Distinguished parents, family and friends, Dean Lisa Rosen-Metsch, distinguished faculty, thank you for allowing me to share this special day with you. To the post baccalaureate premedical class of 2019, congratulations on your graduation from the oldest, largest, and the most prestigious post baccalaureate premedical program in the United States. Many of you have already had great careers outside of medicine - in the arts, sciences, sports, and as entrepreneurs. You are here - not out pressure from a parent or a community or the lure of a financially secure occupation – You are here for the most noble of human reasons. “To apply for the benefit of the sick all measures that apply….To remember that there is also an art to medicine – and that warmth, empathy, and understanding outweighs the surgeon’s knife and the chemist’s drug.” You have arrived at the junction between the completion of academic prerequisites for entrance into medical school or another Allied Health Field - and the next chapter of your lives. That you arrived here at a time when the core values of our Hippocratic Oath are under threat from greed, and bigotry, and social injustice is no coincidence. Indeed, when I look at all of you here today and see the light of today’s accomplishment shining in your eyes, I have hope. I have hope because I believe Dr King when he said that darkness cannot drive out darkness, only light can do that – I have hope because I believe him when he said that hate cannot drive out hate, only love can do that. You see, it is not that people do not care; it is that their numbers are often insufficient to make a difference. Now more than ever, at time when America is at risk of becoming a post-truth society, you need to personify the light of love, to embrace your higher self no matter how hard this might seem.
So please allow me to share a story with you about embracing this higher self in pursuit of a dream. It is the story of Ezra, a young senior-year college student who came to see me with his mother for a second medical opinion. Ezra was diagnosed by another physician with Lou Gehrig’s disease and given 6 months to live. Lou Gehrig’s disease otherwise known as ALS or motor neuron disease, is a terminal disease that killed NY Yankee all-star player Henry Louis Gehrig. To me ALS is a most tragic disease – worse that any infectious disease, cancer, stroke or neurodegenerative condition I have treated. And yet there is widespread belief among neurologists that patients with this disease are always gracious and kind – so much so that we question the very diagnosis when a patient is disagreeable. ALS is incurable, untreatable, relentlessly debilitating with progressive paralysis of every visible muscle of the body. Only the eye muscles are spared. Behind this physical decline is a perfectly preserved mind, like a “corpse with living eyes1”. As a stroke neurologist I am used to seeing despair in the eyes of illness - to that lifeless look of dying patients. But this is not the case with ALS. Paradoxically patients with ALS look alive - with inextinguishable beauty in their eyes. What is the source of this gracefulness? Where is the well of this graciousness. How does a man who loses everything find a higher self?
Surveys of healthcare providers and caregivers of this disease using multidimensional personality questionnaires have consistently found higher scores in the niceness dimension of patients with ALS compared to patients with other terminal diseases. Indeed, Ezra personified this dimension. Five months earlier he developed progressive difficulty swallowing food due to weak and withering muscles in his mouth and throat. Next were his hands, which became so weak that he could no longer hold a pen or type on a keyboard in order to complete his homework assignments. Instead he depended on his mother to transcribe dictations of his answers and responses. Within weeks Ezra’s legs began to give way, and because his hands no longer functioned to the extent that he could hold a cane he became wheelchair dependent. I remember seeing him for the first time as his mother pushed his wheelchair through my clinic door. He was wearing a cervical collar with a chin pad to prevent his head from dangling forward due to weakness of his neck muscles. He looked emaciated. Even the fat under his skin had been used up, causing it to hang loose in folds. This made his face look wrinkled and old - even though he was only twenty-one years of age. The image of Ezra triggered memories of my days as a young doctor in Africa treating infants with a disease of malnutrition called marasmus in which the child loses his hair, and acquires the shrunken face of a frail old man. I found it hard to understand what Ezra was trying to say to me. His words were slurred and effortful due to weakness of his speech apparatus and difficulty drawing adequate breath in order to produce a clear sound. In fact, it took a full minute before I could decipher his gentle plea. He kept looking at me with those patient kind eyes, repeating himself until I finally understood his question. Can you keep me alive until my graduation? He asked. You see Ezra was the first in the family to go to college. He had made a promise to his mother that he would become the first in his family to earn an undergraduate degree. But now this dream was gravely at risk; his graduation was ten months away and it was my clinical opinion that Ezra had less than 6 months to live. But I withheld this clinical opinion. I held back because prognostication in medicine is based on probability and not actual fact; because I have learned that there is no worse death for a patient than the death of hope itself. Sometimes as physicians, our duty is not just to keep people alive; it is also to help them die with dignity.
