty much the same, but to put it in medical terms: it's just a matter of triage.

It's hard to know where the tipping point was--though I have to presume that it was at least in part associated with the addition of our much-beloved third child into the mix--but at some point in the last year, things started getting hard. Not impossible, not un-doable, but subtly, Joe and I started to notice just how tight things were getting. Time was tight, at home, with the kids, with each other. Emotional resources were tight. Patience was less of a resource we could reliably depend on. The days and weeks started becoming these things that we were enduring, rather than living, let alone enjoying. Again, the imagery from an old movie comes to mind--inmates in a prison, grimly notching off yet another day on the wall of their cell.

I don't mean to imply that our life is a joyless dirge--far from it. We love our family, we love our jobs. Even working the hours that we do, we try carve out quality time when we can--long weekends, holidays, family vacations where they fit in. We bolus our family time because our basal infusion rate is so parsimonious, but we do make an effort to compensate. And we liked to tell ourselves that this bolus dosing was sufficient, and it worked...not well, but well enough.

But it didn't change the fact that over the past few years, and over the last year in particular, the feeling of our everyday lives becoming something that we were tolerating started to feel more an more pervasive. When you only see your kids for an hour or two at the very tail-end of each day, only to perform the most basic of maintenance for them (bath! brush teeth! yell at them for not taking their baths and brushing their teeth quickly enough because I'm tired and they're tired and everyone's tired so LET'S ALL GO TO BED AS SOON AS POSSIBLE) you start to feel like you're consisting on a diet of discarded crusts in an otherwise empty pizza box. Maybe you can piece together a life in these scraps of the day, but split between three kids, it's simply not enough time.

Joe and I have been discussing for years our long-term outlook for modifying (read: decreasing) the work hours for at least one of us to have more time with the kids, and for the longest time, our party line has been: soon. We're going to do it soon. "Maybe in a few years or so," was the stock phrase. But there was always the next thing. We'll think about it when I finish my fellowship. We'll figure it out it when I get more settled in my job. We'll do it if I make partner in my group. Later. We'll do it. But later. Meanwhile, time marches on.

Then: I was talking with one of my partners at work a few months ago. He has four kids, the oldest of whom had just turned eight. "I just realized," he said as we were chatting in the front hall of the OR, sidestepping a stretcher careening down the hallway from the PACU, "that he's eight. In another eight years, he's going to be in high school, driving, getting ready to go to college. Half my time with him is already done. I mean, they come home after they go to college and all, but you know what that's like. It's not the same. Half my time of having my son in my house is over already."

There feeling that I had after having that conversation was not unlike being wrapped in a piece of wet burlap and gently asphyxiated. Because Cal was turning eight too. Half our time raising our oldest son in our home was done, and not only had this particular calculus not ever occurred to me, but looking back, I can't say I really know where those eight years went.

Because see, we've always lived like this. Cal was born when we were residents. His entire life--and thus of course, Mack and Nina's entire life too--we've worked. Both Joe and I have worked our tails off. We're not residents anymore of course, and some of the specifics of our jobs have changed from year to year, but the fact of it is that we each work on average 50-60 hours a week, more if we're taking weekend call, and although we've been saying for years that we were going to try to get more control of our work schedules to put some more time into our family life, it hadn't happened yet. The decision point was always pushed off down the road. Later. Soon. Not yet. Someday. And now Cal was turning eight and I have no idea how time passed so fast.

If I'm going to be completely honest with myself I'm sure some of this particular grim inertia was also linked to a perverse macho pride. I've always spoken a lot about work-life balance in medicine and how these antiquated notions, about doctors functioning as around-the-clock automatons sacrificing their personal lives for the greater good, would have to evolve along with the rest of the world. But I think that in some ways I felt safe championing the choice for others to go part-time because I myself chose to work full-time. You do what works for your family, everyone's definition of work-life balance is different. But saying it from the vantage point of someone with three kids and still worked full-time herself felt like a secure platform from which to proselytize, like I was somehow above reproach from people who might accuse all part-time doctors of being lazy or uncommitted. DO WHAT YOU NEED TO DO; BUT AS FOR MYSELF, I AM DOING ALL THE THINGS.

