REMARKS FOR THE WHITE COAT CEREMONY
EDWARD C. HALPERIN, M.D., M.A.
AUGUST 27, 2012
Chairman of the Board Hasten, President Kadish, reverend members of the clergy, officers and faculty of the College, family and friends; my dear young doctors.
Why are you given a white coat? You think you know the answer: You studied hard, did well on standardized tests, ran the gauntlet of the admissions process, and now you are first year medical students. You are to snatch the prize ring on the merry-go-round. You are being rewarded with a symbol of achievement as you are welcomed into the fraternity of scientific medicine; exemplified by the white coat. You look forward to delivering healthy babies, treating infectious disease successfully with antibiotics, performing aseptic robotic surgery, mending injured coronary arteries, ablating malignancies, and restoring lives broken by mental illness.
I wish for you that such will be your future.
The facts, however, are severely different. You have not been given a white coat because of your achievements or because you will triumph against disease. There is no theme in western culture as pertinent today as the idea that you are given a new garment when you distinguish between good and evil. That is why you are receiving a white coat.
“…and when the woman saw that the tree was good for food, and that it was delight to the eyes, and that the tree was to be desired to make one wise, she took of the fruit thereof, and did eat; and she gave also unto her husband with her, and he did eat. And the eyes of them both were opened, and they knew that they were naked; and they sewed fig-leaves together, and made themselves girdles. And they heard the voice of the Lord God walking in the garden toward the cool of the day; and the man and his wife hid themselves from the presence of the Lord God amongst the trees of the garden. And the Lord God called unto the man, and said unto him: 'Where art thou?' And he said: 'I heard Thy voice in the garden, and I was afraid, because I was naked; and I hid myself.' And He said: 'Who told thee that thou wast naked? Hast thou eaten of the tree, whereof I commanded thee that thou shouldest not eat’?”
You don a garment when you distinguish between good and evil. There is a high probability that that baby you will deliver will have an unwed mother under the influence of illicit substances, may be underweight, and may suffer the consequences of poor prenatal care. The child in the emergency room may not be there because of a routine infectious disease but, instead, may have been beaten severely by an adult. Major causes of death and disability among young people are suicide, acts of violence, and substance addiction. The adults you operate upon with aseptic surgery are likely to have suffered the ravages of tobacco and alcohol abuse. While the immediate major causes of death in the U.S. are heart disease, cancer, stroke, and chronic lung disease, the underlying causes are tobacco, alcohol, lack of physical activity, and diet. You will deal with an epidemic of self-induced diabetes and obesity. Many of the mentally ill will be the cast-offs of society. You are given the white coat because you are now to engage in an unremitting and lifelong battle with evil.
Why is there so much evil? This is referred to by the philosophers as theodicy or the "problem of evil". If you believe there are multiple gods, gods of good and evil, then the world makes sense. The gods of good and evil are fighting it out and we’re watching. If you are a person of monotheistic faith, and believe in an all powerful, all merciful, all knowing, and all just God, then why do 8 year olds die of acute lymphoblastic leukemia, young people get killed by random acts of violence, and premenopausal women develop widespread metastatic breast carcinoma?
Why? Is God not all merciful, not all powerful, or not all that interested? Doctors have an easy “scientific” way to “explain this away”. We can explain that people get esophageal cancer because they smoked or drank too much, lung cancer because of cigarettes, or obesity or cardiovascular disease because of diet and exercise. Such explanations, however, fail in other cases like the child with leukemia. Nonetheless, for most doctors, these "scientific explanations" let them get through the day.
My dear young doctors, when you encounter unremitting evil, your scientific explanations eventually collapse. You have, of course, heard alternative explanations. They happen when a well meaning minister sets his or her hand on your shoulder and says "it's all really for the best, we just don’t understand the Divine purpose, but you must have faith". For some people this type of explanation of faith succeeds, and if it does for them and for you, good. Others seek no explanation and simply think that the world is a random place.
If I was the most profound and erudite of Chancellors, I could now tie it all up for you in a little bow and send you off with quick quote and a sound bite explanation. I can't. But I can offer you a few pieces of advice for your life in medicine that may help.
First, I don’t know what the cosmic cause is of evil. When someone asks me if I think there is a Divine purpose to it, I believe the best response is to say that framing the question in that manner, with the word “purpose” is absurd. If I have no concept of the infinite power, purpose, and authority of a Deity, how can I conceive of a language to have a conversation about Its purpose and meaning? Therefore, I believe the only sensible response of a thinking person, whether that person is one of faith or not, is not rationalization but action. I do not know what causes the evils related to disease and disability, but I often do know what to do about it. That is to take action. That is the only sensible, rational, moral and, I submit, religious response: action. (It is the response attributed to Joseph Soloveitchik)
Study very hard, people’s lives depend on it. Gaps in your knowledge can cost the lives of mothers and sons and husbands and lovers and children. Fight ignorance, poverty, disease, and bureaucratic inaction with all your strength. You have donned the white coat as a garment indicative of action.
Second, wear the white coat, don't be worn by it. You must inhabit the garment with dignity, professionalism, seriousness of purpose, and commitment. I do not expect you to bring honor and dignity to this coat and this College (although most of you will), but I will insist that you do nothing to dishonor this coat and this College. You must expect no less of yourselves.
Third, wear the coat with humility. It has been worn by women and men stretching before you in time in a long line and will be worn by others after you. You are temporary custodians of a sacred trust. Be good stewards of the tradition.
You have been given a garment to wage war against evil. You have the tools to learn to wage that war. Becoming is superior to being. You are not obligated to complete the work, but neither are you free to desist from it. (Pirkei Avot 2:21)
Godspeed on your journey, young doctors of the New York Medical College.
Updated: August 28, 2012