The News Service
The 236th Commencement
Jonathan Doris, M.D.: “My Residency Is A Rerun”
Jonathan Doris, M.D., former resident in internal medicine at Brown and current technical consultant to the NBC sitcom “Scrubs,” addressed the medical graduating class during the Medical School’s Commencement Ceremony at 8:45 a.m. Monday, May 31, 2004, in the First Unitarian Church. He was introduced by Interim Dean of Medicine and Biological Sciences Richard W. Besdine, M.D. The text of Doris’s address follows here. (See also news release 03-138.)
Thank you Dean Besdine, Brown medical school staff, family, friends and, of course, graduates.
Doubt, fear, uncertainty, constantly in over your head – these are just a few of the emotions I was feeling backstage 30 seconds ago.
Still, when I was invited to give this Commencement address, I wondered how I could be expected to follow Nobel laureates and surgeons general in such an honor. You see, Linus Pauling, a prior Brown commencement speaker, won one of his Nobel prizes for elucidating the complexities of chemical bonding. And I’m a guy who knows a guy who wrote a TV show. But seeing as I am still in training, there is no one who can better appreciate what you have just completed or relate to what you are about to begin. I offer you congratulations, sympathy and advice. But most of all, I offer you assurance that you are, in fact, prepared to face the challenges that lie ahead.
And my presence here at this podium today is a testament to the fact that a medical school education can and will open many doors. You will be amazed at the array of things people think you are qualified to do just because of the “M.D.” after your name. For example: Give the commencement speech at an Ivy League medical school!
But today is all about you. You’ve finally made it. You finished the 20th grade. Four arduous years of studying, testing and worrying that you might be the only one in your class who doesn’t understand renal tubular acidosis. These were years of great sacrifice as you skipped friends’ weddings, missed family get-togethers and forfeited vacations – all in the name of a medical school education. Yet now you stand at a crossroads. Until now, you were all medical students, doing and learning the same things. In a very short time, your paths will diverge down the individual specialty tracks you were forced to choose.
The varying directions people go in after medical school, however, are not limited only by specialty training. A medical education is unique in that its breadth allows you to carve out your own niche. It is plastic enough to be reshaped by personal interests. I think of physicians like Sanjay Gupta, who is the senior medical correspondent at CNN, and M. Therese Southgate, who has selected works of art to be featured on the cover of each issue of the Journal of the American Medical Association since 1974. And who can forget that 50 years ago, a medical student named Roger Bannister was the first man to run a mile in under four minutes. Or a family physician named William Carlos Williams, who wrote “Patterson,” arguably one of the greatest books of poetry ever written. The permutations are endless and are at your disposal.
Four years ago, my friend Bill Lawrence decided to write “Scrubs,” based on anecdotes of resident life I had been telling him throughout my training. I distinctly remember our conversation. He said: “J.D., if you would entrust me with all of your mistakes, misadventures and gaffes during your residency, I promise no one will know it was you.” So I did. Bill promptly named the main character after me. Then he sent the NBC press corps and USA Today over to interview me about what a bumbling intern I was. So much for anonymity. I have to admit, it was exciting to think that a character on a television show would be based on me. The race was on to find a boring, pear-shaped actor in Hollywood.
I remember fantasizing what it would be like in the writer’s room, hashing out the details of a complex medical storyline. I arrived to the studio with wide-eyed enthusiasm. I knew I would have my work cut out for me when, on the first day, they said: “OK J.D. For this week’s episode we need a story about a young guy who comes to the hospital for an elective surgery but dies.” This is a comedy right? “Oh yeah, and he can’t die from a complication of the procedure or from a mistake by the surgeon. And he can’t die during the surgery, because he has a lot of dialogue afterward. And he can’t die from cancer, because that’s too sad. Call us when you have something. We won’t get to that section for another five minutes.”
During the first season, when I would discuss scenarios with the writers (none of whom has any medical training), I would notice their blank stares as I went on and on about the intricacies of a differential diagnosis or the extra-articular manifestations of rheumatoid arthritis. When I finished, they would nod seriously and spend the rest of the day perfecting their impressions of me boring them to death. Then they’d make up fake medical gibberish to put in the script and ask, “Is DIFUNGOMUCTANE a real word?” And invariably, with every consultation, one of them would slip in a question about their mother’s chest pain or the bump on their elbow that smells like guava.
All jokes aside, involvement with the show has forced me to re-live and re-examine my residency. The writers constantly pressure me to distill my experiences down to their most basic emotional impact. It has given me a new perspective on my training.
Let me pass on some of these insights in the hope that you may benefit from them:
First, you will all undoubtedly find yourselves faced with some of the most putrid odors the infirm human body can generate, whether it be a GI bleed, ruptured viscous or necrotic foot. Don’t feel weird if the smell makes you hungry. We tend to get used to things. Plus, none of these smells will compare to the stench of your on-call sneakers about halfway through you internship. Do yourself and your roommates a favor and never bring them home.
