The following are exerpts from the valedictory address of Joseph Emmanuelle P. Siatan, MD, MBA of the Ateneo School of Medicine and Public Health (ASMPH) Class 2017 during the commencement exercises last July 9, 2017. His speech provides an insightful perspective on medical training, healthcare and medical practice that hopefully would inspire molding Filipino doctors as leaders in health, and catalysts for change
The daily grind of the last five years now formally comes to an end. How can five years be summarized in five letters, MD-MBA? While it is a daunting task to speak to you, and for you, the ASMPH Class of 2017, I will attempt to do so by talking about three kinds of days: the days that define us more than others, the days that define us more than they should, and the days in-between.
Looking for inspiration on how to best talk about these, I turned to the seat of millennial wisdom: Facebook. Luck of lucks, or as he would call it, serendipity, I came across the Facebook status of a good mentor and our speaker this evening, Dr. Sio Marquez. It was a quote from Denzel Washington in the movie, Unstoppable: “In training, they give you a medal if you do well. Here on the job, you lose lives if you fail.”
We spent our days in rigorous study and training, in and out of the school, in and out of hospitals, in and out of community clinics. From sleepless nights with books, to even more sleepless nights watching over patients. We spent the years trying to transform ourselves into the outstanding clinicians the school aspires us to be, or more importantly, the outstanding clinicians we aspire to be. I will borrow words from the book written by late neurosurgeon Paul Kalanithi, When Breath Becomes Air: In medicine, “technical excellence is a moral obligation.” Or as Gian Velasco would tell me before, “Bawal na ang petiks.” (It’s forbidden to procrastinate) Because in medicine, our failures can cost lives. Being petiks (procrastinator) can cost lives.
Days that define us
There are days that define us more than other days do. In medicine, these are the days when we feel the gravity of the mantra, “you lose lives if you fail.” Nothing prepares us more for this than our first codes, or first deaths. Mine happened while on a weekday duty at the Ospital ng Makati at an ungodly hour—about 2 or 3 in the morning. The thing is, when you do your first real cardiopulmonary resuscitation, you are overwhelmed both with fear and excitement. Your adrenaline kicks in screaming I got this! 100 beats per minute. 2 minutes, 2 hands, and 2 inches. We got this! Only that we didn’t. After 20 minutes and 10 vials of epinephrine, we didn’t. And so we retreated back to our quarters.
On the way back, we were met with cries from the family, the loudest from a man in his 30s. It turns out he was a new father who just recently welcomed a baby. But at that moment, he was a husband who had to say goodbye to his wife. But we didn’t even notice that. In our haste to fulfill our obligation, to save lives, we forgot to pay attention to what matters more: kindness, compassion. While technical excellence is a necessary moral obligation, it is never enough. Memory of that day has never left me. It was a point of defeat. A point of humility. A point for learning.
We learn a lot as doctors. And where much can be learned, just as much or even more need to be sacrificed. And perhaps, as Dr. Sheryl Manalili puts it best, the greatest sacrifice is in learning that our lives are not completely our own. It is always, always tied in with our patients’. We share in their defeats and their losses. We celebrate our small victories once we see our patients get a better shot at life.
Nothing reminds us of these victories more than the days when we got our first professional fees or PFs, or more appropriately a token of gratitude from a patient. That day, having convinced ourselves that no excellent doctor leaves work undone, we tried to look at maybe 50-60 patients just before our lunch break. We swallowed our egos on empty stomachs. A 30-year-old father arrived with his young child, consulting for furunculosis, a skin infection. After the consult, he handed us a small paper bill—20 pesos. We bought 10 mojakos, a munchkin-like bread filled with cheese still warm from the oven. That was the best lunch-slash-merienda we ever had. Just with other victories, mojakos are best shared with others. And so that day, we feasted with the midwives and the nurses in our local health center.
Days that define us more than they should
But not all days remind us that life is good. There are days that define us more than they should. Those days show us that while the sun may shine bright in most days, there will always be shadows that remind us of the not-so-good ones. We know this all too well.
At the end of each year, we had always struggled with Endocrine removals just to prove that each of us deserved a spot in the promotions board. And at times, it did not seem fair. Whoever told us that a fine print about leprechaunism in Harrison’s would mean either going on to the next year or staying behind?
These days remind us that life may not always be sweet, great or fun. Sometimes it can be downright bad. But it is in the memory of these days, when the odds are not in our favour, that makes it all the better when we win. But even if we don’t, these days serve as a reminder, in the words said best by Dr. Sio Marquez: “You don’t have to win all your battles. But losing them does not mean that you did not believe in the war.”
Let this day remind us that despite all those other days, we have fought the good war. Let this day remind us that that seat deserves to be filled by none other than you. And for a reason.
