Keynote Speech

Dartmouth Medical School
Class Day Guest Speaker
June 7, 2007

The World is Our Patient
By Dr. Benjamin S. Carson, Jr., Director of Pediatric Neurosurgery, Professor of Neurological Surgery, Oncology, Plastic Surgery & Pediatrics, Johns Hopkins Medical Institutions
(As transcribed from the event's audiotape)

Thank you graduates for inviting me to be a part of this wonderful day, and congratulations.

Entering the field of medicine and medical sciences; when you really stop and think about it, is there anything more important? I came to realize that as an intern. When I would go on the wards at the hospital at Hopkins and I would see people, CEO of this organization, president of this company, crown princess of this or that country; all dying of some horrible malignant disease. In recognizing that every single one of them would have given every title, and every penny for a clean bill of health. In recognizing that this is what people place into our hands, the absolute most important thing that they have.

For me, medicine has really been the only thing that was ever been a great interest. As a youngster, I used to love to go to the doctor's office; I guess that made me a little strange right there. Now there was something about those needles and syringes and alcohol swabs; I really like that stuff. Going to the hospital was the best thing of all because we were on medical assistance so we would have to wait for hours before the one of the interns or residents could see us, but it did not bother me at all, because I would sit in the hallway listening to the P.A. system "Dr. Jones, Dr. Jones, to the Emergency Room; Dr. Johnson to the clinic." They just sounded so important. I'd be thinking, one day they'll be saying, "Dr. Carson, Dr. Carson." Of course nowadays we have beepers so I still don't get to hear it. It's so important to have those dreams, to have something that kind of pushes you on, particularly when times are difficult.

Not all dreams are good, some dreams lead us astray, and we have to recognize which are the good dreams and which are the bad dreams. I was reminded a few years ago with the Bijani twins, the twenty-nine year old Iranian women that were joined at the head. Their dream was to be separated. When I was first contacted about that case, I discouraged them, and I told them about Chang and Eng Bunker, the original Siamese twins who made Barma Baby famous, lived until they were sixty-three. It became clear they were going to go ahead with the separation in Singapore whether I helped or not, so I felt obligated to go. Now I remember meeting those young women, and they were so loquacious, and so intelligent. They had learned to speak English in only seven months which is absolutely amazing. They both had college degrees, they both had law degrees; not just one, but they both had law degrees. They were truly able to understand, and to give informed consent, which was a little unusual. They said something to me that really made an impression on me, they said, "Doctor, we would rather die than spend another day joined together." That seemed kinda harsh to me, and I started thinking about it, putting myself in their shoes. If you think about the person in the world that you like the most, and what if you were stuck to them, twenty-four-seven, and you could never get away, not even for one second; how long would you like them? Think about that. It is so important when entering medical arenas to be able to empathize, to put yourself into people's positions because things can change dramatically when you look at them from their perspectives. Well, we did proceed with that operation, and we were about ninety percent through the separation. Some people were starting to celebrate, and that's when things went awry, and they did not survive. Unfortunately, that is something that happens in medicine.

Not everything you do is successful. You look at Thomas Edison, he said he did nine hundred and ninety-nine ways that a light bulb did not work, but he learned from each one of those. You have all heard of the cleaning formula "409"; why do they call it that? Because the first four hundred and eight did not work! Walter Dandy, the great neurosurgeon from Hopkins, the first thirteen posterior fossas (of the scull) operations he tried, they all died. Can you imagine how discouraging that was? I wonder what he said to the fourteenth patient when they asked, "how'd the other thirteen do?" Probably said, "nobody's complaining." The fact of the matter is, you learn from those things, and that is how you are really able to move on and do extraordinarily well.

Now let me just, at this moment, do a little disclaimer. In medicine, now, we all do disclaimers whenever we get up to give a talk, you say, "I'm on the board of Pfizer", or this or that, or "anything having to do with Viagra must be taken with a grain of salt." My disclaimer is appalling. I notice these days when you speak to a large group of individuals, you are going to offend someone. That was not always the case, you know, years ago when I was a kid growing up, they used to say "sticks and stones may break my bones, but names will never hurt me." Nowadays, names slaughter people. Now things have because people walk around with their feelings on their shoulders, waiting for someone to say something to offend them. Once I was talking to a group about the difference between a human's brain, and a dog's brain, and a man got offended. He said, "you can't talk about dogs like that!" I was talking about how the fashion industry has gotten young women to think that you're supposed to be so thin, "some of them look like they've escaped from a concentration camp," and a Jewish man got offended. He said, "you can't talk about concentration camps. It's too sensitive." He said "it is as if I said something to you about slavery." I told him, he could talk about slavery all he wanted, it does not bother me. Some people choose to get offended.

