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On Little Things

June 06, 2021
by Mark David Siegel

Hi everyone:

Here are excerpts from last Tuesday’s residency graduation speech.

Enjoy your Sunday, and get ready for the new interns, arriving this Friday!


On Little Things (Graduation Speech 2021)

Tonight, I want to talk about little things. After a monumental year, it’s tempting to tackle big topics. We’ve endured existential threats, from a global pandemic to political turmoil. We’ve witnessed huge accomplishments, from novel vaccines to wins against racism. We’ve seen the power of research, learned how inequity undermines health, and reaffirmed why we need a functional, affordable healthcare system.

But as I said, tonight, I want to talk about little things, because we don’t discuss them enough.

Let’s travel back thirty years to my own residency. HIV and chronic hepatitis were rampant and untreatable. IV drug use was widespread, as it is now, but back then we called it “abuse” and didn’t realize how labels hurt patients. Racism was everywhere, though rarely discussed. Attendings were less present than today, and the hidden curriculum—what residents taught each other—was replete with tips I’m ashamed to recall.

One evening we admitted a middle-aged man with fever and back pain. Let’s call him Art Harding. Art had chronic hepatitis and a drug habit. We admitted lots of patients like Art. The admissions followed a pattern: we drew blood, started antibiotics, and when the patients defervesced, we sent them out, knowing they’d soon return. We were jaded.

Before entering Art’s room, I was warned. He was exaggerating. He was drug-seeking. He’d use his IV to shoot up. “Don’t let him manipulate you,” I was told. “Don’t give him narcotics.” Just Tylenol.

I entered Art’s room. He was huge. His eyes were bloodshot, his dark skin drenched with sweat. He was curled up on the bed, groaning and cursing. I introduced myself.

“I need something for this pain,” he said.

“How about Tylenol?”

“That won’t work!” he said.

“Can we try it?”

“No! I need something strong.”

“Mr. Harding?”


“Can we talk?”

“Treat my pain first. I need something for this pain.”

“Can I examine you?”


We went back and forth. Art moaning and mad. Me resolved not to bargain. We were stuck.

“Mr. Harding?”


“Listen, if you let me examine you, I’ll give you whatever you need for pain.”

“How do I know that?”

“I promise.”

He glared at me, then turned his back. “Do it.”

I walked my fingers down his spine, pushing each bony prominence.

“Does that hurt?”


“What about here?”

“Lower down”

And then…

“Goddam!” Art wailed, and a wave of emotion washed over me, a mix of sorrow and regret. I walked to the nurses’ station and ordered antibiotics and morphine. An hour later, he was asleep.

You see, Art had an epidural abscess- painful and dangerous. Thankfully, he escaped neurological damage and within days his fever resolved, his blood cultures cleared, and his pain improved. Before he left the hospital, I shared my faith that he would stop using.

I kept up with Art and his wife Marlene long after residency ended. He quit heroin, and when our daughters were born, Art and Marlene showered them with expensive onesies, bibs, and pacifiers. A few years later, Art succumbed to liver failure, but to this day, Marlene and my wife stay in touch. Her granddaughters are the same age as our older girls. Several times, when we’d return to Philadelphia, we’d visit her home and she’d treat us to dinner in Chinatown. She just called me this morning to catch up, and she encouraged me to share this story.

As I said, it’s the little things. Trust your patients. Treat their pain. Remember their vulnerability. Forge a connection.

You will all accomplish great things in your careers. You will make discoveries. You will develop new treatments. You will write essential papers. Many of you will become professors, section chiefs, and department chairs- maybe even program directors.

But no matter what you accomplish in the years ahead, please remember the little things: the gentle words, the soft touch, the trusting ear- the simple but essential efforts you make when no one is looking. Little things are the humane acts that distinguish our profession; they identify you as a caring physician; they give meaning to your career.

So, in closing, I’ll propose a toast: To our graduates: may you make us proud, may you do great things, may you leave your mark. May you remember the skills and values you learned at Yale- not just the monumental ones but the little ones too. May you pair your infinite skills and talents with compassion and kindness and a never-ending quest to comfort and heal. May that be your calling.

May it be so.

Submitted by Mark David Siegel on June 06, 2021