[Applause]
she called herself a survivor to you
that is what she was to her it didn’t
matter that it came back this time it
would take her life guerilla warfare
occupied every territory of her body her
stole being forced from a home in new
for only three decades solely covering
himself within white covers within white
walls as of preparing for the only color
flag she could raise she called herself
a survivor knowing something was growing
inside of her she could not control that
once was hers but has long ago become
something she no longer recognizes that
is playing mother nature and father time
taking away from her the universe she
wants envisioned cradled comfortably in
her palms space now extinct using only
gravitating grave to ground her she
called herself a survivor that is not
what she was it is what she is she
stares you down with empty eyes tired
but resolute dares you to defy her
reality delirium from brain cancer
metastasis is written in her charts she
is having delusions but she reply her
words see her eyes the resilience in
them as you close your own realize you
didn’t just walk into a hospital room
you walked into a waging war you can’t
see confined within a woman who’s trying
to hold everything together confined
within a woman who still wraps herself
in pink if you were to ask me if I
remembered my first patient I would say
yes but it wouldn’t be what you expected
we met my first week of medical school
in a cold room me with life in my breath
him and a cold silver box with a
selfless gift my classmates and I placed
her hands on the scaffold it’s just
styling with the weight of the moment
and made a careful precise
decision in order to learn every tissue
in the human body we had to step into a
sacred temple I remember my first
patient because he was my first step how
powerful lesson then my medical journey
was designed to begin with the end for
the next several months my classmates
and I meticulously dissected every
artery nerve vein muscle we did this to
learn what was normal and abnormal an
enlarged heart to beating with the help
of a pacemaker a rock-hard liver cysts
accumulating and kidneys plaques
accumulated in ari’s waiting to wreak
havoc a missing I replaced with an
artist rendered glass replica I saw in
vivid detail what the windows to his
soul must have looked like when he was
alive our donor died from blunt head
trauma it was a complete accident a blow
that rattled his brain and his skull
tore some venous sinuses slowly bleeding
out into a crescent-shaped subdural
hemorrhage despite everything that we
had seen the enlarged heart the
pacemaker the liver the kidneys the
stiffening arteries death found him
within hours the inevitability of death
despite knowledge
despite science despite intervention has
never met left me from this experience I
started confronting death in medical
terms I became fascinated with its
history because in the society we live
in today we not actively fear death but
especially in the medical field we view
it as a failure we have created this
culture that says do everything
death is the eternal enemy and the
capacity of the human mind is our Savior
so I did some research what happened
throughout the course of our history and
how did we use it to define death
originally it was defined as a heart
that has run out of beads or brush that
have become air but in the nineteen six
these medical advances allowed us the
physician to use machines to help
provide support to dying bodies this was
the birth of intensive and critical care
we can now give her to break by using
devices to pump blood through their
bodies just as our biological pump does
and allow diseased lungs to heal while
oxygenating the rest of the body at its
most hopeful this with immortality and
its worst made us question whether this
is what we truly wanted for our loved
ones
if hearts and lungs cessation truly
meant to death we were learning to
prolong life to keep tired hearts
beating but what were they beating for
around the same time medicine discovered
organ transplantation the floodgates
open we could now give a dying person a
second chance at life but we didn’t know
what was the definition of death if we
could replace hearts what did it mean to
die if death was a cessation of hearts
and lungs and we were replacing them
what happened to our donors when do we
declare death the heart once seen in
antiquity as the center of the human
being and the source of our humors and
vitality now became an elegant machine
at best so how do we define it the
Harvard criteria says death is defined
by neocortical function that is the
neurons of your brain once firing with
memories thoughts ideas decisions has
now irreversibly ceased this is now what
we call brain death when a physician is
called upon to call the time of death
they’re looking at the function of your
brain but now we have a definition it
doesn’t make the process of dying any
clearer in 1971 President Richard Nixon
