Teri Reynolds with her mother at Commencement.

The following address was delivered by Teri Reynolds - in her eighth month of pregnancy - at the UCSF School of Medicine Commencement exercises in the Masonic Auditorium on May 20, 2004.

I want to thank the boy here for holding off long enough for me to make it to graduation today. In a week or two, you will have some serious competition, but so far, being asked to speak to you today has been one of the most moving moments I've ever experienced.

When you come to med school as a 30 year old English teacher, med students are scary. In 19^th century novels, at their worst, they're grave robbers, drunken louts, and even murderers. At their best, they're nihilistic philosophers, pedantic fops, and awkward dinner companions.

The last thing you expect is to find a group of people like this.

I dont want to say that this place is like Lake Wobegone, where all the children are above average, though there are enough parents in the audience this afternoon that Id probably get away with it, but we talk about outliers in medicine - standouts, cases on the ends of the spectrum - and this is a class of outliers. We have musicians and composers, puppeteers and pilots, a truly unhealthy number of triatheletes and surfers -- and, as I discovered at our class playnot one, but two people who can twirl flaming batons. We have cartographers, photographers, writers, teachers, divers, gymnasts, chefs, and, at one point, even a teenager (who kindly pointed out to me that we were both born in the Chinese year of the roostersince its a 12-year cycle). Being part of this group of people has been like nothing else in my life.

I've been waiting for four years to be found out and sent home, but today I think I can finally say, it's too late.

This is not to say that we aren't scary.

We have become the kind of people to whom it occurs that bilirubin-UDP-glucoronyl-transferase can be sung to the tune of Supercalifragilisticexpialidocious. We can no longer give directions to a restaurant without using the words proximal and distal, weve even lost the ability to use left and right without pausing first to see if we mean our own left. Worst of all, perhaps, we wear clogs in public, something I like to think we wouldnt have done before.

We have changed.

And even to the extent that we have tried to stay the same, we have changed for others. My mother is the baby of eight siblings raised in rural Mississippi, and I'm her only child, so even though I haven't been back to Mississippi in years, the fact that I am in med school hasn't escaped notice, and one of my aunts called me last month to talk about my uncle.

When I was a kid, he drove an RC cola truck- Royal Crown cola for those of you born on the coasts - and during the summers I spent in Mississippi, when my two cousins and I would come back from the town swimming pool every day, he'd have put one RC Cola, one orange Nehi and one grape or strawberry Nehi in the freezer. We never saw him do it; we never beat him home, and the soda was never frozen somehow. And even though his two boys were a year older and a year younger than me and we competed over almost everything else, this was magic enough that we never fought over who got which. My uncle quit driving his truck 15 years ago when he went blind, from diabetes we've always thought. What my aunt called to tell me is that they now know he's had a growing tumor all this time.

This is a woman who used to tell me - you've got book smarts, Teri Ann, but you just got no common sense - so I think it's safe to say, she doesn't overestimate me. She didn't call me for book smarts, or medical advice - my uncle has been transferred to a big city hospital now and is under the care of expert neurosurgeons. She didn't even call to ask me to interpret or explain the information she'd been given. She just called to tell me the story.

I have 22 first cousins on my mother's side alone, and I'm not the one she'd call for anything else, but my aunt called to tell me this story because of what I've done here for the last four years - not because she thinks I have any more common sense now (I guess she doesn't overestimate this institution either), or even because she thinks I know enough to do anything, but because becoming a doctor, I'm learning, means above all, that people bring you their extraordinary moments.

We will hear many stories. We'll demand them: What happened? When? How? We will be readers of our patients' stories, and then, we will rewrite them as our own.

This is a 55 year-old woman who presents with is our Once upon a timeno less formulaic, and no less infinite in its narrative potential. But the stories we tell are not the same ones people bring. They are reaction, analysis, diagnosis, strategywhat we do when faced with a patients narrative.

The difference between a string of events, and the tale taken home at the end of the day is that we deem these events worthy of a second thought, a moment of reflection, worthy of the tellingwe allow to this days work, the accumulation of meaning beyond habit.

The ability to take in someones story, to track and contextualize the meaning of a termwhat does this patient mean when he says painful, when she says dizzy, when he says weakthis is only part of the job. We are readers when we try to understand what has happened to our patients. We are writers when we try to understand what has happened to ourselves.

