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Another
school year, 100 new white jackets
Commencement speaker urges
PAs “to put authority to the test”
A welcome to Yale: Remarks by Dennis Spencer
NOTES
On White Coat day members of the Class of 2007 lined up in front of the
Sterling Hall of Medicine for the traditional class portrait.
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Another
school year, 100 new white jackets
On both sides of the podium, the start of the academic year marks a
new beginning.
For the 100 students in the first-year class, the annual White Jacket
Ceremony is a symbolic introduction to medicine and a welcome to Yale.
This year it was also a chance for Interim Dean Dennis D. Spencer, M.D.,
HS ’77, to introduce himself to the Class of 2007.
Spencer, who has led the medical school since July, described his own
journey into medicine, which started with a boyhood spent on a farm in
Iowa. Although he plowed the fields, he identified most with the local
general practitioner, just back from the Korean War. “He wore a
white coat, walked with a limp from a shrapnel injury, carried a big black
bag and drove an oversized black Cadillac around the countryside, literally—and
what appeared to be miraculously—saving lives, including mine, with
a newly discovered antibiotic, penicillin,” Spencer said.
In high school Spencer tried, unsuccessfully, to make an EEG amplifier,
and then resolved to become a physician. At Grinnell College and in medical
school at Washington University in St. Louis, Spencer followed his interest
in the nervous system, which led him to neurosurgery. Spencer came to
Yale in 1972 to begin a five-year residency and has led neurosurgery here
since 1987.
After sketching his own life, Spencer described the students. The 100
members of the Class of 2007, he said, have attended 46 colleges, earned
master’s degrees at eight universities and Ph.D.s at three.
He urged the students to embrace the Yale System’s emphasis on the
physician as scientist. “You must quantitatively understand the
physical- and biological-science underpinnings of the evolved human by
sharing the bench with our scientists and our clinics with clinical researchers,”
he continued. “You must wear the white coat comfortably in both
places, speak both the language of science and the language of caring.”
Margaret K. Hostetter, M.D., professor and chair of the Department of
Pediatrics, told the story of a white coat she first wore as an intern
in Boston and the reminders of individual patients stitched into its cloth.
“Today you will wear the white coat, and you too will see life’s
fabric torn, its texture raveled and its pattern rent. … And once
you’ve put it on, don’t ever take it off.”
—John Curtis
A welcome to Yale
“We are much more your colleagues with a little more experience,
than we are teachers to be placed on pedestals.”
Remarks by Interim Dean Dennis D. Spencer, M.D., HS ’77, at
the White Coat Ceremony, August 26, 2003.
Greetings to the double-oh-seven class. This is both a lucky number class
and, I suspect, a theme for your second year show (I expect to play Mother
and Dr. Angoff to play Money Penny). Greetings also to your parents and
our alumni. My name is Dennis Spencer and I have a brief introductory
speech which should be taken in the spirit of Mark Twain, one of my favorite
authors with whom I share both an origin in the Midwest and a move to
Connecticut. He said in anticipation of what I will say that “in
our country we have those three unspeakably precious things: freedom of
speech, freedom of conscience, and the prudence never to practice either.”
So who am I , your interim dean? You do need to have an answer to this
question when your parents and friends ask what is going on at Yale what
with worker unrest and new deans. I can provide some data that may serve
to either calm their anxiety or stimulate their concern.
Until July 1 of this year, I was the chairman of the Department of Neurosurgery
here at your future alma mater. Besides specializing in a field that treats
only 1 percent of the patient population, I am even more narrowly focused
on the field of surgery for medically intractable epilepsy, which includes
caring for a relatively small number of patients who suffer from a very
heterogeneous group of syndromes but from whom we have learned most of
what we know about localization of human brain electrophysiology and function.
All of my life’s work has been engaged in trying to understand the
mechanisms of this set of diseases, talking to the patient and sampling
with electrodes, chemical sensors and scalpel the living tissue that constitutes
their brain.
Interesting, but hardly the necessary qualifications for a dean, if there
are any, and, I must say, I have not seen them written down anywhere.
Balancing this very focused career path was a social background originating
in rural southwest Iowa. I was born on a small family farm homesteaded
three generations ago, the son of a farmer/electrician father and farmwife/grocery
clerk mother.
I plowed the fields but personally identified with the tall, young, solemn
G.P., raised in Kentucky and just back from the Korean War. He wore a
white coat, walked with a limp from a shrapnel injury, carried a big black
bag and drove an oversized black Cadillac around the countryside, literally
and what appeared to be miraculously, saving lives, including mine, with
a newly discovered antibiotic, penicillin.
At age 10, I wanted to be that man. However, at age 14, I bought a book
by Wilder Penfield, called Speech and the Brain Mechanisms and
this changed my life. Penfield was the first neurosurgeon with the audacity
and vision to believe that epilepsy, the sacred disease of Hypocrites,
could be localized by an ingenious device, the electroencephalogram (EEG),
and that then these stormy electrons physically extracted. On the way
to providing a cure for this devastating neurological disease, he localized
language and other functions by directly stimulating the awake brain during
these operations for medically intractable epilepsy. So, in high school
I tried unsuccessfully to make an EEG amplifier, and then resolved that
it was more than an ample ambition for a farm boy to become a good general
doctor.
