Why Doctors Should Be English Majors

In early May, I was lucky enough to receive an invitation to see a production of “The Tempest”, by the Hobart Shakespeareans, a fifth grade class led by renowned elementary school teacher Rafe Esquith.  The production was scored, lit, set and acted by inner city ten year olds who, lacking funds for elaborate Elizabethan garb, all wore the same T-shirt emblazoned by an image of William Shakespeare, with the simple slogan “Will Power.”  I wrote about my experience in the blog piece “Such Stuff as Dreams Are Made On.”  Two weeks ago, an op-ed piece by Verlyn Klinkenborg in the New York Times decried “The Decline and Fall of the English Major: http://www.nytimes.com/2013/06/23/opinion/sunday/the-decline-and-fall-of-the-english-major.html?ref=opinionHYPERLINK   As I read it, I reflected on my own experience in medical school and beyond, and I think that Mr. Klinkenborg’s message is one that medical school admissions committees should be hearing loud and clear.

Despite the fact that doctors are faced with increasing mounds of paperwork and decreasing autonomy, medical school admissions are as competitive as ever. All handwringing about the state of the profession aside, young people still desperately want to be doctors.  Students who would vie for a coveted slot in medical school must start their resume building early in their college careers, and must complete with flying colors a standard premedical curriculum which with rare exception has not changed one iota since I applied to medical school in the fall of 1974. Students who major in the basic sciences—biology, chemistry and physics—have an advantage in the race for med school admission because they typically outperform other majors in their MCAT scores and because their majors allow them to get a leg up in scientific research.  In many cases, college students who are science majors apply for medical school with first author publications listed on their curriculum vitae.  And at the end of medical school, students who have taken the time to obtain a dual MD-PhD degree are the ones who are most competitive for those coveted specialties of dermatology, plastic surgery, orthopedic surgery and radiation oncology where the prize at the end of the road is a controllable “lifestyle” combined with high reimbursement.

But even in the rarified world of first author scientific publications in peer reviewed journals, there is that moment of truth, when push comes to shove, and a group of editors must decide whether to publish the paper of one author, or someone else’s.  No matter how brilliant the tables and graphs, in the end that decision will be made on how well the author EXPLAINED the data, how compelling was the argument, and how explicitly the new data informs both the reader and the greater body of work on the subject.  In the end, this is where those former English, and history, and philosophy majors shine, and surpass their basic science background colleagues.  Just ask Dr. Harold Varmus, the current director of the National Cancer Institute, Nobel Laureate, and possessor of both undergraduate and graduate degrees in English from Harvard.

This week I worked with an excellent medical student.  He was bright, personable, and thorough and the patients truly enjoyed speaking with him.  We saw six or seven new patients together, and here is an example of the narrative on the physical exam on one: “ABD: SFT, sMS, NTDR, NABS, NHSM.” Say what?  For the non-MD readers out there, that means that the abdomen was soft and non-tender with no masses, abnormal bowel sounds and no enlargement of the liver or spleen. In this fast paced world of texting messaging and abbreviation, this old English major would like to see her own life history and physical exam written in English, please!   Why does this matter?  Colum McCann said it well in Let the Great World Spin:  “Literature can remind us that not all life is already written down: there are still so many stories to be told.”  Very few doctors will ever win a Nobel Prize.  But all of us should be able to tell a patient’s story, tell it well, and make sure it’s worth listening to.  After all, it could mean the difference between life and death.

The Wisdom of Youth

In the spring of our freshman year at Yale, my roommates and I were shocked to open the Sunday New York Times, so fashionable at brunch in the dining halls, and see an article written by one of our very own classmates in the Times Magazine.  Called “An Eighteen Year Old Looks Back on Life,”(http://www.nytimes.com/books/98/09/13/specials/maynard-mag.html)  the autobiographical essay captured the angst of those of us growing up in the 1960’s, and made the author Joyce Maynard famous.  So famous in fact that she caught the attention of reclusive author J.D. Salinger who began a series of correspondences with her that culminated in her leaving Yale to go and live with him, when she was nineteen and he was fifty three.  Every so often, a kid surprises you.

And so was I surprised a week or so ago when a good friend of mine from medical school sent me his son’s speech delivered as high school valedictorian of his graduating class.  I wasn’t prepared to be impressed.  After all, I had just heard commencement speeches delivered at my daughter’s graduation ranging from her class president glibly and with great flair comparing a medical career to a marriage, to Harold Varmus, the Nobel Laureate and current Director of the National Cancer Institute speaking about the role of the physician in shaping society and public policy.  Isn’t every parent proud of their child who graduates first in his class in high school?  I certainly would have been, had any of mine had that honor.

Since my friend’s son’s speech has not made it into the New York Times, at least, not yet, I asked permission to share it here.  I hope that you will enjoy it as much as I did.  Here it is:

“I had some trouble finding something valuable to say. I fished around, and ultimately, I gave up. I decided instead that it might be easier to babble about the sort of stuff I usually babble about, thinking that would be easier. Two people, 500 people…

Something I think about quite frequently is this concept of a zero sum game. It’s a game in which each player has either a positive or negative number of points, and all the players’ points sum to zero. So, for everyone that wins, everyone who succeeds, someone else has to suffer. There are a lot of these games going on today. Locally, nationally, and globally.

It used to be that everyone was playing these games. 1 human survives, 1 pig-beast becomes food. And of course, over time, these became human sacrifices. We were introduced to the most tragic and relentless of these games, war. One player wins, another loses…

But we find that if we look around, we see a different kind of game. We see games with positive sums, even with increasing sums. Not only does everyone benefit, but the benefit increases over time. Of course, I want to talk about technology. I want to talk about Quinine and Smallpox vaccine and Magnetic Resonance Imaging: Remarkably ingenuitive solutions to seemingly intractable problems.

But I would be lying if I told you that art, and literature, and history, and every other form of creative/analytical human endeavor weren’t included too. They are. They produce information, interpretation, and commentary which is crucial to our collective mental health (it’s no coincidence that great social revolutions are invariably coupled with revolutions in these fields).

As it turns out, the actual field is not particularly important. What is important is what this work represents. It is evidence of a collective endeavor to create, to project the imaginations, designs, interpretations, and realities that exist in our minds onto the world around us. We are all inconceivably powerful creatures, although we might not believe it.

The point is this. We can look at a zero sum game and ask why, and inevitably someone is going so sit us down and tell us that that’s just the way it is: the way it has to be. What we don’t realize is that we have the power, the enormous cosmic influence, to say no. We all make the rules. We are not bound into bad games because we can create alternatives, we can refactor, reconfigure, regenerate.

I’m not a good person to take advice from. Those who know me have discovered this… empirically…What I will say to you guys is that you must bear all this in mind. If you find a bad game, make a better one, whatever field you find yourself in.

You don’t have to worry about being successful (capital S), wealthy, famous, and so on. The only thing you have to do is to open your mind to the mutability of your reality, and start hacking. Let love be your guide and your mind, your hand.”