Late in the Divine Comedy, Dante is asked to define faith, and he says:

Fede e' sostanza di cose sperate ed argomento delle non parventi.

Faith is the substance of things hoped for and evidence of those unseen.

Learning to doctor is something we have done within a network of expectations and support, of competition and friendship - a process of learning to think of ourselves relative to our teachers and our colleagues.

How many times have we paused usually it is very early or very late - with needle or scalpel poised above a patient and looked briefly sideways and with poorly concealed doubt - at the resident or attending standing beside us, and had them say, without urgency and without indulgence, Go ahead.

Perhaps they remember when they stood in our shoes, maybe they quietly celebrate not being there any more, or they silently run the possible complications of the procedure, but they don't look away and they don't smile.

(Remember, because this is important, that there was even a time when you paused with a pen because you were scared to write in a medical chart.)

And you move downward with the needle or the scalpel, not because you believe you can do this, but because the person standing next to you believes you canand because this is enough.

How many times have you entered a room and said Um, Im the medical student on the teamwould it be OK if I " and had a patient say, with fatigue, with amusement, with indulgence but calmly, Go ahead.

How many times have you looked at your classmates and ...gone ahead because you thought, "well, they seem to think we can do this," not understanding at the time that the rest of us were also looking to you.

We act above our expectations for ourselves, because in the end, we are drawn into competence by the faith of those around us. This is the substance of things hoped for, as we search for evidence of things unseen.

The first time I walked into a patients room, traveling in a little pack of white coats stiff enough to stand up on their ownmy main concern, since I didn't know how to fix anything, was to stay out of the way. Unfortunately, I looked down (and this will surprise few of you who know me) and found toothpaste on my shirt, and just as the conversation turned to priapism, backed into a metal instrument tray. My classmates froze, the patient smiled, the attending winced, and at that moment, I decided I'd better redefine my goals. I was no good at staying out of the way.

If medicine is only a fight against disease, if medicine is a zero sum game, and our definition of success is to win, then we can, and eventually will lose.

But we can always get in the way.

We can stand between our patients and confusion, we can stand between our patients and insurance companies, we can stand between our patients and pain. We can mediate our patients' experience of disease - by placing ourselves, our words, our skills - the tools we came in with and those we have learned to use here - between them and what is hard.

We can define the task of medicine as we will -and commit to accompany a patient, as best we can, through the course of a medical experience. This may be across 25 years of struggle with chronic illness, or the arc of an emergency department visit. It may begin with a newborn checkup and end with a college physical. It may be the course of a surgery, a 45-minute hour, or the time it takes to suture a wound. But this is a guaranteed success task.

Before I close, I want to take a minute for Pat Patterson, whom we lost in October without really understanding why. For most of us, when we heard, it had been a while since the time when we saw Pat almost every day in the anatomy lab, and the news took us back.

What I remember most is that no matter what we asked him, Pat would laugh before he answered. I'd ask a question in my best serious student tone, and he'd drop his head and snicker, and then, raise his head and explain. Sometimes he'd start to smile or chuckle when I walked up, before I even said anything. I don't think I ever managed to impress Pat, though I certainly would have liked to, but I know I amused him. Contrary to the saying, Pat would laugh with you and even near you, but he was always also - just a little bit - laughing at you.

And so in that room on the 13^th floor where we first wore scrubs, where we first handled a scalpel, where we laid hands on the first body in our care, and where we first got a glimmer of the ways people would give themselves to our learning, there was a teacher who made it almost impossible - though we certainly tried - to take ourselves too seriously. For this early lesson, we owe him our thanks, but also for the later one: that as we learn, among those we care for and also, those who care for us, there will always be those people and answers that remain outside our reach.  

Here, now that we are at the end of the beginning, I think the most breathtaking thing about this training is that we get real patients so long before we feel like real doctors....

So in the coming months and years, when you're tired, when it's very early or very late, and you look sideways and find yourself alone with the needle or the scalpel or the pen...as you accumulate evidence of things unseen, remember also that there is already substance to the things you hope for.

Remember this story, these people who you began to learn to doctor with, and say quietly to yourself...

Go ahead. Get in the way.