However, through college and medical school the nervous system continued
to seduce and distract me and I eventually became a neurosurgical groupie
at Washington U., wrote my thesis (which was elective at Wash. U.) on
inter-hemispheric transfer of images in the Rhesus monkey, came east in
1971 to do my neurosurgical residency here under William Collins and in
1976 helped to crystallize one of the U.S.’s earliest epilepsy surgery
programs with a small group of neurologists, which included my wife, now
an internationally recognized epileptologist.
Most of you will also become specialists of one form or another. You will
define yourself by an organ or a disease, or even a protein or a gene,
but you must never forget that it is much more difficult to be that general
doctor who lives by Dr. Edward Trudeau’s maxim, “to sometimes
cure, often help, always console.” If you want to burn this into
your brain early in medical school, please join me, two or three at a
time to witness this tension between the art and the science of medicine
by spending some time in a very high-tech, computerized operating room
and a very low-tech, hands-on outpatient clinic. That’s the short
version of who I am, now who are you?
You, the 100 class members of 2007 are highly selected, having completed
119 undergraduate majors at 46 colleges, master’s degrees at eight
different universities, and Ph.D.s at three others. Your research spans
the biomedical sciences, the social sciences and the humanities, ranging
from HIV studies to stem cell research, to neurobiology, to orthopaedics,
to an econometric study of the effectiveness of Medicaid, to an analysis
of environmental toxicants in Harlem, to a doctoral thesis on Holocaust
poetry, and much more. You have been Fulbright fellows in Africa and Asia
and Rhodes Scholars at Oxford.
Beyond your academic accomplishments you are a group of men and women
with an unusual breadth of experience—a group that is quite difficult
to characterize in a few words. You include, for example, an advisor to
the International Gorilla Conservation Program in Kenya, a UNICEF health
and nutrition consultant in China and a volunteer in a Romanian orphanage.
You are Peace Corps veterans, high-tech entrepreneurs, journalists, and
teachers at all levels—from elementary school to high school to
college to delivering lectures at this very medical school. You have shadowed
physicians, served as emergency medical technicians and worked as interns
and volunteers in hospitals around the country and around the world, often
in the most challenging of circumstances.
You are also varsity athletes in several sports, some of you with national
championships and All-America credentials. You have among your members
musicians, actors and dancers who (one can only hope) might lend your
virtuosity to School of Medicine theatrical productions.
You, the Class of 2007 are also noteworthy for leadership roles in social,
political, religious, and professional organizations. You were born in
20 countries and, considering the relatively small size of the group,
represent a remarkable variety of personal backgrounds.
And now for the final questions, where are we and where are we going?
We are sitting in an auditorium in a medical school in New Haven, Connecticut,
but it really matters little where we are because it is a symbolic place
for a symbolic ritual to launch you into the most dynamic medical educational
system the world has to offer, “The Yale System.” You have
read about and listened to its description, which is what attracted you
to apply and accept the invitation to join our ongoing experiment in educational
freedom and responsibility. Those are the two words used most to define
our system, which is designed to motivate, guide and stimulate learning
and collaboration rather than force competition (that you all know too
well) by grades and required attendance. Again I quote from Mark Twain:
“I have never let my schooling interfere with my education.”
We also realize, of course that the self discipline that drove you here
may well drive you harder than we ever could by testing and regulating.
So let me not dwell so much on the system itself as on my own impression
of what the system provides. It allows you to become a node just as I
am a node, in a rich network of scientists and physicians. In fact my
only charge to you is to become physician scientists in the very broadest
sense. That is you must quantitatively understand the physical and biological
science underpinning of the evolved human by sharing the bench with our
scientists and our clinics with clinical researchers. We are much more
your colleagues with a little more experience than we are teachers to
be placed on pedestals.
At the bench and the bedside, you will learn the responsibility of science
as it is directed to specifically conquer a disease and at the same time
the freedom to understand that much of our growth in industrialization,
technology and medicine has come most often from just plain curiosity,
whimsy and often from parallel fields. In industry, the phonograph is
a great example. Thomas Edison invented this device explicitly to record
the last words of dying people, recording books for the blind, announcing
time and teaching spelling. Reproduction of music was not on his list
and after a few years he felt his invention had no commercial value. Likewise
Renes Dubos, the famous Rockefeller scientist and humanist brought his
agricultural background to the use of earth microbes to dissolve the polysaccharide
capsule of the pneumococcas bacteria and thus ultimately inventing the
first antibiotic. From these kind of empirical discoveries we soon became
the reductionists who have been the driving force behind most 20th century
research.
This reductionistic scientific behavior has been based on the assumption
that if we could know the parts we would understand the whole, but having
the parts is not enough if we don’t understand how the process works,
why is it organized in this or that way.
You will also find here at Yale some of the world’s finest Cartesian
reductionists who have for example taken the genome apart and who now
understand that the next great challenge is to put it back together as
targeted therapies for disease.
Then you will walk across the street and experience the everyday tension
and resolution of tension that represents the practicality of caring for
sick and dying patients and you will learn to respect Dr. Edward Trudeau’s
maxim that I previously quoted, “to sometimes cure, often help,
always console.” Renes Dubos adds, “wherever possible, prevent.”
That’s what this ceremony is about today, it is to continue to remind
us when we’re feeling pompous and elite that we had better be humbled
and challenged in a world of such incredible technology when at the same
moment this 19th century maxim of Trudeau’s is still very, very
true.
The white coat for me symbolizes that you are that link from the laboratory
to the bedside and back again. You must wear the white coat comfortably
in both places, speak both the language of science the language of caring.
Once we put the white coat on you, you accept that responsibility and
I know that suddenly educational freedom will have new meaning.
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