Three Poems, One Challenge, and a Promise

Your pain is seen, your fears are real, and you are more powerful than you know. Your courage is contagious.

Today, I offer you three poems, one challenge, and a promise.

Our first poem was penned by a physician, William Stafford, who titled it “The Way It Is." I prefer to call it “Purpose."

When I contemplate this poem, I find myself considering purpose, promise, and duty. Duty, especially, becomes crucial during challenging times. Despite our deep compassion and love as a society, we are confronted with extraordinarily demanding times.

We are emerging from the most devastating pandemic in a century. We have grappled with the shocking reality of systemic racism in our society. Our world, our nation, our communities—all are being tested like never before. It has become alarmingly clear that our systems are failing, often costing lives.

We have endured physical distancing, lockdowns, and political polarization. In our isolation, we have been exposed to graphic videos of death and murder. We exist under a constant cloud of uncertainty, our communities haunted by insecurity. Our children have become tragic victims of our fears. We have witnessed book bans, marginalized communities used as scapegoats, and powerful individuals clinging to power by fueling a maelstrom of escalating hate.

We, as a nation, are facing the fallout of division.

As educators in family medicine, we must comprehend the nature of our discomfort. We are in the toughest phase of birthing a new nation, a nation that Lincoln envisioned as one conceived in liberty and dedicated to the proposition that all are created equal. Any nation born of such a concept should indeed be crowning amidst chaos.

I often tell young physicians that their expertise is needed when things get hard, not when it's easy. We are needed when things become difficult, uncomfortable, and dangerous. That time is now. This is our moment.

Over 7 decades ago, our nation emerged from the global catastrophe of the Second World War. The greatest generation fought that war and built a new America. They established new systems and structures providing opportunities and wealth. However, not everyone was given equal access to these opportunities and wealth, and we are living with those consequences.

The greatest generation made monumental societal changes; they built interstate highways, electrified rural America, made Federal Housing Administration mortgages affordable, opened doors to education with the GI Bill, laid the foundations of our current internet, and in 1969 they took us to the moon.

They built those systems amidst chaos, turmoil, and violence. We face those same fears in different frames.

I propose to you that it is time for the next greatest generation. However, it cannot be just one single generation; our tasks are too great and our time is too short. The next greatest generation is not an age group or a demographic; it includes all of us.

In the midst of this turmoil and pain, we have witnessed incredible kindness, compassion, and courage like never before. This is what fuels my hope. Rising from this, we must decide: will it be hope or fear? Will we pull apart, or can we pull together? Every system is perfectly designed to achieve the results it does.

Our systems are broken. They are unsustainable malignancies, and as they grow, they poison us. Our current systems are built on false scarcity, the concentration of wealth, and the preservation of power by a select few. This has resulted in a health care system with declining life expectancy, an economic system that exploits and impoverishes both the planet and its people, and an educational system that perpetuates inequities under the guise of meritocracy.

We live in communities where knocking on a neighbor's door can be a death sentence, and asking for help can get you shot. In this country, a child is more likely to die from gun violence than a car accident. These systems will break us unless we change them.

The second poem's message is clear:

The next greatest generation will not fix all the world's problems with the same broken systems. To change these systems, we must address the inequities and prioritize the marginalized. When we uplift those with the least, we all rise. There is a path out of this, and we can traverse it together. The only way out is through, and the only way through is together.

This means not forcing broken people to fit into broken systems. It means allocating resources where they are most needed and moving forward with purposeful strength and the courage to hope. These challenges were created by human action and must be corrected by human action. This can be another greatest generation.

So, what can we do? We can build systems that promote abundance, rather than perpetuate scarcity. Stop focusing on who succeeds in broken systems; they will be fine regardless. Instead, look at who has been left out, left behind, and not included on your list.

Don't make choices based on who does well. Don't focus on who survives these dysfunctional systems; it only perpetuates dysfunction. You may wonder, “How do we create a system of abundance while living in a system of scarcity?"

We need new professionalism, we need to leverage technology to change the way we educate people, and we need to support and advocate for and with one another. For too long in health care education, we have only accepted people who have been able to demonstrate that they can memorize and regurgitate facts. We have the most expensive health care system in the world and some of the worst outcomes. To make a real difference, it is time for a change in how we select those who come into our profession.

I was teaching in the hospital about a year ago, and we transferred a patient to another service for a procedure. That patient died while on that other service, and the residents asked for a type of review that I'd never seen before. It was a conversation around feelings about the challenges of caring for that patient. As we gathered, I remember thinking to myself this is not like any other patient review I've experienced.

People discussed their emotions, their concerns, and their challenges. Folks were quite vulnerable with one another, and with me, and honestly, it made me very uncomfortable. When it became my turn to speak, I remember making a choice, and that was to express my discomfort accurately and tap into where that came from. I told a story of when I was an intern in the ICU over 25 years ago.

At that time, emotions had no place in professionalism. We had a very prolonged code on a very young patient. The person doing most of the compressions was a fourth-year medical student who was doing a subinternship. I remember looking at him after the patient was declared dead. I remember seeing that he was in a very hard place and seeing that he would most likely start crying soon so I walked up to him and patted him on the back said “Hey, I think there's some ice cream in the break room, come on.” We went back to the break room. It was completely empty, and we both started crying.

I was trained in a time when emotions were hidden, and that cycle was perpetuated. I contributed to that. I am done contributing to that. On that day, when those residents shared their feelings, I could cry in front of them. Most of us did, and we were vulnerable and honest with each other, and we were still good doctors.

And we were very uncomfortable. The new professionalism that will help us change these systems is that if you are not creating discomfort in a dysfunctional system, then you are not being professional. We need to teach one another and ourselves how to respectfully wrestle with these hard, necessary changes. Start where you are.

Artificial intelligence and new technologies are here to stay. Let's find ways to leverage them so that we can educate anyone with the capacity to become an excellent physician. Let's end memorization and regurgitation, build lifelong learning collaboratives, and teach toward growth, mastery of skills, critical analysis of situations, and reflective engagement. Let's lead in these necessary changes. Use what you have.

Advocating in and out of health care is crucial. Let's add our voices to the multitude crying out for change, and we might find that advocacy will significantly change systems. Do what you can.

This is our time. The next greatest generation is about creating systems that recognize our humanity, care for the least of us, and create abundance for most of us. This will not happen without all of us.

The third poem was published in the essay “Hymn for the Hurting” by Amanda Gorman, written after the latest Tennessee massacre.

One Challenge and One Promise

The challenge is to believe.

We must believe that hope is stronger than fear. We have to believe that compassion and caring can exist without compromise. We have to believe that we are the people who can show up and stand up. We have to believe we can make a difference.

My promise to you is that we can do this. I'm not here to persuade or control you; I'm here to love you and let you know that together, we can do hard things.

Your pain is seen, your fears are real, and you are more powerful than you know.

Your courage is contagious.