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88 89 to say the least, were only partially mapped. I proudly acknowledge those Celtic traits that came from my physician/father - that is, a willingness to seek the poetry of a good battle and to almost relish a fight against wrongs, no matter what the odds. It has been said of the Irish that all their wars are merry, and all their songs are sad. If one did not approach this graduation with an historic and philosophic perspective, it might be very difficult indeed to find causes for merriment in the field of health for those about to begin their own journey of dreams today. For health care is in the throes of upheaval. Some of our hospitals are in bankruptcy; obscenely expensive malpractice premiums are common; physicians’ incomes are publicized on the front pages of our newspapers; and Medicaid mills, brain death, and the right to die with dignity have become part of the semantics of medicine. But I did not accept this gracious invitation to be your commencement speaker to detail the present plight of New York, or to identify the major crises in our health system, or to regale you with tales of how the current administration has met some of those challenges. I come before you not to utter a few polite meaningless words, but rather to encourage you and to share with you my dreams as well as my perception of reality. It is almost embarrassing at times, when learning from colleagues of the troubles in our profession to realize how happy I have been in medicine. A fellow traveler in the desolate swamps of the Sudan, where I once worked for months, said he had the unreasonable feeling that he had found what he was searching for without ever discovering what it was. The philosophy with which you enter the profession New Realities, New Frontiers New Y ork State Journal of Medicine, 1977 It was not too many years ago that I sat at just such a graduation, here at my alma mater, eager for the ceremony to be over, eager to shed the student’s shackles. I left this great university and hospital complex with a healthy trepidation for the future and a sailor’s respect for those sudden gusts of wind that so often alter the expected course of our lives. Although there were the normal fears of an undergraduate about to assume the responsibilities of a physician, I recall leaving Cornell more with a sense of wonder and expectation, an almost irrepressible sense of joy about the unknown paths ahead, and with an innocence that fostered dreams. There were almost no boundaries that I saw, and my concept of medicine was broad enough to embrace the whole world and all its facets. As I did not have the knowledge of where my dreams and aspirations would take me, I hope that you too do not have rigid restrictions to your definition of medicine but are willing to go where your dreams lead, for those are, and always have been, the frontiers of our profession. Where those dreams lead are the borders beyond which physicians must learn to go, not only in the technical science of health but in the arts of sociology, politics, diplomacy, and, indeed, in all the humane endeavors that may make us a civilized people. Medicine is that rare field that can embrace all dreams and accommodate all aspirations. My Bronx and Irish background must have provided a resiliency that not only sustained me through the poverty of student days, but also gave me the strength to embark from the harbor of academia on travels that, 88 89 to say the least, were only partially mapped. I proudly acknowledge those Celtic traits that came from my physician/father - that is, a willingness to seek the poetry of a good battle and to almost relish a fight against wrongs, no matter what the odds. It has been said of the Irish that all their wars are merry, and all their songs are sad. If one did not approach this graduation with an historic and philosophic perspective, it might be very difficult indeed to find causes for merriment in the field of health for those about to begin their own journey of dreams today. For health care is in the throes of upheaval. Some of our hospitals are in bankruptcy; obscenely expensive malpractice premiums are common; physicians’ incomes are publicized on the front pages of our...

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