The American Dream

Yale School of Medicine Commencement Speech by Alfredo Quiones-Hinojosa. MD.

First, I would like to thank the Yale Medical School class of 2008, the deans, faculty, parents and family members for inviting me to share this special occasion with all of you. I know these are emotional times for many reasons and I hope I have something meaningful to say. Nine years ago I was sitting in the same place you are today. Let me start with a story. Not long after I graduated from medical school, I was caring for patients with severe neurological problems. One night I was in the emergency room at San Francisco General Hospital, the only Level One trauma hospital in the San Francisco Bay area. On the emergency room radio, I heard, Weve got officers down! No, it was not a made-for-television movie or a re-creation of a 911 call for a television series. This was reality: the high-speed chase of a dangerous suspect that resulted in a fatal collision, killing an SFPD officer and leaving another in my hands in the operating room in critical condition, comatose. When I was a boy, my father would say, Even if you do not have good aim, if you shoot for the sky you may hit a star. I aimed high with this officer. Thanks to his strength, stamina and wonderful care by a team of specialized health care providers, we came out victorious and he was back in the police force a year later.

I received a plaque from this patient with a quote from Vince Lombardi that read, The quality of a persons life is in direct proportion to their commitment to excellence, regardless of their chosen field of endeavor. (Commitment to excellence: I will get back to that later.) In addition to a certificate of appreciation from the SFPD and a commendation from the chief of police, I also received a Get Out of Jail card, which I am sure will be handy one day!> I would like to share some powerful moments I have experienced with my patients and some lessons I have learned. This DREAM that I will discuss has guided my life. This dream involves (1) D for determination; (2) R for resilience and responsibility; (3) E for excitementthat is, passionas well as excellence; (4) A for ardor that is, dedicationas well as admiration; and (5) M for mentorship. Lesson 1: Determination. My story in the United States began like many of your own, or the stories you hear from your parents or grandparents. One night in January 1987 I packed the few belongings I owned, and, with $65 in my pocket, crossed the border illegally. I should note that 17 students graduating from the Yale School of Medicine class of 2008 were born outside the United States in 15 different countries. As I was growing up, my grandfather used to tell me not to go where the path may lead, but to go instead where there is no path and leave a trail. I landed in the fields of California, where I became a migrant farm worker. I spent long days in the fields picking fruits and vegetables, sleeping under leaky camper shells, eating anything I could, with hands bloodied from pulling weeds. These are the same

hands that today have the privilege and honor of working on the most beautiful organthe brain. The brain, Plutarch once said, is not a vessel to be filled, but a fire to be ignited. I wish I could tell you what inspired me to leave the fields of San Joaquin Valley the day I was told, This is your fate. You will spend the rest of your life working in the fields. It was an experience that has reminded me of what Henrik Ibsen wrote: Rob the average man of his life-illusion, and you rob him also of his happiness. Sure, I was afraid. Once a very wise migrant farm worker, Csar Chvez, said the following about fear: If youre not frightened that you might fail, youll never do the job. If youre frightened, youll work like crazy. I was determined to pursue my dreams. I could not let anybody tell me, You cant. Lesson 2: Resilience and responsibility. On April 14, 1989, an accident made me reevaluate my life. I fell into a railroad tank carrying liquefied petroleum gas and almost died. I remember being alone at the bottom of that tank, eighteen feet belowdeep, dark, without oxygen, gasping for air, fighting for my own life. This brush with death gave me a new perspective on life. I knew that my time in this world had come to an end but I was not leaving without a fight. I saw my childhood unfold in front of my eyes: my dreams of becoming someone one day, of helping my parents and siblings, my dreams of contributing to humanity in a meaningful way. How ironic, I thought. It will all end here today. I was able to pull myself to the top with my two hands by using a rope that a coworker threw into the tank. By the time I reached the top I was spent, and

surrendered my life. This time I dropped to the bottom of the tank like a rock. Thankfully, I was pulled out of that tank alive, after a neardeath experience. Right then, my father told me, You have been given a gift, a precious gift. Life is short. Be good to others. Resilience: the ability to both withstand difficult situations and also to remain stable under continuous adverse conditions. Resilience can be best illustrated by our patients; our founding fathers; our greatgrandparents, grandparents, and parents that brought us here to this wonderful country; and, of course, every single one of you. You have weathered a rigorous training and these special qualities will serve you well in the challenges to come in the next step in your lives. On the subject of surrendering and responsibility, one of my patients wrote to me the following about a moment we shared in the operating room: Awake brain surgery: this was truly an example of one person putting his whole trust into another person. I cannot think of another example in which one human being would submit more than just his life, but the risk of dramatic and potentially tragic change of life to another person. When I surrendered my life, I had a feeling of relaxation and faith. I knew that it was all going to be all right. I did not know which way it was going to go, but I gave all I had and there was nothing left probably not much differently than the way many patients have trusted and will continue to trust you with their lives. They will have faith in you. They will trust that you will care for them, that everything will be all right.

