by Alan Alda
So I began to see a paradox both in doctoring and in acting: the need to be empathetic and coolheaded at the same time. You had to have some distance from it, but not too much. We had to be precise in our work; words and motions had to be exact. You needed to get your hand into a sticky surgical glove in exactly the time it took to speak some complicated medical talk. Sometimes the comic business needed split-second timing. Yet if there was no simple authenticity about it, it would look mechanical. To keep technique from dominating us, we cut through it with playfulness. We were a little like the surgeons in this: For the patients’ well-being, we layered them in bandages; but for our own well-being, we laid on the badinage.
As I talked to the young doctors graduating from Columbia P&S, I was struck by this tension between technical skill and the human connection and how sometimes they could be at odds with each other.
You’ve had to toughen yourself to death. From your first autopsy when you may have been sick or cried or just been numb, you’ve had to inure yourself to death in order to be useful to the living. But I hope in the process you haven’t done too good a job in burying that part of you that hurts and is afraid.
I know what it’s like to be absorbed in technique. When I write for M*A*S*H, I’m always writing about people with what I hope is compassion and feeling. Yet one day I found myself talking to someone who was in a real crisis, in real pain, and I remember thinking, This would make a great story.
Becoming set apart—becoming your skill—can make it tough to face your feelings, and you get left out of the loop.
I was unqualified to talk to them about medicine. But I was an expert in one area of medicine: I had been a patient. This was an expertise from which I could speak to young doctors from the heart.
With all your study, you can name all the bones in my body. You can read my X-rays like a telegram. But can you read my involuntary muscles? Can you see the fear and uncertainty in my face?
If I tell you where it hurts, can you hear in my voice where I ache?
I show you my body, but I bring you my person. Can you see me through your reading glasses?
Will you tell me what you’re planning on doing to me, and in words I can understand?
Will you tell me when you don’t know what to do? Can you face your own fear, your own uncertainty? When in doubt, can you call in help?
Even if, in time, you don’t deal directly with patients—if you’re in research, administration, if you write—no matter what you do—eventually there is always going to be a patient at the other end of your decisions.
Will you care more about the case than the person? (“Nurse, have the gastric ulcer come in at three.”…“How’s the fractured femur in room 208?”)
You’ll know you’re in trouble if you find yourself wishing they would mail you their liver in a plain brown envelope.
Where does money come on your list? Will it be the standard against which you reckon your success?
I didn’t know then that one day medicine in our country would be run by accountants and that actual doctors would have little chance of making any money—unless they ran an HMO. If they did, there would be a special waiting room for them in the outer office of heaven, where they would sit forever.
Where will your family come on your list? How many days and nights, weeks and months, will you separate yourself from them, buried in your work, before you realize that you removed yourself from an important part of your life?
And if you’re a male doctor, how will you relate to women? Women as patients, as nurses, as fellow doctors—and later as students. Will you be able to respect your patient’s right to know and make decisions about her own body? Will you see nurses as colleagues—or as handmaidens? I hope you men will work to grant the same dignity to your female colleagues that you yourselves enjoy.
And if you’re a female doctor, I hope you’ll be aware that you didn’t get where you are all by yourself. You’ve had to work hard, but you’re sitting where you are right now in part because way back in 1848 in Seneca Falls, women you never knew began insisting you had the right to sit there. Just as they helped a generation they would never see, I urge you to work for the day when your daughters and their daughters will be called not “a woman doctor” or “my doctor, who’s a woman,” but simply “my doctor.”
When you think about it, there isn’t an area of your work that won’t be affected by what you decide to place a high value on and what you decide doesn’t count.
Well, that’s my prescription. I’ve given you kind of a big pill to swallow, but I think it’ll make you feel better.
I thank you for taking on the enormous responsibility of caring for other people’s lives and for having the strength to have made it to this day. I don’t know how you’ve managed to learn it all. But there is one more thing you can learn about the body that only a nondoctor would tell you, and I hope you’ll always remember it:
The head bone is connected to the heart bone—don’t let them come apart.
Many years later, a young woman came up to me in an airport and told me she had been there that day in the graduating class. She said that for a long time she had carried a copy of the talk around with her to remind herself of the kind of doctor she wanted to be. I was moved by the thought that someone had actually taken my words to heart. And it wasn’t until then that I got the real message of what I’d said that day: how much more alive you can feel—even a sense of purpose—knowing there are real lives at the other end of your ministrations, or your art, or your talk, or even your jokes.
