• Graduation speech to Ethiopia’s first emergency doctors….

    (Note: the conversation continues at jamesmaskalyk.com)

    Biruk, Sofia, Yenalem, Seble…..

    You did it.

    I feel like there should be 84 million, nine hundred ninety-nine thousand, nine hundred and sixty more people in this room. In fact, I feel like the whole world should be here, not just to celebrate your graduation as an occasion that marks a safer future for the most vulnerable, or that the means by which you were trained is replicable and available, but to see how people from three different countries can come together in a spirit of peace and make something beautiful.

    I came to Addis, for my first time, not from a place of peace, but from one at war. Sudan. It suffers still. I was working for MSF in a small hospital, overwhelmed by the sick and dying and fighting, the heat and the sand, and when a chance came for me to leave that place, to come to Ethiopia and learn how to care for patients with Tuberculosis, I took it, not just to help them get their breath back, but to find mine again, even if just for a week.

    The air that I stepped into, at Bole’s international airport, smelled so sweet. It still does.

    A professor from Addis Ababa University taught me everything I know about TB, with his x-rays and experience, saved dozens of peoples lives, through me. Because of him, because of Ethiopia, in Addis Ababa in 2007, I touched hope when it seemed far away, and it carried me through my mission, and it has carried me back here, to stand in front of you, the country’s first emergency doctors, and it stretches from this room towards forever. I’m fond of repeating a quote of Vaclav Havel, told to me by my friend James, that hope is not a belief that things will work out regardless of circumstance, but the belief that regardless of circumstance, something makes sense. That you are experts in the type of medicine where minutes matter in a country with such a surplus of emergencies, makes sense.

    I wrote a book about my time in Sudan. I’m writing another now. Some of it is about Ethiopia. You are all in it. Don’t worry; I’m generous.

    I was talking with a friend of mine about how to focus it. I knew it was going to be on emergency medicine, but was deciding on a larger direction. James, he said, remember in your first book, you wrote about that woman who walked for six days with a baby’s arm reaching from her, unable to be born any further? Yes, I said. It was blue.

    Write about what she was walking towards.

    She was walking towards you.

    I know you think emergency medicine is about what you know, the skills we’ve helped you learn on resuscitation, ultrasound, reading electrocardiograms. Maybe you think it is about decision making in times of crisis, or how to manage many things at once with grace and compassion. Or you might even think it is about research that allows you to do better medicine, or advocate for societal change.

    It’s not. It’s about a room that never closes. It might be the only room in the city that is open twenty four hours per day, seven days per week, Eid, Timket, Easter too, and anyone can enter it, rich or poor, no one is turned away, and in that room, they will be asked “how can we help you” by someone who means it, with nothing to sell, someone with no other interest except listening to the answer and working to satisfy it, no matter the difficulty.

    I’m not sure there are any other places like that. Churches? Are they open 24 hours per day here? Some. Ok.

    This is my challenge to you: make your ER a church. Make it the place where you pray towards something that makes sense. People misunderstand the word prayer. They think it is a conversation with god where one can ask for things; relief, salvation, even material goods. That is not prayer. That is wishing. Praying is an activity, a movement towards a world you want to see. Prayers like that get answered, wishes, never. If you pray towards a world that makes sense, with your gestures, even the small ones, it will move into view. This is the magic of the world, your true power.

    There will be struggles, not just to find the right medicines in time, or dialysis for that little girl before she drowns from her own backed up kidneys, but in your spirit. You might not be able to transform peoples sickness as often as you would like, but in those instances, you can transform their fear of being unheard. And if you use those encounters as a way to pray towards an easier day for the people who will follow, by working with your nephrologists to get emergency dialysis even though it seems like it will take years and you want it tomorrow, one day it will come, you’ll see, and that day or the day after, a little girl will walk into that room gasping, and a week later, she’ll leave it skipping, and the relief will be so complete, you can almost feel it from here. In the meantime, if you suffer a lack of means, until they make themselves available, you are able to offer the most important thing: your presence and compassion. Let it shine. Teach the juniors well, because they will own that space with you, and the more of us that do, the stronger it is.

    As you make that place for the sick and suffering, keep its lights on and door open, you must keep your heart open with it. That becomes your daily practice. Practice makes practiced, never perfect, only better, but you’ll see as you try to keep it open, the longer it stays that way, and soon you’ll see that it will be filled as brimming full as your stretchers. You will not just have a satisfying career, and a place in the history of your country, but food on your table, the company of fine people, and dare I say it: the true love that is only possible with knowing our one shared heart.

    If a goal of life is to create one of possibility, you’ve done it. Doctor. Teacher. Researcher. Leader. What will you do with that rooms sacred space? That place where you make no distinction between man, woman, tribe, country, but see the sickest first, then everyone else in the order they come. Take it throughout the country, let it put the young men and women who are knocked down firmly back on their feet so they can help pull your entire nation towards easier days? Maybe take it to Sudan, Somalia, let the peace it promises do its work, and watch that space grow.

    Whatever you want is possible. Nothing can hold you back. Today, you join the company of thousands of men and women around the world who share your same space, your same struggles, who are as committed as you are to being excellent. Lean on them. You will find solid ground.

    And you will find me. I’ve come to know you well over these past years, and I can sincerely say you are up for the task. It is my pleasure to retire myself from being your teacher, and instead, offer myself as a colleague, and friend.

    May the long road ahead rise to meet your steps.

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