My disclaimer is the following: it is not my intention to offend anyone, and if anyone is offended, too bad. There were a lot of obstacles to me realizing my dream becoming a physician, not the least of which was the fact that my parents got divorced when I was eight years old. My father was one of twenty-four children, and got married at age thirteen, and she and my father moved from rural Tennessee to Detroit. He was working at a factory. She discovered that he was a bigamist. I remember telling that story at graduation at the University of Utah, nobody really thought it was that strange. See! I probably offended somebody! Now of course they don't do that in Utah anymore, that's a thing of the past. At any rate, she thought that was very strange, so we moved from Detroit to Boston to live with her older sister and brother-in-law, typical tenement, large multi-family dwellings; rats, roaches, sirens, gangs, murders; both of my older cousins were killed. Horrible situation, terrible poverty; never enough money for anything. I think, in looking back, hardship is a great thing because it puts 'fire in your belly' and makes you want to achieve, it makes you not want to go back there again regardless of anything that faces you.

I remember as a first year medical student I did not do very well on my first set of comprehensive exams, and I went to see my counselor, he looked at my record, and he said "you seem like a very intelligent young man, but there are a lot of things you could do outside of medicine." He tried to convince me to drop out of the medical school. He said, "you know, you have only spent six weeks, so it's not like you have wasted your life. So, if you quit now, it won't be that bad, you won't torture yourself for everybody else." Well, the 'fire in the belly' would not allow me to listen to him. I went to my apartment and I started evaluating my life, got my brain into gear and thinking about what kind of courses I struggled with, what kind of courses I did not. I also thought back to when I was a youngster in grade school, in fifth grade. My nickname was 'Dummy'. Everybody thought I was stupid, including myself. I was always the kid who was shooting paper-wads, and telling jokes, and trying to create disturbances because I did not think I was going to learn anything, so why pay attention? My favorite thing though, was getting other people kicked out of class. And I was good at it, because what I would do was I would figure out what would make them very, very angry and I would irritate them, and then when the teacher was nearby, I would push their last button and they would explode and the teacher would kick them out of class. It was really cool...

And so, I remember one day, I was studying this girl because she was 'Miss Goody-Two-Shoes'; she never got in any trouble, always had her work done on time, was quiet, teacher's pet; teachers love students like that. I said, wouldn't it be great to get her kicked out of class? So I started studying her, and I figured out what made her really angry. I mean, the steam was coming out of her ears; she was about to explode. But I did not push the last button, I just waited until we were in class. Low and behold, she sat right down in the seat in front of me. I said, "the Lord is good." As the teacher approached, I pushed the last button, but she did not explode. She just quietly turned around. She said quietly, "you and me on the playground at recess." That one did not work out that well. I became a brain surgeon, and she became a professional wrestler. But, I did stop bothering people.

I was a terrible student because I did not pay attention. I have noticed unfortunately that there are a lot of students still in our society, who are like that, I have a program at the hospital, I invite eight-hundred students at a time and they come from as far north as New York and New Jersey, and as far south as North Carolina, and I show them slides of the brain, things that go on in an academic medical setting, and I talk about medical careers and human potential. At the end, I allow them to ask me questions, but sometimes I ask them questions. I remember asking once, "how many of you can name for me five NBA players?" Do you know virtually every hand went up? Everybody could name five NBA players. "What about five Major League Baseball Players?" No problem. "NFL?" Piece of cake. Rap singers, movies stars, they could name them all, not a problem. I said, "who can name for me five Nobel Prize winners?" Out of eight-hundred, only ten hands went up. I said, "leave your hands up because I'm going to call on one of you." All the hands went down. Then I said, "well look, this is the 'Information Age', the 'Technological Age'; who can tell me what a microprocessor is?" Of course, now they were weary about it, so now only one young man raised his hand. I called on him, he proudly stood up. He said, "a microprocessor is a tiny processor." That was it. That was the extent of his knowledge. Extraordinarily superficial. And you know, it's kind of funny, but it's all so extraordinarily sad when you stop and think about the level of education.