Chapter 5
* * *
The Talking and the Doing of It
You could hear them falling from the trees and thudding onto the ground or hitting the shoulders of the people listening to the commencement speakers. They were locusts: long, green, swarming grasshoppers. It was 1982, and since we assumed they were seventeen-year locusts, we felt they hadn’t been out in the real world like this since 1965, which might account for their curiosity as they climbed up people’s legs or crawled around on their laps while the talks went on.
It was hard to think of anything but bugs that day. Elie Wiesel was there to receive an honorary doctorate from Kenyon College, as I was. We ran into each other a couple of decades later, and the first thing he said was, “Remember the locusts?” I gave the commencement talk, but all I remember of it now was a sea of faces registering revulsion and disgust.
They were probably reacting to the green things on their legs and not to my talk, but when I look again at the things I said—a litany of troubles that was the state of our world then—it makes me a little sad.
I cataloged things the graduates could do to make the world better, but it was really a list of all the ways we had screwed things up for them. I hadn’t done any special research; I got all my depressing information from the daily newspapers. When I look back now and imagine that sunny day twenty-five years ago when my daughter Elizabeth was graduating from Kenyon College with hope in her heart and a chuckle in her throat, I notice that, in fact, it wasn’t sunny. It was gloomy and gray; the world had been mangled, and on top of that, locusts were falling out of the trees onto our heads. There aren’t any good old days. On that day, though, she did have hope and a chuckle.
It was something she always had. Not long after she was born, the doctor said her feet were turned in a little. It wasn’t serious, he said. Casts for two or three months would straighten them out. At first, we were brought down by the sight of her small legs heavy with the plaster that encased them. But within a few days, we noticed she had invented a game. She knocked the casts together and laughed at the sound they made. She had turned them into a giant pair of castanets. She would grin up at us from her crib and slam the casts together, laughing toothlessly. Her laughter cheered us, as it would time after time from then on.
As she got older, her wit sharpened to a fine point. There was a running joke in the family, promoted usually by Elizabeth, about my nose, which the chil
dren regarded as unusually long. Once, on a cold day when she was eight, I announced that the end of my nose was freezing. “Sure,” she said, “the circulation can’t get out that far.” I told my friends how funny she was and offered her twenty-five cents for every funny line she or her sisters submitted to me for a television series I was writing. If I used the line, I would give them a dollar. It wasn’t that I was cheap; I just wanted to help them know the value of money. This led to some frugality on their part, but mostly to a new line of jokes about how cheap I was.
But now something new was happening. The little kid who went to sleep laughing while I sat at her bedside was graduating from college. And I was at the podium, looking for words that could catch this transition just long enough to make sense of it.
It seems hard to believe that you grew from that little baby…into a friend of mine. From my child to my equal.
I don’t know about everyone’s mom and dad today, but I know that for me—as glad as I am for you, as much as I feel this sense of pride and relief and accomplishment—that’s how nervous, anxious, and edgy I am about this whole thing.
I was talking to my daughter from my heart to hers, but I felt I had to make it a public talk, and I headed off on a commencement riff about the state of the world. I should have kept it personal.
What bothers me is not just letting you go. It’s the world you’ll be going into that scares me. What kind of place have we made ready for you? And how will you cope with it? Dirty water, dirty air, racism, sexism, unemployment, inflation, crime in places high and low, war and rumors of war: It’s a real utopia.
We’re leaving you with a government that solves these problems in an oddly creative way. “Why think of them as problems?” they seem to be saying. “Let all the problems be solutions for one another.” A couple of months ago, the president suggested that the unemployment figures would be much lower if we just stopped counting so many women among the unemployed.
You may feel that working on all this will take forever. But, actually, all these problems can be wiped out in five minutes, because we’re also leaving you the nuclear bomb. This is the ultimate problem solver, and Washington has been thinking about it.
They have a department in Washington called the Federal Emergency Management Agency, whose job it is to prepare America for the effects of a nuclear war. The head of this agency has been quoted as saying that after a nuclear war, “whatever the losses in food and manufacturing, they will be balanced by losses in population.” So one problem solves another.
FEMA was only three years old in 1982, and I hadn’t heard much about it. It wasn’t as far removed from reality as it would be after Hurricane Katrina, but they were already operating from another planet.
The agency says it hopes to keep American deaths down to only forty-five million in a nuclear war, and they have stashed away seventy-five thousand pounds of opium in secret locations to ease the suffering of those who survive the firestorm.
By the way, I’m not making any of this up. We’re giving you a world that runs like clockwork. And the clock it runs like is a cuckoo clock.