declared war on cancer he said the time
come in American history where we took
the same concentrated
that’s what the atom and took man to the
moon and take it and concentrate on
conquering the stright disease 46 years
later a medical student me is strolling
the halls of the largest Cancer Centre
in the world it’s remarkable groups are
of physician friend intense
conversations talking about patient
treatment plans as they’re walking
through sky bridges for meetings to
patient rooms researchers are discussing
their latest lab findings clinical trial
results the poster presentation they had
at a recent international conference the
patient with cancer strolling at their
own pace with their IV poles wearing the
effects of chemotherapy admiring the
places left for them to reflect
sometimes sharing precious moments with
loved ones this is an entire different
world the atmosphere is electric filled
with hope and signs of progress
and it’s hard to be there without
feeling like you were part of something
bigger than yourself like you are
soldiers fighting this war like you’re
making cancer history but I remember
visiting a patient holding her hand
listening as she told me her story her
cancer had relapse
she showed me videos of her daughter’s
wedding sent to her when she was when
she was recovering from her first
surgery videos of her grandchildren
graduating said to her when she was
doing chemotherapy she asked me why the
higher power she believed in could
bestow on her such misery started
questioning what she ever did to deserve
this
she said perhaps she was too happy too
blessed and this was her punishment
when I tried to offer her words of
comfort she burst into tears she was
tired of being told she was strong she
was tired of having to be strong it was
enough for her to have gone through this
once before it to have come again
completely shattered her she wanted what
she needed someone to acknowledge her
feelings to not make her feel otherwise
so I went home that day and I started
speaking about terminal illnesses the
words we use to help those who are
teased by the Grim Reaper on a daily
basis how do you comfort a person as
they lay dying you let them vocalize
their hopes their fears their griefs
their anger their frustration their
denial their acceptance you sit in
silence listening let their thoughts
take a place that is engaged in their
heads replaying over and over you let
them hang their burdens up to dry so
they feel comfortable wearing them so
they can hear their tongue taste for the
first time what they were maybe too
frightened too ashamed too naive to
admit and you don’t pretend to know what
it feels like to walk in their shoes
because you don’t and there is no one
way a person can or should react to
something as existential as their
mortality so you sit in silence and
listen let them speak
do not feel shame do not feel sad in
there is power and letting their soul
occupies space their body no longer
recognizes and sitting there silently
listening to witness reflecting on the
moments I spent in her room I realized
that she was struggling to consolidate
how she view death with how those around
her view death she saw death as a reason
to cherish space and time to acknowledge
her existence to identify why it is she
lives
we were so occupied with her conquest of
taking over mortality that we
couldn’t ease her suffering we
constantly tell people as they lay dying
to keep fighting without understanding
what it is they are fighting in between
the lines of this guerrilla rhetoric we
use they become lost in translation I
realized that death isn’t failure our
failure lies in not easing their
suffering when they have already
accepted death and we keep telling them
please don’t give up I took care of a
patient in a coma I came to her bedside
every morning said hello introduced
myself though I knew she couldn’t
respond I listened to her heart and her
lungs as she was hooked up to IVs that
kept her sedated and paralyzed machines
that kept blood flowing through her body
because her organs couldn’t when I was
done I would read just the stuffed
animal her family brought her tuck in
her sheets make her comfortable because
what if I came every day to her bedside
hoping for something better that that
day would be the Dame who would give her
family good news I was clinging to hope
even though our chart said that she was
sustained saying that perhaps she was
getting better I had a gut feeling she
was at the brink of recovery and she was
steadily increasingly becoming more
independent steady steady steady crash
that day was the toughest presentation I
had ever given it had taken her back
months and when it hit me
it didn’t just sink in it anchored we
told her family to give her time we were
trying to cling to hope even though we
weren’t sure if there was any left on my
last day on the service we took the IVs
and the machines off her body started
recovering
told us it was ready became autonomous