My wife and I were in Hartford, Connecticut not long ago. One of the school officials told us that they had a seventy-one percent high school dropout rate. This happens in many school systems around our nation. Look at the results. Last year, we produced sixty-thousand engineers in this country; forty percent of them were foreigners. China produced three hundred and ninety-two thousand engineers. Now you don't have to be a brain surgeon to figure out what is going to happen into the future if we do not change that equation. It really is extraordinarily serious. You combine that lack of intellectual pursuit in the appropriate areas with the fact that we seem to be drawing out our value system. There has come into our nation a pernicious philosophy called 'Political Correctness' which means there is nothing right and there's nothing wrong and everything is of equal value. Those of you who are students of history, know that this is the same kind of thinking that proceeded the decline of the Roman Empire. The reason that this is so disturbing is because we are the pinnacle nation in the world right now, the United States of America. We are not the first pinnacle Nation; however, there have been others before us, Ancient Egypt, Greece, Rome. "Number One." No competition; going to be there forever.

Where are they now? What happened in each case? They became enamored of sports, entertainment, and lifestyles of the rich and famous. They lost their moral compass, and they went right down the tubes. And some people say it cannot happen to the United States, but I think an honest appraisal would indicate it is already in the process of happening. The real question is: "can it be stopped?" Can we be the first pinnacle nation in the history of the world to actually learn from history and not make the same mistakes? The answer to that question really lies with your generation. My generation blew it, I have to tell you. They bought hook, line, and sinker into the sports and entertainment lifestyles of the rich and famous. Now, on the surface it wouldn't look like that, because they love to talk about education and how important that is, but don't let the baseball stadium or the football stadium be fifteen or twenty years old, we're ready to blow it up on CNN, build a new system for one billion dollars, but the schools can be falling apart and the books have no covers and nobody gives a care. That's called hypocrisy. That characterizes our nation.

What do we think is important? Well, go back and you look at the big news stories. Anna Nicole Smith, and this other skinny chick who is going to jail [Paris Hilton]. You know, why is that important? Somehow, we have got to change the dial. I don't think there's anybody more capable of moving that dial than people in the medical field because we have more education than anybody else in society. Now you go back one hundred years or more, you would find that those of us in the medical arena, scientists and physicians, spent a great deal more time in the community, helping solve the issues that affect our society at large. And now we have retreated into our laboratories, and our clinics, and our operating rooms, to complain about what the insurance companies are doing and what everybody else is doing and we have no right to do that, because we are the ones who relinquished all of that into their hands and we have to take control of those things again. Your generation has to take control of the distribution of medicine and our country because nobody else really gives a care, they're just in it to make money and it's a business for them, and it does not work. Thirty-nine cents on the health care dollar goes to pay administrative costs. Nineteen cents goes to pay professional costs. That's just one of the issues. We have thirty-seven million, no, make that forty-seven million, people who don't have health insurance in the wealthiest nation in the [world]. We all bemoan the fact, but we have to do more than that.

We have to come up with solutions. We cannot leave it to others, and that means venturing out into the community. It means running for Congress, running for Senate. A few years ago, when I was talking to Bill Frist, I said, "you're the only physician in the Senate." He said, "if you go back in twenty-five year blocks, you would find more. Twenty-five years ago, there were two. Twenty-five years before that, there were six, and if you go all the way back to the first Congress, there were forty-six." No wonder people talked about the wisdom of the founding fathers; they were physicians! They were people who understood things. Now you got lawyers, think about that. You know, think about that. Actually, some of my favorite people are lawyers. Because for every one of those, there is another one on the good side. But, the fact of the matter is, the point being, we have to get out there, and we have to solve those problems, and we can do it.

Well, at any rate, I have to finish the story. As I was in my dormitory room thinking about things, I did fortunately realize I did not do well with lectures, boring lectures, and I was spending eight hours listening to boring lectures every day. I just made an executive decision to skip the boring lectures in medical school and to spend the time reading, and the rest of medical school was a snap after that. I must say, when I went back to my medical school as the commencement speaker there, I was looking for that counselor because I was going to tell him he was not cut out to be a counselor. There are so many people who are negative all the time. The important thing is, to recognize that our patients are not just people who come to see us, but they are all the people in our spheres of influence. Those spheres of influence include the entire world. We have a responsibility to do something about that. What is success? Is it a big house? And a lot of degrees? And fancy cars? I don't think so.