I quote the famous Peter Parker/Spiderman that my children and I have seen in movies numerous times: With great power comes great responsibility. Lesson 3: Excitementthat is, passionas well as excellence in everything we do. As I became older, I learned that knowledge is better acquired by action than contemplation. I also learned that it takes much more than intelligence to succeed. Hard work, humility, patience, seriousness and passion for family, patients, and workthere are no clear borders between these passions. Like many other immigrants (such as your family, your loved ones, or yourself), I arrived with only a dream, excitement, passion and the desire to pursue excellence. I continuously ask myself, Was it good luck? I am sure some of you do the same. Nobel laureate Ramn y Cajal once said, Chance and good luck do not come to those who want it. They come to those who look for them. Excitementthat is, passionas well as excellence in everything we do. The rest will come. Lesson 4: Ardorthat is, dedicationand admiration. Poet Madeline Bridges once said, Give the world the best you have, and the best will come back to you. The following is an excerpt from a newspaper column by one of my patients, a well-known sportswriter, written and published just a few weeks after surgery.

As with other aspects in life, the days before and days after proved far more traumatic than the actual event itself. Nobody looks forward to brain surgery with a sense of anticipation. But the operation itself? Surreal would be a fitting description. Conscious, albeit sedated but aware of those around you and exactly what theyre attempting to do, its difficult to explain what goes through the mind when that very same mind is being invaded. Fear? Not really. Pain? Not at all. There are no pain sensors in the brain. Anxiety? Perhaps. My patient was back to work a few weeks later. He loves what he does. He has ardor and dedication as well as passion for his work. Nothing can stop him from his mission. He is a true hero! Csar Chvez wrote, There is no substitute for hard work, 23 or 24 hours a day. And there is no substitute for patience and acceptance. I continually tell my students and residents that the brain can envisage more than what the eyes are trained to see. I tell them that rules are important but I encourage them to go beyond just following the rules. Question them, and, if possible, make them yourself. In order to find an opportunity in the midst of difficulty, I consider it crucial to have ardor, and dedication to ones work, life, family and patients. Let me share a related story with you from one of my patients: After the diagnosis of brain cancer, I had a very difficult conversation with my 14-year-old-daughter. Her first question to me after I discussed my disease was, How long did they tell you you have to live, Dad? My response was probably the most inappropriate. I simply burst into tears, not because of my own fear, but for what I felt

I was doing to her. She took my response better than any adult could have. She came over to me and hugged me and told me I will be all right, Dad. I admire my patients and their families. Most importantly, I admire their strength. Many people may think that what makes a good physician or scientist is intellect. I disagree. I think it is character, humility and passion in addition to intellect. Martin Luther King Jr. once said the following about character: The function of education is to teach one to think intensively and to think critically. Intelligence plus characterthat is the goal of true education. Lesson 5: Mentorship. I agree with Ramn y Cajal, who said, Science, like an army, needs generals and soldiers. The former may do the planning, but the latter do the conquering. I continue to learn every day from all my interactions with people. I learned a very important lesson a few years ago from my son, David, who was 4 years old at the time. We got up at about 6 a.m. on a beautiful Sunday morning and went for a walk. I told him, David, you are the man. He was quiet for a few seconds, and then replied, No, Dad, I am not the man. I was quiet for a few seconds and said, I just want you to believe in yourself.

David looked me in the eyes and said, Dad, I do believe in myself, but I know I am not the man. My son David, at age 4, taught me a lesson of humility and selfawareness. Albert Einstein once said, The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing. Our duty is to be mentors and not tormentors. I have shared with you some lessons I have learned through my own experience and mistakes: determination, resilience and responsibility, excitement (passion) and excellence, ardor (dedication) and admiration, mentorshipDREAM. Regarding my wife and three children, my parents and siblings, and my mentors: how can I thank them? I am reminded of what Einstein once said, Many of the things you can count, do not count. Many of the things you cannot count, really count. Therefore, a few tips: Learn from your and other peoples mistakes. The A in DREAM is not for arrogance. There is a fine line between confidence and arrogancetry not to cross it! Sometimes we fall so we can have an opportunity to get up and try again. Pursue your dreams, and dont let anybody tell you You cant. Treat others the way you would like your loved ones to be treated. Rules: dont just follow themmake them. Dont just build character; cultivate it as well. Mentor and let others mentor you. Train your eyes to see beyond your knowledge. Chance and good luck: look for them.

I leave you with a short note from a gracious patient that he allowed me to share with you: I was asked if I was looking forward to seeing the PBS special documenting our shared operation this summer of 2008. I answered that I had a friend who had all of his childrens births videotaped. He could not get beyond the first few moments of any videotapes. He would get so emotionally affected because of the enormity of watching the beginning of his childs life that he could not bear to watch. Knowing what I know now, about my diagnosis, about the severity of my disease, about the complexity of the procedures and its effect to all those around me, I understand what my friend had felt. Instead of the overwhelming emotion of watching a childs life began, I will be watching the beginning of my lifes end. However, it is not about how I am going to die, but it is about how I am going to live the rest of my life. Lux et veritas: light and truth. Congratulations, parents, family, and Yale Medical School Class of 2008.