IU School of Nursing Commencement Remarks Bloomington, Indiana
May 4, 2013
Chad Priest, RN, MSN, JD
Dean Broome, Dr. Hendricks, Dr. Krothe, my fellow School of Nursing Faculty and Staff colleagues, parents and guests, and my brand new fellow alums, thank you for allowing me to share this important and joyous day with you. There are rules about graduation speeches, namely that they be brief, hopeful and not radically challenge the status quo. I promise to be brief and VERY hopeful.
Graduation day is an extraordinary day in the life of the university. It is a day that marks the end of your undergraduate career and the beginning – the commencement – of your professional lives. While you may not remember every detail about the ceremonies and the speeches -(excepting this one of course) - , you will surely remember the feelings you are having today for the rest of your lives: EXCITEMENT about what the future holds. A bit FRIGHTENED about the world beyond the Sample Gates. CONCERNED about what you will do with the forty Kilroy’s t-shirts you own, now that you realize you can’t wear them in public without deep shame in any town except Bloomington.
CONFIDENCE gained from achieving your goals and making it to graduation. The JOY of being surrounded by your family and friends. And deep GRATITUDE for their love and support.
Take a look around the tent at the people assembled here today to celebrate with you. These are the people that matter. You should say thank you. Like, right now, you should say thank you. My mom and daughter are here today too – my mom mostly because I don’t think she ever believed I would be speaking at a graduation ceremony. Especially considering I just barely passed college math. Emerson is just here because she wanted to see all the pretty college students. Sorry guys, she specifically was NOT talking about you. Seriously, I love that she has 60 extraordinary role models to look up to – a wonderful opportunity for an 8 year old. So thanks for everything mom and thanks Emerson for supporting your dad.
For all these people around you – the ones you just thanked – remember that today is equally special for them and they will remember the feelings they have today for the rest of their lives as well. They are feelings of PRIDE at your success. Perhaps some RELIEF at your graduation. A bit of SADNESS as you formally embark out into the world and perhaps move away from family. --- But most importantly, they are feelings of HOPE. All of us on this stage, and in this tent have a deep and relentless HOPE that your work - - that your lives - - will someday transform OURS… that maybe you will secure for all of humanity the future many of us envision but will likely never see ourselves.
Our hopes for you are social and abstract, but they are also personal and concrete. Every NURSE in this tent is entrusting the future of our profession to you. We know that your first few years of practice will be spent doing your damnedest to make sure you don’t hurt anyone. But we also know that soon – sooner than you think – you will be called upon to lead. And we know that your leadership will either advance the science of human health – or not. This is why over the course of your education, the extraordinary individuals behind me on this stage have sought to not merely train you to be competent practitioners, but to unveil new ways of thinking and inspire you to greatness. It is a solemn obligation that we all take very seriously because our legacy is – ultimately – you.
Everyone in this tent, and everyone in your community, also has a great hope for you – that you will lead us to health – because we are all now your patients. Of course we aren’t all sick but, as Jay Walker has pointed out, there is no word in the human language for someone who isn’t a patient, but is seeking health. This should tell us something about our values. Regardless, we have deep hope that you will keep us safe and competently minister to us when we are sick, that you will help us usher in new life, that you will tend to our emergencies and that you will help us to die with dignity and grace.
We also hope, all of us, that you will keep us healthy. And here your greatest challenge awaits because we are, by any measure, not a healthy bunch. In fact, here in the US we are in deep, deep trouble.
Consider that despite spending more money as a percent of GDP on healthcare than nearly every other industrialized nation, we have some of the worst health outcomes. That’s hard to imagine when those of who are fortunate enough to have insurance have imaging on demand, can get a knee replacement with no wait and have access to hundreds of specialists. But the reality is that while we are exceptionally good at providing specialized medical care in the US, we are in nearly last place on every measure of health among industrialized nations. Last place.
What’s worse, we’re messing up the easy stuff. We have robots that can perform complex surgical procedures, but we can’t figure out how to get prenatal care for everyone who needs it – contributing to a disgraceful infant mortality rate that is worse than Lithuania and Slovokia and only barely better than Belarus.
Over 48.6 million persons in the US are uninsured, nearly 910,000 right here in Indiana. Unless you have faced a medical bill without insurance, it is nearly impossible to appreciate this terrible injustice. Hard working Hoosier families are routinely forced to choose between medicines or rent - healthcare appointments or a car payment. Somehow, inexplicably, in 2013, a full-time working in the United States can still go bankrupt as a result of becoming sick.
Despite what you may have heard on the television, these outcomes are not inevitable. They are the result of choices we have made. We have invested trillions upon trillions of dollars on a medical system that treats people’s illnesses without fixing what is that makes them sick in the first place. In any other area of our lives we would find this cruelly absurd, but in healthcare we beam with pride at our ability to fix you once we’ve let you slip into illness.