In 1997, when I was asked to come to South Africa, to be the head of the team in an attempt to separate type II vertical craniopagus twins [CPT], I knew it was going to be a great medical challenge. There had been thirteen attempts to separate twins like that previously, none of which had been successful. This was going to be their chance to stand shoulder-to-shoulder with Cape Town, and Johannesburg, and all the other great universities, because it was going to be done at University of South Africa at MEDUNSA, the only major Black teaching hospital in South Africa, always the stepchild throughout the apartheid and post apartheid period. But, you see, I was not ready for the social pressure as the leader of that team. I just said, "Lord, you're going to have to show me something here because more capable and smarter people than me have tried and failed." As I was studying the various radiographs on the three-dimensional workstation which can integrate CT scan, MRI, and angiogram into a 3-D picture and you put on the goggles. I noticed that the common drainage system was a little narrower centrally than it was peripherally. Traditional neurosurgical literature said you should decide which twin to give the drainage system to, and to divide them over the course of three, four, or five operations, separated in time by weeks or months, so that they could develop collateral circulation. But I felt impressed, if we concentrated on the central area where it was narrowing down, that over the course of many hours, they would develop collaterals, and we would be able to separate them. When I explained that to the team, they said, "you're the boss; we'll do whatever you want to do." Now I remember going into that operating room two days before New Years in '98; big sign over the O.R. that said, "God Bless Joseph and Luca Banda." They were having psalm service, and prayer service, and I was thrilled. I asked them to bring a stereo system in so we could play inspirational music. Nineteen hours into the operation we were only three-quarters of the way finished. The part that remained was so complex, the blood vessels were adheased, engorged and tangled; it looked impossible. We stopped. We went into conference. I said, adjust it over with skin, come back in a few months, they would have developed collaterals and we could cut through and they would survive. The doctors from South Africa and Zambia said, "I know that would work at Johns Hopkins, but we don't have the ability to keep partially separated twins alive; they'll die."

Now I really felt the weight of the world on my shoulders, as I walked back in there with my loops and my scalpel; I didn't have all my fancy equipment, and I said, "Lord, it's up to you." I just started cutting between those blood vessels that were so thin you could see the anesthetic bubbles coursing through, just daring you to make a nick in them. To make a long story short, when I made the final cut that separated those twins, there came from the stereo system the Hallelujah chorus, and everybody had goose bumps. When we finished that operation after twenty-eight hours, one of the twins popped his eyes open, reached up for the endotracheal tube, and the other one did the same thing. By the time we got to the ICU, within two days they were extubated, within three weeks. Within two - three days they were eating, within two weeks they were crawling, and today they are graduating from the fifth grade. That, however, is not the success. The success you had to be there to witness, was the reaction of the people who had been there following so closely, something being done in their country and their community. Their level of self-esteem was so high, they were literally dancing in the streets, and that's what I mean by success, and that's what I mean by "think big."

Each one of those letters mean something special. The 'T' is for talent, which God gave to everybody, not just the ability to sing and dance and throw a ball, but intellectual talent. We, in our spheres of influence, must emphasize that, we must reward that if we want to turn this thing around.

The 'H' is for honesty, lead a clean and honest life, no skeletons in the closet, because they always come out when you do not want to see them. If you always tell the truth, you don't have to remember what you said three months ago.

The 'I' is for insight which comes from listening to people who have already gone where you are trying to go, [you] do not have to reinvent the wheel.

The 'N' is for nice. Be nice to people, because once they get over the suspicion of why you are being nice to people, they'll be nice to you. You get so much more done when they're being nice and you're being nice, and we all need to take the niceness pledge- can we all raise our hands? [Dr. Carson raises his hand]. Everybody in here, if the person beside you doesn't have their hand up, you may kick them, okay? Because this is the last time you can do it! Because now we have taken the niceness pledge, which means we are going to be nice to every single person we encounter for one week, okay? That includes spouses, and members of your family. Now what does it mean? It means no talking about people behind their back for a week; some people are going to stroke out, I understand that. If you see somebody struggling, you are going to help them. Men, we are bringing chivalry back. We are opening the doors for the ladies, holding the chairs for them. Ladies, you are not cursing them out when they do that. One spot on the elevator, you are letting one person get on, and when you are on the elevator you are not going to act like you never saw the numbers change before. Speak to people. You may have to practice CPR, but talk to people. Talk to guards, talk to janitors, talk to maids, talk to people you normally walk by, and act like they don't exist because they do. As you guys go off to become interns and residents: make sure you establish a relationship with the cleaning people, with the ward clerks, with the aides. Those people can be some of your best friends and they can really help you out. You are going to get in your car. There are no more parking spaces; three people are following you and your car because they want your parking space. When you get in the car, you are not going to open the glove box and pull down the mirror. Just get out of the space. Let them have it. Not going to have to revel in your power.