Second, during internship you will face extreme challenges with a new group of people. Some of these folks will become lifelong friends. Others you will fantasize about choking. I would recommend, however, that you consider videotaping yourself while asleep prior to your first night on call. You see, the call room uncovers an entire dimension of people that is rarely observed. You will be amazed at the variety of sleepwalking, sleep-talking, sleep-screaming and sleep-’bodily functioning’ that can be displayed while in a stress induced slumber. I, obviously, am a sleep eater.
Third, after years of dedication and sacrifice, you have achieved a monumental accomplishment. Each one of you deserves to be here. Now look at your parents and thank them. Remember, you’re the reason they don’t own a boat.
Still, you need to realize that your family and friends, who gave their unending support, are here today to help you celebrate. What you don’t realize is that there has been an unspoken contract signed; a lien placed on your soul. And they will be collecting. While they are genuinely proud of your success, please know that they will forever come to you seeking medical advice for themselves, their friends, their friends’ friends, their colleagues, their colleagues’ uncles and, at times, their pets.
Forth, you will soon have bestowed upon you a long, white lab coat – the true diploma of medical school completion. With this one ultimate reward comes responsibility – and bigger pockets. Although you will fill these pockets beyond their capacity with backbreaking books, PDAs and equipment, I implore you to never keep your saline eye drops in the same pocket as your hemocult developer. The burning is indescribable, and vision doesn’t fully return for weeks – or so I’ve heard.
During your clerkships, you have gotten a glimpse into the hospital culture. You have embraced the perverse humor employed by the house staff to help ease their fears and insecurities. The pressure and exhaustion are intense, but are balanced by the camaraderie of your peers and the mentorship of those dedicated to teaching you. At times, residency training can feel overwhelming, but I hope you will be able to appreciate the lighter side of the process by which we stumble into competence and the cornucopia of oddball personalities we endure on our trip. This experience is unique, so when you take a step back, you will see it is rich with the most interesting, bizarre and grotesquely hysterical moments of your lives. I can’t think of another group of professionals who harken back to their training so fondly as physicians. Every attending seems to have an unending cache of anecdotes that could fill seasons of “Scrubs.”
Remember that a sense of humor is the best medicine. Laughter will get you through the most stressful times. Humor will put both you and your patients at ease. Accepting yet another new consult is easier when it is requested with a smile, and there is no better retort to an insufferable colleague than a chuckle and a grin. Look for the humor as you wade through the patients and the paperwork. Aggressively embrace a positive attitude. The hospital can be a morose place, but laughing at the ridiculous can reinvigorate even the most sleep-deprived intern. So as you finish your last H+P five minutes before you have to start pre-rounding for the next day, remember to look back and laugh. Then frantically go read about your admissions before Dr. Bossypants starts pimping you to tears.
July 1st. I enjoy July 1st. You can see real fear on the faces of the incoming interns. Yesterday, nobody expected you to know anything. But on July 1st your pager will beep and a nurse will ask you a question expecting that you know the answer. He will be annoyed when you nervously say, “Let me ask my senior resident.” And it will feel strange to write an order that no one has to co-sign. Let me assure you that come July 1st, everyone will be nervous and they will be nervous about the wrong things. Although it is scary to think about potassium replacement, insulin sliding scales and chest pain, it’s just as important to find out the combination to the call room door, where the bathrooms are, and who on the cafeteria staff you have to schmooz to get free food. The point is, you already know the other stuff.
On my July 1st I thought I was safe. I started on an elective, so I was in Rhode Island Hospital sitting in the Au Bon Pain, which I think is French for “expensive, stale sandwiches.” Anyway, I was drinking coffee and reading the paper. Then I heard a Code Blue announced and I eagerly went running. Quickly I realized that I was very close and that I would surely be the first on the scene. As I ran, I passed a newspaper dispenser. I remember this detail six years later because I had suddenly developed an intense interest in what was on the front page. You see, whoever gets to the Code first has to assess the situation and presumably initiate the appropriate therapy. At that point in my career I felt more comfortable reciting the steps of the Krebs cycle than the ACLS algorithm. As I stopped and acted immensely interested in the newspaper, one of my fellow interns pointed and yelled: “I saw you stop, you didn’t want to be the first one there!” I felt like an idiot until he told me that he’d retied his sneakers four times to stall before responding to the Code.
Your July 1st is still a month away, and as you prepare you should know that as a group, interns maintain the dubious distinction of being the most overworked, sleep-deprived people with the least libido. So, keeping that in mind, do not leave here today to go practice one-handed surgical ties or review the steps of central line placement. Make this next four weeks self-indulgent and invigorating. Travel, play, drink, eat – all the weight will come off. Someday. You have a lifetime of learning ahead of you. It can wait another 30 days.
So grab your diploma, your intellectual curiosity, your humanity, your ethical standards, and, yes, your sense of humor.
Welcome to the fraternity of those illustrious women and men who have gone before, and like you, have proudly dressed in scrubs.
Thank you and congratulations.