A welcome to Yale

Greetings to the double-oh-seven class. This is both a lucky number class and, I suspect, a theme for your second year show (I expect to play Mother and Dr. Angoff to play Money Penny). Greetings also to your parents and our alumni. My name is Dennis Spencer and I have a brief introductory speech which should be taken in the spirit of Mark Twain, one of my favorite authors with whom I share both an origin in the Midwest and a move to Connecticut. He said in anticipation of what I will say that “in our country we have those three unspeakably precious things: freedom of speech, freedom of conscience, and the prudence never to practice either.”

So who am I , your interim dean? You do need to have an answer to this question when your parents and friends ask what is going on at Yale what with worker unrest and new deans. I can provide some data that may serve to either calm their anxiety or stimulate their concern.

Until July 1 of this year, I was the chairman of the Department of Neurosurgery here at your future alma mater. Besides specializing in a field that treats only 1 percent of the patient population, I am even more narrowly focused on the field of surgery for medically intractable epilepsy, which includes caring for a relatively small number of patients who suffer from a very heterogeneous group of syndromes but from whom we have learned most of what we know about localization of human brain electrophysiology and function.

All of my life’s work has been engaged in trying to understand the mechanisms of this set of diseases, talking to the patient and sampling with electrodes, chemical sensors and scalpel the living tissue that constitutes their brain.

Interesting, but hardly the necessary qualifications for a dean, if there are any, and, I must say, I have not seen them written down anywhere.

Balancing this very focused career path was a social background originating in rural southwest Iowa. I was born on a small family farm homesteaded three generations ago, the son of a farmer/electrician father and farmwife/grocery clerk mother.

I plowed the fields but personally identified with the tall, young, solemn G.P., raised in Kentucky and just back from the Korean War. He wore a white coat, walked with a limp from a shrapnel injury, carried a big black bag and drove an oversized black Cadillac around the countryside, literally and what appeared to be miraculously, saving lives, including mine, with a newly discovered antibiotic, penicillin.

At age 10, I wanted to be that man. However, at age 14, I bought a book by Wilder Penfield, called Speech and the Brain Mechanisms and this changed my life. Penfield was the first neurosurgeon with the audacity and vision to believe that epilepsy, the sacred disease of Hypocrites, could be localized by an ingenious device, the electroencephalogram (EEG), and that then these stormy electrons physically extracted. On the way to providing a cure for this devastating neurological disease, he localized language and other functions by directly stimulating the awake brain during these operations for medically intractable epilepsy. So, in high school I tried unsuccessfully to make an EEG amplifier, and then resolved that it was more than an ample ambition for a farm boy to become a good general doctor.

However, through college and medical school the nervous system continued to seduce and distract me and I eventually became a neurosurgical groupie at Washington U., wrote my thesis (which was elective at Wash. U.) on inter-hemispheric transfer of images in the Rhesus monkey, came east in 1971 to do my neurosurgical residency here under William Collins and in 1976 helped to crystallize one of the U.S.’s earliest epilepsy surgery programs with a small group of neurologists, which included my wife, now an internationally recognized epileptologist.

Most of you will also become specialists of one form or another. You will define yourself by an organ or a disease, or even a protein or a gene, but you must never forget that it is much more difficult to be that general doctor who lives by Dr. Edward Trudeau’s maxim, “to sometimes cure, often help, always console.” If you want to burn this into your brain early in medical school, please join me, two or three at a time to witness this tension between the art and the science of medicine by spending some time in a very high-tech, computerized operating room and a very low-tech, hands-on outpatient clinic. That’s the short version of who I am, now who are you?

You, the 100 class members of 2007 are highly selected, having completed 119 undergraduate majors at 46 colleges, master’s degrees at eight different universities, and Ph.D.s at three others. Your research spans the biomedical sciences, the social sciences and the humanities, ranging from HIV studies to stem cell research, to neurobiology, to orthopaedics, to an econometric study of the effectiveness of Medicaid, to an analysis of environmental toxicants in Harlem, to a doctoral thesis on Holocaust poetry, and much more. You have been Fulbright fellows in Africa and Asia and Rhodes Scholars at Oxford.