Heart-strong…let this day remind us of our calling as we move out into the bigger world. That we move out with purpose and with courage. That in the midst of all the fake news and propaganda, we choose truth. Heart-strong. That while radical terrorists occupy and divide Marawi, we choose to respect differences in culture and religion. Heart-strong. That while others choose to spread a rhetoric of hate, we choose the path of those who unite and serve. We choose to be healers. And we choose to be leaders.
Heart strong. For a heart that is strong and good beats with rhythm, beats with courage and with purpose. With the onslaught of doctor-shaming in social media, we need more doctors with the biggest of hearts. We need doctors who will not only look at patients, give them their pills, and send them home. We need doctors who will look beyond the people’s grievances – and say, “hey, we can do so much better!”
Indeed, we can do so much better.
We can help build health structures that are much more accessible, affordable, and empowering to the poor. We can make health delivery closer and closer to the communities who especially need it the most. We can make health truly universal. But this can only happen through change – a lot of change. ASMPH has prepared us enough for this daunting but necessary task. The school has given us the lenses of a systems perspective – through ManDyn, OpMan, Strama, and through all those MBA Saturdays. But more importantly, the school has given us kindred spirits ready to be the agents of change the country needs today—the school has given us each other.
We must never forget though: change can only truly happen through those who have the most creative minds and the biggest of hearts. And I have seen these brilliant minds and hearts in us. Indeed, we need more oncologists like Paul Dy, one of the most intelligent and hardworking persons I know in and out of medicine. We need more surgeons like Mich Carias, whose wit and vibrance will surely make us smile despite standing for long hours. And definitely not the least, we need more dermatologists unique as Erwinne Aquino – who can show the world, the universe rather, that doctors are confidently beautiful, with a heart.
Days in between
Apart from those days are the quiet in betweens – the days that are not so much endings as they are beginnings. When all the rush, the excitement, and the drama die down, we go back to the routine of our day-to-day lives. Going in and out of class, in and out of hospitals, in and out of community clinics. Those days that are not filled with so much drama, those days are the ones I will miss the most. They remind us that while we usually celebrate the loud and the grand, we also need those humble and quiet days to ground us. Heart strong, heart steady. For a heart that is strong is also a heart that is steady.
So, let our hearts beat steady and strong. As they should. For while our days may mean a lot, one thing is certain: they are numbered. Recently, the ASMPH community lost one of its precious students, Pat Teng. I saw in him one of the promising leaders of the school, and of the country…one of the most passionate hearts the school has ever seen. The countless messages of longing and gratitude speak of his character. His life is a reminder that he lived as graciously as he danced; and he loved generously as he lived.
In that light, I hope this day be a reminder that we have lived and continue to live our lives in grace and gratitude. That we have made it this far and now stand tall because of those who walked before us.
Let me take this opportunity to thank our parents, including my own dad and mom. We have made it! But always know that while we are now your MDs, you were first our M and D too. Mom and Dad. Maraming salamat sa pagpapakita ng pagmamahal na walang hinihinging kapalit. (Thank you for showing the love that asks nothing in return) To my own M and D, I love you too.
Gratitude is also due to all our friends who have journeyed with us. You have made the detours, the stops and the side quests all worth it. Most of all, you have made the main journey all the more manageable and enjoyable.
I am a scholar. A proud scholar. None of my days would have been spent in medical school had it not been for the generous hearts of our benefactors. I would particularly like to thank Sir Chris Peabody and the ASMPH Scholarship Committee for investing in our education and believing that we also deserve the opportunity. To my dearest co-scholars, it is now our time to pay it forward.
This day is also a celebration of our teachers, mentors, and the administrators and staff of ASMPH. They have shared with us a part of their lives, more than what was asked of them. It has not been an easy five years. Your commitment to hard work, learning, and kindness will always be an inspiration.
None of us would be doctors without our patients. They have witnessed us grow from clerks with shaky hands during IV insertions to the confident young women and men standing here today. Let this day be our promise that we will always be excellent and compassionate doctors.
Finally, this day is a celebration of God and His love through whom our failures and triumphs, and all our days have been made possible.
In ending, there are days that define us more than other days do. There are days that define us more than they should. And there are a lot more days in-between. But I reserve this point as my last. While there are days that define us, we must not forget that WE define our days. So, choose to go the extra mile for your patients today. Choose to show love to your family today. Choose to stay in the country for the health of Filipinos. Choose the good fight. Because in the end, it is what we choose that defines us.
Let us make our choices count. Let us make our days count.
“In our haste to fulfill our obligation, to save lives, we forgot to pay attention to what matters more: kindness, compassion. While technical excellence is a necessary moral obligation, it is never enough”
August 2017 Health and Lifestyle