it was a medical miracle on my final
note note I knew the family would read I
wrote the patient is conquering I never
had a chance to hear her say hello back
to me but I know she’s waking up every
morning saying hello to those who love
her she knows nothing of the student who
came to her bedside introducing herself
listening to her heart and lungs waiting
for air to enter it this stiff so she
could breathe waiting for the love dubs
of life praying this is medicine
what Oh sir calls a science of
uncertainty and an Arctic probability we
are constantly balancing between
illnesses that we know we can heal and
when we should let go as the medical
students I’m given the opportunity to
ask questions not many are allowed to
ask to tell stories now many are
privileged to hear in order to cure
diseases with knowledge I dedicated the
rest of my life to acquire as I
progressed through this journey I am
seeing life and death and everything in
between
these are the dialogues that need to be
opened sometimes I think of the moment
that I have to stand before a family and
say that their loved one is a brain-dead
and a lump forms in my throat
even if through a machine their heart is
still beating even if they are still
breathing even if there’s a twitch here
or there that show some sign of life but
science says that it is improbable it’s
meaningless and I have to suggest that
it’s time to let go and I have to be
confident suggestion I have to be
confident and how I defined death and
meaning but there is progress being made
we are pushing for more end of life
discussions we are starting to realize
that maybe we’re not using science as we
should because prolonging death is not
the Fountain of Youth we are starting to
recognize that perhaps dying is highly
personal
now we shouldn’t tell people what they
should feel but we will meet them at the
place they wish to be met and I will be
at their bedside listening I wish I can
have all the answers and I wish I can
stand here and tell you these answers
but I’ve come to accept that perhaps we
cannot deconstruct ourselves down to the
cellular level and define function by
the cogs in our wheels but that the sum
of our parts contains a variable that
cannot scientifically be accounted for
in all of our equations there will
always be the unquantifiable h human so
instead i’ve learned to make my heart
big enough to hold everything my mind
can’t answer this i dunno it is because
we lay dying that we truly know we live
she called herself a survivor to you
that is what she was to her it didn’t
matter that it came back this time it
would take her life guerilla warfare
occupied every territory of her body her
stole being forced from a home in new
for only three decades solely covering
himself within white covers within white
walls as of preparing for the only color
flag she could raise she called herself
a survivor knowing something was growing
inside of her she could not control that
once was hers but has long ago become
something she no longer recognizes that
is playing mother nature and father time
taking away from her the universe she
wants envisioned cradled comfortably in
her palms space now extinct using only
gravitating grave to ground her she
called herself a survivor that is not
what she was it is what she is she
stares you down with empty eyes tired
but resolute dares you to defy her
reality delirium from brain cancer
metastasis is written in her charts she
is having delusions but she reply her
words see her eyes the resilience in
them as you close your own realize you
didn’t just walk into a hospital room
you walked into a waging war you can’t
see confined within a woman who’s trying
to hold everything together confined
within a woman who still wraps herself
in pink if you were to ask me if I
remembered my first patient I would say
yes but it wouldn’t be what you expected
we met my first week of medical school
in a cold room me with life in my breath
him and a cold silver box with a
selfless gift my classmates and I placed
her hands on the scaffold it’s just
styling with the weight of the moment
and made a careful precise
decision in order to learn every tissue
in the human body we had to step into a
sacred temple I remember my first
patient because he was my first step how
powerful lesson then my medical journey
was designed to begin with the end for
the next several months my classmates
and I meticulously dissected every
artery nerve vein muscle we did this to
learn what was normal and abnormal an
enlarged heart to beating with the help
of a pacemaker a rock-hard liver cysts
accumulating and kidneys plaques
accumulated in ari’s waiting to wreak
havoc a missing I replaced with an
artist rendered glass replica I saw in
vivid detail what the windows to his
soul must have looked like when he was
alive our donor died from blunt head
trauma it was a complete accident a blow
that rattled his brain and his skull
tore some venous sinuses slowly bleeding
out into a crescent-shaped subdural
