Hi Everyone:
Here’s an edited excerpt of my remarks from last night’s graduation:
We’ve reached the part of my speech where I’m supposed to impart my wisdom unto you. The presumption that I can do so assumes I know something about your futures, which I don’t.
2026 marks thirty-five years since my own residency graduation. As luck would have it, I heard from one of my dearest residency classmates this afternoon, Frank Anania. Frank is a hepatologist who was Chief of Digestive Diseases at Emory for many years before joining the FDA. As I was preparing these remarks, he texted me to share the news that he had won a Distinguished Service Award from the AASLD, which is one of those recognitions you get for a lifetime of contributions. It’s been a joy over the years to stay in touch with Frank and other classmates, and I can promise you, as you look around this room tonight, at your own friends and classmates, this joy awaits you too.
But back to my graduation…In July 1991, I began a year as an emergency room attending at Pennsylvania Hospital. There was no EMR back then. We were working through some of the darkest days of the AIDS epidemic and had available only one modestly effective drug, AZT. We managed ARDS patients with tidal volumes that make me cringe today—10 cc/kg—and it would be another 10 years before we realized we were killing patients with our ventilator settings. We had few treatment options for lung cancer, AML, and other malignancies managed effectively today. The same was true for diseases like pulmonary hypertension, inflammatory bowel disease, lupus, and addiction. Many of today’s state-of-the-art therapies—from GDMT to CAR-T, PD-1 inhibitors, GLP-1 agents, biologics for asthma, and CRISPR—were beyond our imaginations. And who could have predicted we would now be using artificial intelligence to design effective treatments, such as Rentosertib, for IPF?
I do miss some aspects of 1990s medicine. Patients had fewer diagnoses and, consequently, smaller charts. Departments were a fraction of the size they are today, which made it easier to build community. We were less tethered to computers, and the iPhone hadn’t been invented yet, so we had fewer interruptions. In the absence of an electronic medical record, we took pride in concise, thoughtful notes (though, admittedly, many of us had indecipherable handwriting). At night, the hospital was quiet, even peaceful. We were comfortable doing our own gram stains, retinal exams, U/As, joint aspirations, central lines, and “taps” of all kinds. We may not have been as skilled as today’s experts, but we savored the satisfaction of self-sufficiency.
But this is a safer and more hopeful time to be a physician. Your access to knowledge is orders of magnitude greater than the information contained in the spiral notebook I kept in my white coat pocket. You can answer almost any question instantly in OpenEvidence, UpToDate, and Yale-New Haven’s Care Signature Pathways. You have effective therapies for conditions my co-residents and I considered lethal. You’ve become adept at POCUS, and your commitment to patient safety, clear communication, and patient-centered care is proof of medicine’s growing commitment to quality. We’ve also learned that to care for patients well, we must care for ourselves. For these reasons and more, I believe this is the best time in history to be a physician.
But to be honest, I thought I was graduating at the best time in history too, so I wonder what you might say to graduates 35 years from now. Will you tell them that in your day, patients still died from cancer and heart disease? That we still relied on human donors for organ transplant? Or that we viewed the microbiome, gene therapy, and AI as cutting edge?
But here’s what I know for certain: You will be called upon to put your patients first, no matter what the competing demands. You will be called upon to advocate for medical science in the face of uninformed skepticism. You will be called upon to defend the marginalized and less fortunate against insularity and xenophobia. And despite all the miraculous medical advances to come, we will not find a cure for death; and so, you will be called upon to be physically present, to listen, to heal, and to be compassionate—in the best tradition of medicine—when technology reaches its inevitable limits.
And finally, should I still be around in thirty-five years, at age 98, I hope to be here with you, taking pride in your accomplishments, your contributions to our field, your innate kindness, and your dedication to the health and well-being of our patients.
Congratulations to all of you!
Enjoy your Sunday, everyone. This afternoon, we’ll be recreating last weekend’s wedding ceremony for my mother-in-law at Seacrest in West Haven.
Mark
P.S. Intern orientation starts Thursday, June 11, with pizza in Amistad Park.
P.P.S. Congratulations to last night’s award winners:
- Outstanding Preliminary Intern: Santiago Clocchiatti-Tuozzo
- Rotating Intern of the Year: Christopher Nguyen
- Sam Kushlan Award (PGY1): Caitlyn Brashears
- Sam Kushlan Award (PGY2): Johnny Allsop
- Stephen Shell Award (PGY3): Abdel Abushouk
- Fred Sachs Award (PGY3): Abigail Marriott
- Marcella Nunez Smith Award for Antiracism in Medicine: Emily McNeill
- Yogesh Khanal Global Health Leadership Award: Wayne Wong
- VA Firm A: Allie Cao
- VA Firm B: Ahmed Ahmed
- VA COE: Christina Cotte
- Laura Whitman NHPCC Award: Dorian Kaminski
- Janet Henrich Award for Leadership in Medical Education and Equity: Amelia Khoo
- Christopher Phillips Servant Leader Award: Rohanit Singh
- Fred Kantor Teacher of the Year Award (YNHH): Nikolai Podoltsev
- Asghar Rastegar Teacher of the Year Award (VA): Michael Arcieri
- Fellow of the Year Award: Alexandra Schwann
- Jack Hughes Ambulatory Teaching Award (VA): Cindy McNamara
- Luz Vasquez Award for Humanism (VA): Delly Alcantara
- NHPCC Teacher of the Year Award: Benjamin Gallagher
- NHPCC Humanism Award: Gretchen Berland
- Fair Haven Community Health Center Teacher of the Year Award: Mario Ochoa Prieto
- Partners in Care Award: Laura De Vaux
- Staff Award: Seanna Watson
P.P.P.S. What I’m reading and listening to:
- The Last of the D-Day Veterans By Kevin Maurer
- For 90 Minutes, I Watched an Execution Go Horribly Awry By Maria DeLiberato
- What a Week in the Hospital Showed Me About Our Broken Healthcare System By Gregg Gonsalves
- Use It or Lose It By Adrienne LaFrance
- Think for Yourself By Dan Chiasson
- What 400,000 Essays Reveal About AI and Creativity on Plain English with Derek Thompson
- Mark Siegel: The Craft of Teaching Doctors On Health & Veritas with Harlan Krumholz and Howie Forman