Indian Country

By Dr. Arne Vainio
News From Indian Country 12-08

I was asked to be the keynote speaker at the White Coat Ceremony for the UMD Medical School Class of 2012 last month. The white coat symbolizes a lifelong commitment to medicine and service to community and patient care; putting it on for the first time in front of family and friends is a proud moment.

What do you say to someone just starting out on the greatest adventure of a lifetime? Something like this:

“Congratulations. You are fortunate to be in the position you are now in. Not because you finally finished college. Not because you will make a comfortable living. Not because you were chosen over so many others for acceptance into medical school. You are fortunate because you get to follow your heart’s desire. You get to work with the smartest people you will ever know, every single day. People who care about others and about the greater good. Not just doctors and other medical providers, but nurses and pharmacists, lab and x-ray technicians, social workers, counselors and others. Not everyone gets this opportunity.

“This will be a busy time; medical school will consume your waking hours and even come into your dreams. It will distance you from loved ones. No one in your family will understand this, your friends won’t understand this. Only someone who has been through medical school can possibly understand the stresses you will be under, the constant pressure to excel, the desire to learn everything there is to learn.

“But you can’t learn everything. Even after 18 years, I still consider myself to be a medical student. I learn something new every day. Sometimes from reading, sometimes from other doctors, sometimes from students, but most often from patients.

“You will be terrified. A delivery gone bad in the middle of the night, an operation that doesn’t go the way it should have, an unstable patient getting worse in spite of everything that can be done. You will feel alone at these times and will need to fall back on the education you receive here.

“The last time I was terrified was a few weeks ago. It was a difficult delivery, with a baby girl who came out limp, gray and not breathing. Eighteen years ago, when I was in your position, I made a promise to that little girl that I would do everything that I could, would use everything that I learned to make sure she would survive. I kept that promise to her and she went home with her parents after 2 days in the nursery.

“When you put that white coat on, you make the same promise.

“You will see death. It will strike elders, but it will also strike those who are young and healthy. Cancer, accidents, overdoses, homicide and suicide. No one can stop death, but we can prevent many from happening. Stroke, heart attacks, kidney failure, pancreatitis and congestive heart failure. Managing chronic illnesses: diabetes, hypertension, obesity, high cholesterol and heart disease are vital. Prevention programs for chemical and alcohol abuse, smoking and domestic violence will help many.

“Sometimes, your job will be to make sure that someone’s passing is as easy as you can make it. This is one of the hardest times for families, you will be needed to ease that pain and make sure everyone understands what can and cannot be done. You will need to answer the hard questions, even if they are directed at what you could have done differently.

“You will see strength. A patient with a terminal illness facing death and caring not about herself, but about her family and making sure everyone else is supported. Someone else rising to the challenge of a family tragedy, another finally beating the addiction that has held him down. Strength will come to those you least expect it from at times, this will never cease to amaze you.

“You will make mistakes. A missed screening test in a patient that doesn’t come in often, or comes in for acute issues and you never get to address screening for cancer or other diseases. You will always second guess yourself at these times, but you will need to keep the lessons learned and strive to be better, always better. This is the only way to honor those mistakes.

“You will know love, laughter and beauty. You will be an integral part of families and will have the trust of everyone from children to great grandparents. You will be the one who got them through the tough times and who was the strong one when they needed strength. You will be the one who gave them direction when they needed guidance and answers when it didn’t seem like there were any. You will be the one who delivered their babies.

“You will be trusted because you walk in the footsteps of all the physicians who have come before you. You have become a part of a profession overall known for its integrity, honesty and ethics. Others will walk in your path long after you have gone and will be trusted because of your actions. This trust will not only be expected of you professionally, but in your personal and community life. You will be looked up to by children, students, parents and grandparents. You will need to be worthy of that trust.

“When you walk into the exam room, you represent your family and your people. You walk in as the tip of an arrow, with all of your ancestry behind you. Ancestors you never knew will be proud of you. Their struggles and sacrifices allow you to walk into that room. Many of you will be the first doctor in your family, others will be following family members who are already physicians.

“Regardless, medicine is a family in and of itself. We will need to support each other and teach each other about our cultures and values. Our strength lies in our diversity.”

“Welcome to my family. Welcome to OUR family.

“Do us proud.”