Beyond your academic accomplishments you are a group of men and women with an unusual breadth of experience—a group that is quite difficult to characterize in a few words. You include, for example, an advisor to the International Gorilla Conservation Program in Kenya, a UNICEF health and nutrition consultant in China and a volunteer in a Romanian orphanage. You are Peace Corps veterans, high-tech entrepreneurs, journalists, and teachers at all levels—from elementary school to high school to college to delivering lectures at this very medical school. You have shadowed physicians, served as emergency medical technicians and worked as interns and volunteers in hospitals around the country and around the world, often in the most challenging of circumstances.

You are also varsity athletes in several sports, some of you with national championships and All-America credentials. You have among your members musicians, actors and dancers who (one can only hope) might lend your virtuosity to School of Medicine theatrical productions.

You, the Class of 2007 are also noteworthy for leadership roles in social, political, religious, and professional organizations. You were born in 20 countries and, considering the relatively small size of the group, represent a remarkable variety of personal backgrounds.

And now for the final questions, where are we and where are we going?

We are sitting in an auditorium in a medical school in New Haven, Connecticut, but it really matters little where we are because it is a symbolic place for a symbolic ritual to launch you into the most dynamic medical educational system the world has to offer, “The Yale System.” You have read about and listened to its description, which is what attracted you to apply and accept the invitation to join our ongoing experiment in educational freedom and responsibility. Those are the two words used most to define our system, which is designed to motivate, guide and stimulate learning and collaboration rather than force competition (that you all know too well) by grades and required attendance. Again I quote from Mark Twain: “I have never let my schooling interfere with my education.” We also realize, of course that the self discipline that drove you here may well drive you harder than we ever could by testing and regulating.

So let me not dwell so much on the system itself as on my own impression of what the system provides. It allows you to become a node just as I am a node, in a rich network of scientists and physicians. In fact my only charge to you is to become physician scientists in the very broadest sense. That is you must quantitatively understand the physical and biological science underpinning of the evolved human by sharing the bench with our scientists and our clinics with clinical researchers. We are much more your colleagues with a little more experience than we are teachers to be placed on pedestals.

At the bench and the bedside, you will learn the responsibility of science as it is directed to specifically conquer a disease and at the same time the freedom to understand that much of our growth in industrialization, technology and medicine has come most often from just plain curiosity, whimsy and often from parallel fields. In industry, the phonograph is a great example. Thomas Edison invented this device explicitly to record the last words of dying people, recording books for the blind, announcing time and teaching spelling. Reproduction of music was not on his list and after a few years he felt his invention had no commercial value. Likewise Renes Dubos, the famous Rockefeller scientist and humanist brought his agricultural background to the use of earth microbes to dissolve the polysaccharide capsule of the pneumococcas bacteria and thus ultimately inventing the first antibiotic. From these kind of empirical discoveries we soon became the reductionists who have been the driving force behind most 20th century research.

This reductionistic scientific behavior has been based on the assumption that if we could know the parts we would understand the whole, but having the parts is not enough if we don’t understand how the process works, why is it organized in this or that way.

You will also find here at Yale some of the world’s finest Cartesian reductionists who have for example taken the genome apart and who now understand that the next great challenge is to put it back together as targeted therapies for disease.

Then you will walk across the street and experience the everyday tension and resolution of tension that represents the practicality of caring for sick and dying patients and you will learn to respect Dr. Edward Trudeau’s maxim that I previously quoted, “to sometimes cure, often help, always console.” Renes Dubos adds, “wherever possible, prevent.”

That’s what this ceremony is about today, it is to continue to remind us when we’re feeling pompous and elite that we had better be humbled and challenged in a world of such incredible technology when at the same moment this 19th century maxim of Trudeau’s is still very, very true.

The white coat for me symbolizes that you are that link from the laboratory to the bedside and back again. You must wear the white coat comfortably in both places, speak both the language of science the language of caring. Once we put the white coat on you, you accept that responsibility and I know that suddenly educational freedom will have new meaning.