You are a super smart group, but let me give you a concrete example. If given the choice between professionally cleaning your gutters for $200 or mitigating a leak or flood that could cost $10,000, we would all choose to have our gutters cleaned. We all understand that even though there never seems to be enough time, we need to change the oil in our car every 3 or 4 months or risk terrible, terrible outcomes. I have a funny story about this. My brother, who is older and maybe wiser than me in most things, borrowed my car one summer. It wasn’t just any care. It was a 1978 Toyota Corolla hatchback, and it had an 8-track player. For those of you sitting in the middle here, that was a precursor to the audio tape. Wait, you may not know what that is either. Suffice it to say, the 8 track player was the coolest thing on the planet. I had the entire Woodstock concert on 8-track. At least two dozen 8-tracks in a sort of suitcase thing I bought at a thrift store for $5.00. The thing was, the car leaked oil. Which was understandable in 1998 because the care was almost 20 years old. So you had to replace the oil and get it changed. Pretty regularly. Except my brother didn’t, and once while driving on I-65 a piston in the engine actually flew out of the engine, through the engine block and onto the inside of the hood. I sat stranded on I65 and Emerson Ave. counting the ways in which I would exact my revenge. The cost to repair the car would have bankrupted me – so the car had to go. And with it, my freedom to move on my own volition. It was, as Vice President Biden would say, kind of a big deal.
It didn’t need to happen. And while the example is sort of silly, this is really happening in America in 2013. Fourteen states refused to expand Medicaid to provide primary care and hospital coverage to millions of uninsured this year (almost all of them working poor), ostensibly to save money. Consider, however, that nearly 80% of all people who die are enrolled in Medicare, and that in 2009, Medicare paid $55 Billion dollars for care delivered in the last week of life. Why is that we are comfortable with spending money on health only when it is too late for the money to do any good? This is the very definition of insanity and it is, cruelly, killing us. For the first time ever, the current generation is likely to have a shorter life expectancy than the one before it. This isn’t supposed to happen. Our healthcare system and reimbursement scheme are also very, very broken. And while the Affordable Care Act makes some changes on the margins, it doesn’t address the fundamental problem with American healthcare - that we don’t have healthcare at all in the United States. We have a sick-care system that, ironically – cruelly - is making us sicker.
Right now you are thinking – wow – glad we asked this guy to talk with us. He’s a real chipper guy.
Despite the very real, and very concerning realities of American healthcare, I remain - as promised - profoundly hopeful. I’m hopeful because spread out before me are 60 young women and men - 60 future nurses - 60 leaders who are poised to revolutionize healthcare. Each of them, republican, democrat or undecided – Nick’s fans, Kilroy’s fans or the elusive Video Saloon connoisseurs, they all understand an epically important truth: That even though the biomedical sick-care system in our country is irreparably broken, we need not be held hostage by it any longer. These graduates have a lot to learn. What they don’t know about healthcare is epic. You know that right? But they have an enormous advantage in that they have chosen as their calling – health. And they know that in matters of health, none of us can afford to be neutral.
The future of healthcare is in preventing illness. The future of healthcare is in, ironically enough, HEALTH. And these graduates have spent the last four years at one of the premier nursing schools in the nation learning how to maintain and restore health. They understand that our patients desires are not necessarily the same as ours. They know that community care can be delivered in the ICU as easily as it can be delivered in a community clinic. They are ready for a future that will see shrinking hospitals, but larger and more accessible emergency departments. They are prepared for a future when technology will disrupt our archaic models of care and open up doors to a future we can hardly imagine. Consider that this group of graduates was practically raised on smart phones, which are already becoming powerful devices capable of diagnosing and even treating disease. They also understand that the future of nursing is, in many ways, bound up in our past. Florence Nightengale was not merely the founder of the first formal school of nursing – she was a statistician. Something that the nurse researchers behind me surely can take pride in. She understood then what we are now re-learning – that the power of evidence to inform decision making in healthcare will enrich and save lives.
Maybe most importantly, they know that the cure for most of what ails us – most of what makes us sick – has nothing at all to do with healthcare. It has to do with safe communities, clean water, clean air, strong social networks and healthy food. This is a group of nurses that can rescue you in an emergency – even in an underground subway, restore your heart to a normal rhythm, provide expert mental health care, look after young children as competently as old adults, and on top of all that – keep you healthy so you never need their services.
While I may have lost a lot of my faith in our elected officials over the course of this year (on both sides of the aisle), I’ve had the privilege and opportunity to work with these leaders -- your sons and daughters, your spouses and friends -- nearly every week since August and I can assure you that our future – while far from certain – is in good hands.
To the 2013 graduates of the Indiana University School of Nursing, here in beautiful Bloomington: we have placed our hopes and dreams with you. It is a heavy burden to be sure, and it isn’t necessarily fair. But it is the burden that every graduating class bears – and I know you will not let us down. Leave this place prepared to make your mark. Go out there and nurse us to health. You don’t have to change the world all at once – start with what you know. Start with that first patient of yours, the very first one you care for all on your own and recognize that that patient is all of us as well. All of us in this tent. Look into this patient’s eyes with respect and humility and hope, and ask simply “What shall we do together today?”
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