I couldn’t do much about the bomb. I’m sorry. I started working for a treaty to ban nuclear tests almost twenty years ago, when you were very small. But instead of things getting better, they’ve got worse.
Scientists have calculated that the three hundred million dollars it took to wipe out smallpox in the last decade are equal to five hours of the military budget.
Eighty percent of the world’s illness is caused by contaminated water, yet the cost of a sanitary global water supply is equal to three weeks of the arms race.
I know that today these words sound like the ravings of a naïve Hollywood liberal, but in a way, I can’t help it. I grew up in an age when this kind of woolly thinking was common. Take, for instance, this stinging denunciation of war and the preparations for war by a typical lefty of my youth:
“Every gun that is made, every warship launched, every rocket fired, signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”
These words, which today might seem dangerously close to undermining our national defense, were spoken in 1953 by President Dwight D. Eisenhower.
I wanted to speak to Elizabeth’s hope and cheerfulness, but there were a string of mournful events fresh in my mind that day, and I couldn’t keep away from them. I had just spent almost ten years campaigning for the Equal Rights Amendment. Scenes from those years still flashed in my mind. Eleanor Smeal and I pulling up to a church in Oklahoma, running in, and speaking to a crowd that surged and swayed with energy. Working with dignified, graceful Betty Ford, announcing a countdown campaign in the last year we had to get it ratified. Standing with Arlene and our daughters in Lafayette Park outside the White House, urging a crowd of a thousand people to not give up. But here was a time limit on ratification. Time had almost run out in 1979 when Congress voted for an extension. Now, in May 1982, if the amendment wasn’t ratified by three more states within a few weeks, it would not become part of the Constitution, and there was no chance for that to happen.
I wanted to give you a world that respected you as a woman as much as it did me as a man. I wanted the pledge of that respect engraved in our Constitution. But, unless a miracle happens within the next thirty-seven days, you’re not going to get it. You’ll pay the same taxes as a man, Congress can send you to war, just like a man, but you won’t be guaranteed equality of rights under the law. Not this year, and not next year, and maybe not for the rest of this century.
While we were campaigning for the amendment, I heard three fears expressed by opponents with surprising frequency. One was that under the ERA men and women would have to share the same bathrooms. This seems ludicrous now, but people actually expressed this concern on the floor in a number of state assemblies. Another was the worry that women would be forced to fight in the military alongside men, and the third was that states would be forced to allow same-sex marriages. Legal scholars said repeatedly that whether or not these outcomes were desirable, none of them would be mandated by the amendment. But the fears won the day, and the amendment wasn’t ratified.
Our culture changed anyway. Without the amendment, we now have men and women using the same bathrooms (sometimes, in college dorms, the same showers), we have women fighting and dying alongside men in combat zones, and in some states, there are same-sex marriages. But women and men still aren’t guaranteed equality under the Constitution.
There always had been plenty wrong with the world, of course, and there probably always would be. The hope for my daughter was that she would be strong enough to survive in it.
If there’s one urgent thought I want to leave in your ear in this parting hug—it’s that I want you to be strong. I don’t mean hard and brittle. The tree that won’t bend with the storm will snap in two. I hope you’ll flex and give and then stand straight again with your roots where they ought to be.
And being strong doesn’t mean having all the answers. Even when you’re in charge of something, don’t be afraid not to know exactly what you’re doing. Ask questions. Some people may look at you funny, worried at your hesitation. They’re only showing their own frailty. I’ve known some strong people, and they weren’t afraid to hold their uncertain ground while they searched for a solution.
It takes courage to be creative. And we’re going to need your creativity or we’re done for. And I hope you’ll give other people a chance to be uncertainly creative, too. Someone else may be able to contribute one idea that will solve one of the insurmountable problems we’re handing you, even though that person may be totally wrong about everything else.
Steer clear of ideology. Like jargon, it can be a
substitute for thought. The lure of the simple solution can lead to handing over your life to people who make the trains run on time—but who take away your freedom to go where you want on those trains.
Be open to change, and take risks—that’s the adventure and the art of life. Find the bridge between constancy and experiment. Be flexible, but principled. Be a dissenter, but patriotic. Be disciplined, but improvise.
Freud said, “Health is the ability to work and to love.” Add a third: Be able to play. Be playful about the most serious things in your life; you’ll enjoy them more and have them longer. Playfulness is a sudden shift of vision—a kind of affectionate dissent. It brings you closer to what you love.