What are you doing during that week? Thinking about others first. Could imagine what kind of society we could have if everybody thought of others first? As physicians, we are taught to do that, but we need to use our influence to get other people to think that way, and I think it will have a profound effect.

The 'K' is for knowledge. It is the thing that makes you into a more valuable person. Do I have a big house? Yes. A lot of cars? Yes. I grew up in Detroit; I like cars. All these things that Robin Leach thinks that are important? Yes. Are these things important? No. They mean nothing if they all disappeared tomorrow; I do not care, because I can get them all back immediately with what is right up here [hand gestures towards brain], or at least I could before managed care. That is what [King] Solomon, the wisest man who ever lived meant when he said, "gold, silver, and rubies are nice, but we treasure far above those knowledge, wisdom, and understanding," because that is the stuff that allows you to elevate other people and give you real fulfillment in life.

The 'B' is for books, which is the mechanism for painting that, do not ever get rid of those books.

The 'I' is for in-depth learning; learning for the sake of knowledge and understanding, as opposed to superficial learning: people who cram, cram, cram for a test. Sometimes people do okay and three weeks later know nothing. I'm sure no one here knows anyone like that. We really can't afford that kind of learning as we move into this Information and Technological Age; we have to change that paradigm.

The last letter, 'G', is for God. We live in a society that is trying to kick God out. I think that is a big mistake. Many people in the scientific arena, they take all those letters behind their names and they try to rearrange them to try to spell God- I think that is a mistake. A few years ago, some lawyers came to us and they said, "you can't put your 'Think Big' banners in public schools." (that is part of our program which we try to elevate young people across the country.) They said, "because the 'G' stands for 'God' and the First Amendment says, "there can be no government support of religious expression."" Well, I reminded them that the First Amendment says, "there can be no government suppression of religious expression." We had a rather vigorous argument. I suggested that we resolve it at the level of the Supreme Court, which seemed like a bold and reckless statement, but it really wasn't because I knew the next day I was going to the Supreme Court to receive the Jefferson Award. So, I figured I would ask while was there, and I did, and Justice Sandra Day O'Connor said they were all wet; they had no idea what they were talking about. People who say silly stuff like that: do they really understand the implication of what they are saying?

Our Country right now is facing perhaps right now the most severe threat it has ever faced. There are people who want to destroy our Nation, and our way of life, and they have very, very strong beliefs. They may be errant beliefs, but they are strong beliefs. If we abandon our beliefs, and we are faced with people with very strong beliefs, all you have to do is go back and study history and you see that people with strong beliefs always win out over the people with no beliefs. Couple that with the fact that people who say silly stuff like that; do they realize that out founding document, our Declaration of Independence talks about "certain unalienable rights" given to us from our Creator, a.k.a. God? Do they realize our Pledge of Allegiance to our flag, says we are "One Nation Under God", that most courtrooms in the land on the wall it says, "In God We Trust?" That every coin in our pocket, every bill in our wallet says, "In God We Trust?" If it is in our founding document, it is in our pledge, it is in our courts, and it is on our money, but we are not supposed to talk about it; what in the world is that? You know from your Psychiatry residents; that is known as schizophrenia. Doesn't that explain a lot of what goes on in our Nation in a day? We need to make it perfectly clear that it is okay to live by Godly principles: of loving your fellow man, of caring about your neighbor, of developing your God-given talents to the utmost so that you become valuable to the people around you. Having values and principals that govern your life, and if we do that, not only will we have a healthy nation, and not only will we remain a pinnacle nation, but we will have one Nation, under God, indivisible, with liberty and justice for all.

Thank you, congratulations and welcome. [Applause and Standing Ovation].

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