Graduation Day 2000

BY JEFFREY MORTIMER

The University of Michigan Medical School Class of 2000 was the first class of a new century (or the last of the old, depending on your point of view), and the graduating class of the Medical School's sesquicentennial year. It graduated in the year that the mapping of the human genome was completed, and it is the first class in U-M Medical School history to establish its own endowment upon graduation.

But what really sets this class apart is that its members are almost certain to remember their commencement address — not just because it was delivered by Francis S. Collins, M.D., Ph.D., director of the National Human Genome Research Institute and perhaps the best known medical scientist in America at the moment, but also because Collins concluded his presentation by accompanying himself on the guitar while singing a parody he penned of Frank Sinatra's signature song, "My Way," which included such lines as the following from the last stanza:

Collins may be on leave from his U-M Medical School faculty appointment, but he retains his ability to surprise and delight students. He had reached the last of what he called the "four food groups of a balanced life" — work, spirituality, love, and fun — when he paused to note that, "Fun is sort of a difficult subject to lecture on. Perhaps, instead, we need a demonstration."

That's when he departed the podium to fetch his guitar from behind a draped table upon which the furled diplomas awaited their new owners. "I bet the dean wondered what that other microphone was for," he grinned before crooning a tune whose lyrics went from medical student's lament to professor's triumph and brought down the house at Hill Auditorium. This was after pointing out that "fun is important, folks. Medicine is full of sobering, tragic moments. So is the rest of life. Don't forget to exercise your sense of humor. You're going to need it."

He noted at the outset that "the kind of wisdom that is conveyed in commencement addresses tends to have a half-life measured in milliseconds." Mitigating against that outcome were both his boffo finish and the simplicity of his theme: "Let me urge you to do this one thing: seek a balanced life. Do not allow the pressures of your profession, noble though it is, to crowd out the other aspects of a happy and fulfilled life. Medicine is a selfish mistress. Don't give in to her. Nurture four areas, not just one."

Even though (or perhaps because) he heads the most spectacular medical technology project of our time, Collins made a comment by Albert Schweitzer the centerpiece of his remarks on the "work" portion of the "food groups": "Our technology must not exceed our humanity."

You will experience the flowering of evidence-based medicine in a way that many of those who came before us did not enjoy," he said. "New technologies, some of which we can now glimpse, many of which we cannot, will illuminate your approach to disease and lead to unprecedented abilities to diagnose and treat illness. But as we celebrate those technical accomplishments, I hope we will remember what medicine is all about."

His own revelation came at a time when his spirits were sagging during a stint as a volunteer in a mission hospital in Nigeria. Having gone there full of idealism, "I soon discovered that my puny services weren't much help," he said. "It was clear that much of the illness that surrounded me in that hospital was because of poor public health, and that our efforts to try to treat disease were really just putting a brief thumb in the dike. There was no chance that my presence on the scene was going to change those circumstances."

A farmer of about 30 appeared, with dramatic edema of the lower extremities. Collins diagnosed it as a large pericardial effusion, drained it as best he could with the tools available, saw the patient improve dramatically, started him on a treatment for tuberculosis, and knew perfectly well that he would be going back to the same conditions that had made him ill in the first place. "It all seemed so pointless," he said.

On rounds the next morning, the farmer told Collins that he looked as if he were wondering why he had come to Nigeria. "Is there any chance I'm right about that?" he asked.

Collins said he was indeed right. "I want to tell you something," the farmer said. "You came here to this place for one reason. You came here for me."

"I realized that was absolutely everything that any physician could ever hope for, to be there for that person at that time," Collins told the graduates. "All my grand ideas about changing the public health of the Third World paled in comparison to what this young farmer was saying to me. What it's really about is you and that patient at that moment when they need you. Even if what you have to offer is, in your mind, insufficient, you are doing something for them. Do not forget that."

"Spirituality" is essential, he said, because "as a physician, you will struggle every day with profound questions." God must be a consideration in their contemplation, he said.

"In my view," said Collins, "there's no conflict in being both a rigorous, show-me-the-data scientist, which I consider myself to be, and a person who believes in a God who takes a personal interest in each one of us and whose domain is the spiritual world. That domain is not necessarily possible to explore with the tools of science, but within the heart, the mind and the soul. It is remarkable how many of us fail to consider these questions of eternal significance until some personal crisis, or perhaps advancing age, forces us to face our own spiritual impoverishment. Don't make that mistake."

The "food group" called "love," he suggested, includes both "love for one another," the fellow members of our species, and romantic love. The Human Genome Project's finding that "we are 99.9 percent identical, all of us," he noted, is "a lovely thing to realize," adding that, although prejudice still abounds, "You have a chance to change that, one person at a time."

Romantic love, he cautioned, is a comparable challenge on the personal level. "Realistically, medicine places romantic relationships at risk," he said. "Whether you've found your life partner already or are still looking, make this a priority. Don't put it aside, and don't fail to give it the attention it deserves."

And, of course, there was fun, a quality that also abounded in Michael Case Overbeck's remarks on behalf of the Class of 2000.

"Maybe I can introduce you to them by their characteristics," the emergency medicine graduate said of his classmates. "From my standpoint, I'll tell everyone here that this is the most diverse, intelligent, rigorous, kind, talented, affectionate, dog-loving, cat-loving, rat-loving, scuba-diving, plane-flying, family-oriented, smart-alec, spitwad-throwing, sleep-deprived, awe-inspiring, capable, and complex group of individuals I've ever been associated with."

When the applause died down, he added, "Oh, and I left out smart. They are scary smart, too."

Overbeck reported experiencing a personal moment of revelation much like Collins did in Nigeria. It came in his fourth year, after a particularly trying visit on rounds with a particularly trying, and not terribly ill, patient. As he was leaving, the man in the next bed, who was much sicker and not Overbeck's patient, grasped his hand, patted it, and said, "You are a great doctor."

"On that day, I realized what we had been doing for the past four years, what it's all about," he said. "It's certainly not about grades or board scores...It's about life and sometimes death and comforting and relieving. It is about the richness of the human experience from a vantage upon which we are privileged to perch."

Earlier, he had talked about rediscovering a paragraph he had written as a fifth grade assignment about what he would be doing in the year 2000. "Most of all, I will be rich," he had recorded then.

And, he told his fellow graduates, he had indeed become rich, though not exactly as he had anticipated. "I am wealthier than I ever could have imagined when I was a 10-year-old boy," he said. "I've accumulated wealth over the last four years beyond my wildest dreams. I stand before you today, sweltering in this hot robe, a rich man."

Graduate Commencement 2000

The Rackham School Studies Awards More Thirty Ph.D. Degrees Biological Sciences Three Ph.D. Graduates Also Earn M.D.s

Commencement ceremonies for spring 2000 began on Sunday, April 28, with the graduation exercises of the Horace Rackham School of Graduate Studies. While the Medical School awards M.D. degrees, students pursuing Ph.D.s in medical fields officially enroll in and receive their degrees from Rackham though their studies and research take place within the Medical School. This year, more than medical Ph.D. degrees were awarded fields ranging from biological chemistry to human genetics. Three students receiving Ph.D.s went on to also receive M.D.s from the Medical School during its graduation exercises on June 9, earned within the University’s prestigious M.D./ Ph.D. program.