And to be honest, we were getting by. It wasn't wonderful, but it was OK. We were surviving. Maybe we weren't "living our best life" to invoke an Oprah-ism (and I don't even know how I know that since I never even watched Oprah) but...day to day, we were getting by.

And then, the week before Memorial Day, our nanny of five years quit. With no warning, and giving zero notice. She just left one day and mentioned on her way out the door that she wasn't coming back.

Boom. Game-changer.

I'm not going to talk too much about the nanny thing because frankly, after probably the most stressful two months of our lives, I'm just over it. It wasn't even so much the issue of finding a new nanny--though that, obviously, was a huge part of solving our problems, at least in the short term.  But the larger and more important part was having to honestly evaluate our life, our choices, and just how much time we did indeed spend at work, away from our children. It was like turning the stark, faintly buzzing fluorescent exam light onto the fish-white underbelly of what kept things functioning at a level that passed as "OK" for the past five years. And what we realized was that: it really isn't OK. Having to outsource this much of our children's care--of our children's lives--to someone else, particularly someone who after five years could walk out on them without so much as a backwards glance...is not OK.

(This is putting aside the obvious logistical difficulty of finding a non-live-in person to work 50-60 hours a week. It's a tough sell to say the least. One suggestion, perhaps less helpful than most, was that we should just hire two nannies. To which my reaction was, if you have to hire two people to take care of your kids while you're at work, it's possible you're not spending enough time with your kids.)

So. Joe and I discussed and agonized and number crunched and evaluated. We talked to a lot of people. We agonized some more. And what's going to happen now is this: as of September 1st, I will be going part-time at my job. Joe and I would have been fine with either one of us working less, but because of the ways our jobs are structured, it makes more sense right now for the part-time working parent to be me. My new schedule will have me working three days a week, mixed in with my share of nights, weekend and holiday call. And my main goal for the other two days of the week? To do some of the things that I've never been able to do with my kids because I've haven't had the time. Simply to be around more.

I know this all seems unnecessarily melodramatic of an announcement to some, because plenty of people in a multitude of fields choose to work part-time. But for me, it is a big deal, because to be honest, when you're accustomed to following a prescribed path, swimming against the current for a change can be scary. And there are a lot of issues--job guilt, fear of resentment from co-workers or being perceived as less than fully committed to medicine, concerns about crippling my career potential--that I'm working through having finally made this decision. There's a fear of not wanting to let people down.

But that's it on the other side too, isn't it? I don't want to let people down. I want to do my job well. All my jobs. And I think that right now, I need to spend more time with my kids. Nothing's broken, I still love being an anesthesiologist, and the fact that I've worked full-time for the first eight years of parenthood wasn't the wrong call nor has it damaged our family. It's just that our choices then are not the same as our choices now, and when we have better options we owe it to ourselves to take them. We could be making more of this life. We could be doing better.

I'm not going to be there hovering in the periphery for every single second of my kids' lives, nor frankly should I be. But I'm looking forward to just being around more.

So that's what's going on with us. In most ways, it's really no big thing. But in other ways, it's the biggest thing.

Wright State University Boonshoft School of Medicine, commencement address, May 24, 2013

Good evening and congratulations to the Class of 2013!

I graduated medical school almost exactly ten years ago today (which sounds like a much longer span of time than it actually feels) so naturally when I started to write this address I thought back to my own med school commencement ceremony, or what little I remember of it.  Particularly I tried to recall the invited speaker we had that year and what pearls of wisdom he imparted, so that I could frankly plagiarize them and pass his pithy truths off as my own.

The problem is, I can’t remember anything he told us.

Our med school commencement speaker for 2003 was Jimmy Breslin, a reporter for the New York Post and certainly a more illustrious figure than I.  And he had a very well-written speech—I mean, probably he did, because again, I can’t remember—but all I really do recall is that he spoke a lot and he spoke for a long time.  And I remember thinking to myself, as I sat there in my academic regalia, sweating under the layers of polyester like one of those cook-in-the-bag microwave meals, that this man and his endless speech were the only things standing between me and my medical degree.

(He did eventually stop talking, by the way.)

I can’t convey to you what an honor it is to be invited to share this day with you all, which with the possible exception of this address, is likely one of the most important and memorable days of your life.  So when I sat down to write this speech, I had only two goals in mind.  First goal: to give you real advice that you can actually carry with you for the long road ahead.  And my second goal: keep it short.