hemorrhage despite everything that we
had seen the enlarged heart the
pacemaker the liver the kidneys the
stiffening arteries death found him
within hours the inevitability of death
despite knowledge
despite science despite intervention has
never met left me from this experience I
started confronting death in medical
terms I became fascinated with its
history because in the society we live
in today we not actively fear death but
especially in the medical field we view
it as a failure we have created this
culture that says do everything
death is the eternal enemy and the
capacity of the human mind is our Savior
so I did some research what happened
throughout the course of our history and
how did we use it to define death
originally it was defined as a heart
that has run out of beads or brush that
have become air but in the nineteen six
these medical advances allowed us the
physician to use machines to help
provide support to dying bodies this was
the birth of intensive and critical care
we can now give her to break by using
devices to pump blood through their
bodies just as our biological pump does
and allow diseased lungs to heal while
oxygenating the rest of the body at its
most hopeful this with immortality and
its worst made us question whether this
is what we truly wanted for our loved
ones
if hearts and lungs cessation truly
meant to death we were learning to
prolong life to keep tired hearts
beating but what were they beating for
around the same time medicine discovered
organ transplantation the floodgates
open we could now give a dying person a
second chance at life but we didn’t know
what was the definition of death if we
could replace hearts what did it mean to
die if death was a cessation of hearts
and lungs and we were replacing them
what happened to our donors when do we
declare death the heart once seen in
antiquity as the center of the human
being and the source of our humors and
vitality now became an elegant machine
at best so how do we define it the
Harvard criteria says death is defined
by neocortical function that is the
neurons of your brain once firing with
memories thoughts ideas decisions has
now irreversibly ceased this is now what
we call brain death when a physician is
called upon to call the time of death
they’re looking at the function of your
brain but now we have a definition it
doesn’t make the process of dying any
clearer in 1971 President Richard Nixon
declared war on cancer he said the time
come in American history where we took
the same concentrated
that’s what the atom and took man to the
moon and take it and concentrate on
conquering the stright disease 46 years
later a medical student me is strolling
the halls of the largest Cancer Centre
in the world it’s remarkable groups are
of physician friend intense
conversations talking about patient
treatment plans as they’re walking
through sky bridges for meetings to
patient rooms researchers are discussing
their latest lab findings clinical trial
results the poster presentation they had
at a recent international conference the
patient with cancer strolling at their
own pace with their IV poles wearing the
effects of chemotherapy admiring the
places left for them to reflect
sometimes sharing precious moments with
loved ones this is an entire different
world the atmosphere is electric filled
with hope and signs of progress
and it’s hard to be there without
feeling like you were part of something
bigger than yourself like you are
soldiers fighting this war like you’re
making cancer history but I remember
visiting a patient holding her hand
listening as she told me her story her
cancer had relapse
she showed me videos of her daughter’s
wedding sent to her when she was when
she was recovering from her first
surgery videos of her grandchildren
graduating said to her when she was
doing chemotherapy she asked me why the
higher power she believed in could
bestow on her such misery started
questioning what she ever did to deserve
this
she said perhaps she was too happy too
blessed and this was her punishment
when I tried to offer her words of
comfort she burst into tears she was
tired of being told she was strong she
was tired of having to be strong it was
enough for her to have gone through this
once before it to have come again
completely shattered her she wanted what
she needed someone to acknowledge her
feelings to not make her feel otherwise
so I went home that day and I started
speaking about terminal illnesses the
words we use to help those who are
teased by the Grim Reaper on a daily
basis how do you comfort a person as
they lay dying you let them vocalize
their hopes their fears their griefs
their anger their frustration their
denial their acceptance you sit in
silence listening let their thoughts
take a place that is engaged in their
heads replaying over and over you let
them hang their burdens up to dry so
they feel comfortable wearing them so
they can hear their tongue taste for the
