The following speech was delivered at the 2018 Pinning Ceremony for the graduates of the Whatcom Community College Nursing Program.
Minor ad libs almost certainly occurred during the live event.
~ ~ ~
Good evening graduates, family, friends, faculty –
BOY HOWDY. Do you all have any idea how much I have AGONIZED over this speech? ANY IDEA?
I tossed around so many thoughts and themes. So many of them were so BAD. So many of them were so TRITE. I didn’t want to give you a typical ‘nursing graduation’ speech…..and that didn’t really leave me with very much to write about.
And not only did I have to write this speech, but I also was packing and organizing and getting ready to go to Haiti, where I spent the first ten days of June. So, zero stress there.
In Haiti, I worked with a Washington-based organization that operates a small outpatient clinic in an extremely rural area of the southwest part of the country. We saw more than 800 patients in five days, and yes, for those of you with calculators handy, that’s between 150 and 200 patients a day. We performed a variety of lab tests, screening exams, and distributed hundreds of pounds of medication for diabetes, hypertension, seizures, STIs, parasites, worms, and many common over-the-counter meds – all for free.
It was also nearly 100 degrees every day, with 60% humidity, and there was no wind to keep away the mosquitos carrying malaria, Zika, chikungunya, and dengue fever.
It was clearly the perfect restful environment in which to write a graduation speech.
…Actually, in all seriousness, it was.
By Wednesday morning last week, I knew what I was going to say to you. I knew the advice I wanted to pass on to all of you, the simple but difficult truths that have changed my nursing practice forever, and made me a better person.
I’m going to tell you the story of two patients.
The first patient is a very young mother whom I saw at the clinic in Haiti last week Tuesday. She had walked, from a tiny rural village, over a mountain, for nearly five hours to come and see the American doctors. And it wasn’t just her – she had carried her tiny three-month-old daughter with her, over that mountain, along that five-hour walk.
She waited in line at the clinic for eight hours – from 5 a.m. when the line started forming until nearly 3 p.m., when she made it to my triage chair. After I completed the mother’s paperwork, I started on the baby’s triage form.
“Is she vaccinated?” I asked. My translator, a bright and friendly man named Richard, rephrased the question into Haitian Creole.
“No,” replied the mother.
I was completely surprised by her answer. Literally every single child I had triaged at clinic was fully immunized. Parents routinely bring their child’s immunization card with them, carefully folded into a thin plastic bag to protect it from the rain. All Haitian mothers vaccinate their babies.
“Why not?” I asked.
She and Richard talked for a moment. He then turned to me and said, “She says the person who comes to the village to vaccinate the babies never showed up.”
About thirty seconds later I had bodily dragged poor Richard into the office of the Haitian nurse at the clinic, – who was already done working for the day — BEGGED her to vaccinate this baby, and shortly thereafter the nurse and I reached a compromise. I went back out to the mother.
“The clinic nurse can vaccinate your baby tomorrow morning at 9 a.m.” I waited nervously as Richard translated. “Do you need to go home to your village tonight?”
And the mother replied, “If she can get her vaccines tomorrow, I will spend the night here.”
So, let me offer you a summary of our first patient. A young mother, not twenty years old, carrying her three-month-old infant daughter, walked for five hours, over a mountain – while WILDLY anemic by the way, something we discovered in her lab testing – waited eight hours to see a doctor, and was now willing to spend the night, in a town where she likely knew no one, to get her child vaccinated the following morning, before returning to her village, walking over a mountain, five hours away.
There. That’s patient one.
Now, here is patient two.
This patient is a young man who is very well known to the staff of the Emergency Department of a local hospital that shall remain nameless He is chronically homeless. He is addicted to methamphetamine and heroin. He has Hepatitis C from sharing needles. He presents to the ED regularly with a spectrum of complaints, from itchiness due to scabies, to a cough from smoking meth, to a suicidiality that seems to resolve after a night in a hallway bed and a few sandwiches.