Now, as a fourth year medical student, you probably already experienced the fact that the world is teeming with people all too eager to give you advice.  Much of the advice from senior doctors in particular will be strangely centered around when, how and if you should eat, sleep, and eliminate during residency.  (Clearly people have strong feelings about such things.)

But as a fairly junior attending physician myself, the idea of giving you all advice outside the realm of the purely practical does feel a little presumptuous.  The field of medicine is constantly changing—maybe now more than ever before—and I can’t pretend that I know what the future will look like any more than you can. Therefore, I only have one piece of advice, so as to make it easier for you to remember, and that is this:

Remember who you are in this moment.

And who, exactly, is that?  At this moment, you are a fourth year medical student, just minutes away from being granted your medical degree. You are proud, and you should be.  You are excited, and you should be. You are a little apprehensive about what comes next—intern year, residency, the hours, the new responsibility. That, you should be too, but I’ll not belabor the point—other than pregnancy, there’s no condition about which people like to recount horror stories more than medical residency.  Finally, and perhaps most importantly, you are still idealistic. I hope, at least, that even at the end of medical school you have retained the idealism that brought you into medicine in the first place.

And why did you go into medicine? I’m sure there are a host of different reasons, phrased in a number of different ways—but I think, and I hope, that it all boils down to this: you want to help make the world a better place, one patient at a time.  And right now, this seems like the most obvious thing in the world, the thing that has powered you through years and years of books and finals and 4:00am scut rounds done on no sleep and an empty stomach.  You’re doing all this not just for yourself, not solely for any kind of personal glory or reward, but to help other people.

Remember who you are in this moment.

Older doctors, particularly the more cynical ones, will speak of idealism as though it’s a bad thing, some sort of marker for naivite.  But I’m going to tell you this right now: idealism is never a bad thing.  And idealism seasoned with experience is maybe one of the very best characteristics a doctor can have.

Remember who you are in this moment.  A young doctor on the cusp of doing great things.  Some of these great things will be large acts, the majority of them will be small, but all of them will stem from who you are in this moment, who is someone with the energy, idealism and work ethic to make the world a better place.  With all the pomp and circumstance of this particular day and all those that preceded, it seems like the concept of service would be difficult to forget.  But believe me when I tell you that forgetting is the easiest thing in the world.  I have forgotten it many times myself.

Because there will come a night on call during internship when you’re going to feel beaten down and tired and regretful of having ever gone to medical school in the first place. And right when you manage to sit down, the first time that you’ll have had a chance to sit down all night, the charge nurse on that floor will yell at you for sitting in her special chair. And right then, you will forget who you are in this moment.

Or during residency, you’ll have a patient who will push all of your buttons.  And that patient will be loud and belligerent and unappreciative and will say things that make you feel inadequate even after the hours and hours of work you’ve put in trying to take care of him. That patient will make you angry, unsympathetic, and when that happens, you will forget who you are in this moment.

Or there there will come a time when you’re an attending, after you’ve been working late for the fourth evening in a row. This will be the one day that you have any hope of getting home to see your spouse and kids before bedtime, and right as you’re finishing up your dictations and ready to hit the door, an emergency case rolls in that no one can staff but you.  And that particular evening, you will forget who you are in this moment.

Cynicism is a protective adaptation.  It is a shell that doctors build around themselves after they feel that they’ve worked too hard, seen too much, been burned too many times.  It’s a way for doctors to broadcast to their colleagues and to the world at large that they’re so expert in the human condition that nothing surprises them anymore.

But don’t be that person.  Don’t be the cynic.  Be for the rest of your career as you are today, someone who doesn’t tuck your idealism away like an obsolete relic of your years in training, but proudly wears it on the lapel of your white coat. 

Be ready for everything you think you know now to change. Be open to new experiences. But always remember who you are in this moment.

Congratulations to the Wright State University Boonshoft School of Medicine Class of 2013.  Congratulations, doctors. May each of you have a long, fulfilling career filled with interesting patients, challenging days, and a lifetime of surprises. The rest of us have been waiting for you, and are so happy to have you join the team.

Now roll up your sleeves and get in here. We’ve got a lot of work to do.