What Are You Going To Do With It?
Commencement Address, August 2, 2013
Creig Hoyt, SFGI10
Dean Sterling, Director Carl, esteemed faculty, staff, fellow graduates of the Institute and friends. I am deeply honored to give this commencement address. As a recent graduate of the Eastern Classics program I remain in awe of the uncompromising commitment of St John’s College to engage in a long-term community discourse in order to glean meaning and clarity from the writings of the world’s great thinkers. I also am mindful that some of the tutors who sit here today on the podium have given this address at previous graduation ceremonies. That I do not possess their depth of knowledge of the great writings you have studied is obvious. Therefore, it would be inappropriate for me to base my presentation on an analysis of one or some of the thinkers you have read here.
Moreover, you can hardly expect to receive wise career counseling from one who stumbled from a flirtation with music to philosophy in undergraduate school, who became enamored by neuroscience in medical school primarily because of the beauty of the brain’s organizational structure, but who fled from a career as a neurologist because it involved caring for patients I could not cure and finally stumbled into a rewarding career as an ophthalmologist specializing in infant visual problems: rewarding not because the problems primarily involved the visual brain but because I discovered I loved caring for children despite an intense dislike of pediatrics in medical school. I hope that by offering you some personal reflections on the ongoing impact that my St John’s education has had on my life and work I will provide you some useful reflections.
Today we salute these new graduates of the Graduate Institute. We know the rigor involved in the academic programs they have completed. We recognize and admire their fortitude and considerable academic accomplishments. Today is a day of celebration not only for them but for all of us who deeply care about the uncompromising scholarly traditions and demands of this extraordinary college. So let me speak for all us when I say to the new graduates, “Yours is a noteworthy accomplishment at a unique institute of higher learning. You have much to be proud of. Bravo”.
Ok, now let’s get serious. “What are you going to do with it?” Those were the exact words of my ninety-four year old mother four years ago when I informed her that I hoped to be a student in the Graduate Institute. These were not the words of encouragement a son craves. Adding insult to injury, this was the first time in my educational wanderings that I was not seeking any parental financial assistance. So what did she have to lose in offering her moral support? You would have thought a woman who lived with a single abiding passion during her 70’s and 80’s- to win as many tango competitions as possible- would have embraced the novelty of her aging son’s desire to become a full-time student in an area about which he knew absolutely nothing. What was I going to do with it? I was not even certain I could qualify for the program let alone complete it. I no longer recall what attempts at justification I mumbled to her, but the notion that my adventure was to be judged by what I might “do with it” irritated me. It reminded me of European colleagues who find it insulting that the first question Americans ask on meeting them is “what do you do?” In the remainder of my talk I will reflect on the primacy of the notion that one’s education is to be judged by what one can “do” with it.
Regrettably, the sentiments expressed by my mother have been heard by all of you in many different guises, all of them cloaked and protected by the seemingly impervious provenance of real life experience and practical counsel: “What kind of job can you get with that degree?”, “Wouldn’t computer science be more sensible?”, “Can you justify the cost for something so impractical?” “No one studies humanities anymore!”
No one doubts that it is prudent and wise to carefully consider and reconsider each step in one’s educational journey. Accumulating unreasonable amounts of school-related debt can restrict future life choices. Some professional degrees no longer guarantee an interesting and well-compensated career: this has become a serious concern for many of our law schools. Other career choices apparently require a carefully structured path consisting primarily of educational prerequisites that permits little time for exploring what might be simply interesting or enlightening. Note that I said, “apparently require”. In the case of medical schools there are some educational prerequisites that absolutely must be completed, but I can assure you that we who are involved in medical education are always looking for applicants who are not only capable of completing the scientific studies in our medical curriculum, but who also bring to medicine unique educational and work experiences.
Even though I intensely dislike her question can I now provide my mother a satisfactory answer? Can I explain in what ways my St John’s experience has changed not only how I think but what I do? Undoubtedly, a startling result of my graduate study at St John’s is that instead of remaining permanently retired I have resumed my position on the faculty of UCSF Medical School albeit on a part-time basis and without any administrative duties. Why? In no small part because St John’s re-energized my intellectual curiosity after a long period of time when my career had become dominated by all-consuming administrative duties that left no time for the pursuit of my research and creative activities. I realized I wanted to spend a few more years in the University concentrating on teaching and completing several unfinished research and writing projects. It also became clear to me that I missed caring for children and their parents. I agree with the Dalai Lama who in his commencement address at Tulane University this year said, “A pathway toward a meaningful life lies in caring for other people”. I have returned to what I know how to do- caring for vision problems in children.
Perhaps surprising to some of you, my St John’s experience stimulated new research interests that I believe I can study with the assistance of my UCSF colleagues. Those many seminars on Buddhism radically disturbed my previously unchallenged notions concerning certain aspects of what we mean by “perception” and “cognition”. In particular, I think the techniques of neuroscience may provide an interesting framework with which to explore the limitations and unreliability of sensory perceptions.
I am currently studying unusual visual percepts that occur in many adult patients who experience visual loss. I appreciate that no Johnnie wants to hear an oversimplified bottom line statement without first hearing all the details that lead to that conclusion, but our time today is short. Therefore, let me simply summarize some preliminary impressions and conclusions. It seems that the inherently high run rate of the brain does not allow it to turn off or suppress higher centers when peripheral sensory input is denied it. In the case of some visually impaired patients the brain will create a recognizable formed visual image even when the patient cannot process visual input in the eyes due to pathological changes such as macular degeneration. This can be profoundly unnerving for the patient who is already coping with a serious visual impairment. From the point of view of the student of Buddhist thought the only reassuring aspect of this phenomenon is that the patients are fully aware that the created image is false although they are often afraid to talk about it for fear that the listener will conclude they are demented or mentally ill.