first time what they were maybe too
frightened too ashamed too naive to
admit and you don’t pretend to know what
it feels like to walk in their shoes
because you don’t and there is no one
way a person can or should react to
something as existential as their
mortality so you sit in silence and
listen let them speak
do not feel shame do not feel sad in
there is power and letting their soul
occupies space their body no longer
recognizes and sitting there silently
listening to witness reflecting on the
moments I spent in her room I realized
that she was struggling to consolidate
how she view death with how those around
her view death she saw death as a reason
to cherish space and time to acknowledge
her existence to identify why it is she
lives
we were so occupied with her conquest of
taking over mortality that we
couldn’t ease her suffering we
constantly tell people as they lay dying
to keep fighting without understanding
what it is they are fighting in between
the lines of this guerrilla rhetoric we
use they become lost in translation I
realized that death isn’t failure our
failure lies in not easing their
suffering when they have already
accepted death and we keep telling them
please don’t give up I took care of a
patient in a coma I came to her bedside
every morning said hello introduced
myself though I knew she couldn’t
respond I listened to her heart and her
lungs as she was hooked up to IVs that
kept her sedated and paralyzed machines
that kept blood flowing through her body
because her organs couldn’t when I was
done I would read just the stuffed
animal her family brought her tuck in
her sheets make her comfortable because
what if I came every day to her bedside
hoping for something better that that
day would be the Dame who would give her
family good news I was clinging to hope
even though our chart said that she was
sustained saying that perhaps she was
getting better I had a gut feeling she
was at the brink of recovery and she was
steadily increasingly becoming more
independent steady steady steady crash
that day was the toughest presentation I
had ever given it had taken her back
months and when it hit me
it didn’t just sink in it anchored we
told her family to give her time we were
trying to cling to hope even though we
weren’t sure if there was any left on my
last day on the service we took the IVs
and the machines off her body started
recovering
told us it was ready became autonomous
it was a medical miracle on my final
note note I knew the family would read I
wrote the patient is conquering I never
had a chance to hear her say hello back
to me but I know she’s waking up every
morning saying hello to those who love
her she knows nothing of the student who
came to her bedside introducing herself
listening to her heart and lungs waiting
for air to enter it this stiff so she
could breathe waiting for the love dubs
of life praying this is medicine
what Oh sir calls a science of
uncertainty and an Arctic probability we
are constantly balancing between
illnesses that we know we can heal and
when we should let go as the medical
students I’m given the opportunity to
ask questions not many are allowed to
ask to tell stories now many are
privileged to hear in order to cure
diseases with knowledge I dedicated the
rest of my life to acquire as I
progressed through this journey I am
seeing life and death and everything in
between
these are the dialogues that need to be
opened sometimes I think of the moment
that I have to stand before a family and
say that their loved one is a brain-dead
and a lump forms in my throat
even if through a machine their heart is
still beating even if they are still
breathing even if there’s a twitch here
or there that show some sign of life but
science says that it is improbable it’s
meaningless and I have to suggest that
it’s time to let go and I have to be
confident suggestion I have to be
confident and how I defined death and
meaning but there is progress being made
we are pushing for more end of life
discussions we are starting to realize
that maybe we’re not using science as we
should because prolonging death is not
the Fountain of Youth we are starting to
recognize that perhaps dying is highly
personal
now we shouldn’t tell people what they
should feel but we will meet them at the
place they wish to be met and I will be
at their bedside listening I wish I can
have all the answers and I wish I can
stand here and tell you these answers
but I’ve come to accept that perhaps we
cannot deconstruct ourselves down to the
cellular level and define function by
the cogs in our wheels but that the sum
of our parts contains a variable that
cannot scientifically be accounted for
in all of our equations there will
always be the unquantifiable h human so
instead i’ve learned to make my heart
big enough to hold everything my mind
can’t answer this i dunno it is because
we lay dying that we truly know we live
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