Over the next few months the disease became even more aggressive. It worsened to the point where the painful spasms in Ezra’s paralyzed legs became unresponsive to the narcotics I generously prescribed. He no longer had the strength to sit upright in a wheelchair and was reduced to a life on a home hospital bed. It was not long before Ezra became mute, before he required the use of a communication device. A laser pointer was attached to a headband on his forehead, which he slowly directed at letters, phrases and words by shifting his head from left to right. For several hours a day, his mother helped interpret, painstakingly typing out responses to his course work via his laser and letter board. Soon Ezra’s breathing began failing, requiring supplemental oxygen through a mask that covered his mouth and nose. Even though I was powerless to prevent this tragic decline, I was inspired by his courage – his determination to graduate in that bedridden state - to unshackle himself from an incapacitating fate and reach beyond his grasp for an improbable dream. The end of Ezra’s life was free from the usual phases of death – denial, anger, bargaining, and the diminuendo of depression – rather it was a symphony of spiritual triumph; freedom from fear in the crescendo of affliction, as the edge of a cliff becomes a beautiful garden, and we realize that when all has been said and done, we are no different from leaves blowing in the wind.
Two weeks before he died, Ezra realized his dream. He received an email from his college congratulating him for completing all the credits required for his graduation. I know this because a few months after the funeral, his mother dropped off a thank you note and a copy of his diploma in my office. To be honest I teared up a little when I discovered the contents in the large brown envelope. You see sometimes being wrong can be one of the most beautiful experiences in life.
Victor Frankl, a holocaust survivor, described the gap between pain and suffering – the space between a stimulus and our response. While I do not always agree with some of Frankl’s more controversial practices during his subsequent career as a psychiatrist, I do agree when he said that what we do within this gap can dictate our growth and freedom. This is where we gain access to the heartbeat of our suffering and resume control. It is where Ezra broke free - how he was able to hold on to his dream.
When I was growing up in Africa, I met good people. For many of them a dream was eating a full meal or sleeping under a mosquito net. Most African children do not attend school – they just cannot. Adult literacy rates are well below 40% and the situation is even worse among women. For many Africans the greatest inheritance is resilience – the kind of resilience residing in the gap between pain and suffering.
Perhaps this is why I am grateful. Perhaps this is why I feel so fortunate. Not too long ago I was the lucky medical student who could afford to buy books and eat more than one meal a day; not because of my skill - but because of the zip code in Nigeria into which I was born. I still cast my mind back to those days – to the overpopulated slum on the outskirts of Lagos where my medical school was located. I still see the children playing in open sewers. I still smell the heaps of refuse beyond the moldy campus walls of my humble abode. I still remember mosquitoes swarming through torn nets of dilapidated lecture rooms in a hundred-degree heat. I still mourn the countless men and women and children I failed to save from diseases of destitution and social rejection.
And yet I am grateful. I am grateful because I found a way to enter the gap – to find the resilience to hold onto my own dreams. To find the Ezra within me. It was in this gap where I learned what true success is …. that true success is not defined by the size or scope of the work we do, but by our ability to hear the cry of one heart and respond to it. This is the reason for my gratitude. This is the reason I am living an improbable career dream. It is this definition of success that guides my approach to my every patient encounter; it is what inspires my scientific research into healthcare disparities; what motivated me to begin my Hip Hop Public Health Foundation to improve the health of underprivileged children; what fuels my love for the disenfranchised heart.
My advice to you today is to never relinquish your dreams - no matter how hard this is. To never surrender to fear - no matter how frightening the experience may seem. You see, fear is a tributary of vision, flooding the mind like a blood red sea, extolling retreat like an incantation. You must confront your fears on the highlands of self-doubt - and if you lose a battle here and there …..and you will …. realize this - that you are only growing in the gap, training in the valley - improving the skill with which you will wield your sword the next time around.
My dear graduates, the spirit of Ezra lives within each and every one of you. Find this higher self and channel it into everything that you do. For he who pours oil into the lamp fills the whole house with light2. This oil is your higher self. It is the key to making a difference. Find this higher self and never let it go. Use it to make a difference. Do what needs to be done to get there. Do it fast. Do it slow. Do it right. Do it in the daylight. Do it in the moonlight. Do it alone. Do it with others. Get paid to do it. Do it for free. Do it for yourself. Do it for the world.
Thank you and God Bless you all.
© Dr. Olajide Williams 2019
1 Alexander Dumas character description in The Three Musketeers
2Khalil Gibran “Love Letters” edited by Suheil Bushrui and Salma Haffar al-Kuzbari