This time he presents in the custody of local law enforcement, and is brought in the back door of the department handcuffed, hog-tied on an EMS gurney, and screaming at the top of his lungs. As we try to move him onto an ED bed and place him in four point restraints, he first tries to spit on me, and then manages to insult my looks, my gender, and my mother, all in the same breath, using language that the Whatcom Community College Health Professions Department would most certainly NOT approve of me using here at your graduation.
He will need sedating medications to prevent him from harming himself or us. He will need bloodwork, urine testing, probably IV fluids, charting done every 15 minutes for as long as he remains in restraints, a consult with the social worker in the morning when he is calm, and probably an evaluation by a Washington State Designated Mental Health Professional.
There. That’s patient two.
OK, time for a quiz.
I hope you studied.
And I want your family and friends and loved ones here with you today to take the quiz, as well.
Answer silently, in your own head.
Here’s the quiz. It’s just one question.
Which patient is more important?
. . . .
Are you done?
The answer is: neither.
They are equally important.
They matter exactly the same.
. . . .
This is one of the most important, most fundamental, and truly, one of the most difficult truths that you will face in this line of work.
In 2003 the Pulitzer Prize-winning author Tracy Kidder published his book “Mountains Beyond Mountains,” the story of Dr. Paul Farmer, the founder of the non-profit organization Partners In Health. It’s an excellent book. In there, he elicited one of Dr. Farmer’s most famous quotes: “The idea that some lives matter less is the root of all that’s wrong with the world.”
I worked for Partners In Health for several months as a contractor, and let me tell you what, that quote is EVERYWHERE. It is printed on ALL of their advertising, ALL over their Facebook page….It is KINDA ANNOYING to see it again and again and again….
But here’s the kicker – it’s true.
The idea that some lives matter less is the root of all that’s wrong with the world.
. . . .
Just as an aside, I want you to not confuse “importance” and “urgency.” All patients are equally important. But the man over there having a huge heart attack who needs CPR is absolutely more urgent than the man who has a sore throat.
OK? Important versus urgent. Different things.
. . . .
Now, back to importance – the mental gymnastics needed to BELIEVE this – to truly believe, deep down in that leaky tile-floored basement of your soul, that all patients are equally important – that’s some very, very difficult work.
It’s hard to be compassionate when you’re being screamed it.
It’s nearly impossible to be kind when you’re being threatened.
So how do you do it? How you do incorporate this belief into your practice, into your work, into your self?
I’ll tell you how I did it – and how I continue to do it, because let me tell you what, there are days working in the Emergency Department when I need to refresh it pretty much hourly.
Here it is:
The only perspective any human has …. is their own.
The only perspective any of us have is our own.
Remember patient one, the Haitian mother with the infant? Her only perspective is her own. She cannot comprehend what it is like to be a young, homeless, drug-addicted man in America. There is no way for her to have that perspective.
And that young man in the ED, patient two? He cannot comprehend what it is like to be a young mother with a three-month-old infant, living in rural Haiti, a country where one out of every twenty children die before their first birthday.
He does not have that perspective.
He CANNOT have that perspective.
And you must remember that.
You cannot treat him as less because he is not a Haitian mother.
You cannot treat her as less because she is not a homeless man.
You must treat them, care for them, respect them, and work with them from their OWN perspective. You must meet them exactly where they are coming from.
. . . .
When you put these two pieces together – all patients are equally important, and all patients have only their own perspective – when you have done the work to get there, to truly understand and embody these truths – the joy you will find in your practice as a nurse will exceed your wildest expectations.
. . . .
Because nursing is a profession of joy. In my worst days, my lowest moments, when I have come home from work and sat on the kitchen floor and cried and cried and cried, I would still never take a moment back. I would never change my mind about my career. And I would never do anything different with my life. Because for all of those moments of grief, there are a thousand more where my patients and I laughed, joked, smiled, hugged, comforted each other, celebrated.
What a gift all of you are to this world. What a gift you have given this world by choosing to be nurses.
And what a gift you have all given me, by being my students. By asking me to speak today, and letting me give you these final pieces of advice.
May your joy in your work lead you forward, from this day on.
Congratulations to you all.