Yet, more important than this example of a specific research question that was initiated and nurtured by my St John’s experience I would like to consider the learning skills that I and all students acquire on this campus. Numerous newspaper articles and news broadcasts have recently addressed the question of whether American colleges and universities are adequately preparing students for future employment in a rapidly changing marketplace.
In a recently published special report of The Chronicle of Higher Education and American Public Media’s Marketplace half of the employers in the study reported that they had trouble finding qualified recent graduates. Most of you will not be surprised by this jeremiad; you have undoubtedly heard or read similar complaints. What is noteworthy about this study is that responding employers were not speaking of deficiencies in specific educational training or technical skills. Their complaints were more fundamental: they insisted that the primary obstacles were that the graduates were deficient in essential core skills. I quote from the New York Times, dated June 29, 2013: “When it comes to the skills most needed by employers, job candidates are lacking most in written and oral communication skills, adaptability and managing multiple priorities, and making decisions and problem solving.” In this same article a vice-president of a human resource organization was even more explicit when he said, “young employees are very good at finding information, but not as good at putting that information into context.”
If we believe these criticisms accurately describe the major obstacles facing recent college graduates seeking employment, how are St John’s graduates likely to fare in their attempts? Perhaps, the most straightforward way to assess this is to ask, “What does St John’s do best?” My evaluation will be from a student’s point view and I am aware that some of you may feel I am oversimplifying the issues. Nevertheless, I think St John’s prepares students to do exactly what these critics claim today’s young employees cannot do well. In my experience, the keystones of the St John’s educational process are learning how to:
1. read carefully and critically some of the most challenging literature, and
2. express and defend one’s ideas clearly in a seminar, but also
3. evaluate and integrate the conversations of other students and tutors into one’s understanding of the problems under discussion.
I thought I was a reasonably skilled reader until I enrolled here. I was adept in my professional reading and could quickly find and prioritize the central issues in a reading a scientific paper. I successfully edited an international ophthalmology journal that required me to read and review a few thousand manuscripts a year. I even imagined myself to be reasonably “well read” outside my medical field of expertise. Naively, I was not particularly perturbed by the breadth and length of the reading list sent to me by the Graduate Institute prior to my enrollment. I was in for a rude awakening. It became apparent in early seminars how many details, subtleties and inferences I routinely missed in my readings. Learning how to be a more nuanced reader was a slow process and that process continues.
Yet, it is the uniqueness and central importance of the St John’s seminar that I especially want to highlight and examine. I have attended many seminars as a student in undergraduate school and medical school and as a faculty member of a medical school. When I came to St John’s I was confident that I understood the dynamics of a successful seminar and how to function effectively in it. I was wrong, at least in regards to what was expected here. I had never been in a situation where my education depended primarily on the quality of thinking and conversation of my classmates. My classmates weren’t my competition but rather they were my teachers. I was amazed by the ability of some of my classmates to penetrate and analyze texts that appeared to me to be nothing less than incomprehensible. In particular, I am recalling certain Vedic texts, Yoga sutras and Nagajura’s notions of truth, but there were plenty of other readings that I found more perplexing than enlightening. I remain indebted to my classmates for so much of what I learned here. I still seek the advice of several of them about their recommendations for further reading.
Of course, one quickly learns that different skills are brought by various classmates to the seminars. A small cadre of my classmates seemed to be able to hold forth on any topic and at least sound informed and thoughtful. Others enjoyed slowly mulling over the arguments of other classmates and only adding an occasional insight or critique and then quickly retreating once again to the role of thoughtful observer. However, some of this latter group proved to be essential in keeping conversations moving forward and exploring avenues of thought untested by the rest of us. That at times some classmates substituted a bit of blarney masquerading as insight should surprise no one. Indeed, one of the endearing features of a St John’s seminar is its tolerance of what might be called Brownian thinking and even the occasional complete collapse of group focus resulting in an unintentional homage to Jabberwocky. A St John’s graduate’s ability to negotiate through the verbiage of a two hour seminar and condense the essential elements of it into a few coherent sentences is a skill that any potential employer should prize.
Having returned to the clinical practice of medicine I now realize how invaluable the listening skills that I learned at St John’s are in my work. Yes, they are helpful in the give and take with student physicians and in navigating the still far too frequent committee meetings. More importantly they are critical in the most essential aspect in caring for a patient: obtaining a history of the patient’s illness. It may seem counterintuitive to you, but the medical history obtained from a patient is usually far more important in establishing the correct diagnosis than the physical examination or laboratory testing. I remember a wise senior professor of medicine reassuring me when I was nervous 3rd year medical student that history taking would be the most difficult skill I needed to learn in order to be a good physician. Why is this true? A patient comes to a doctor’s office with a specific complaint: in most fields of medicine it is pain or physical discomfort but in ophthalmology it is usually visual loss. The problem is to identify the cause of the pain or visual loss. The art of history taking is to question a patient in such a way that they provide the clues to lead you to the correct diagnosis. This involves ignoring a lot of the conversation that the patient deems essential but that you judge to be extraneous or even misleading and diverting. On the other hand, it is sometimes vital to focus on a seemingly trivial bit of information that ultimately points you directly to the diagnosis.
Shortly after I returned to clinical practice I was asked to see a young teenage girl who had suddenly become blind in one eye as the result of bleeding within the eye. Her referring ophthalmologists were unable to identify a cause for the bleeding. Her blood count and clotting studies were normal. She was not a diabetic. She denied experiencing a blow to the eye. She and her parents were extremely nervous because of the understandable fear that she might become blind in both eyes. I proposed that we start from the beginning and have her describe how this problem had come about. She grew frustrated with my suggestion since she had told her story several times to numerous doctors. She finally agreed and in a disgusted tone of voice said, “It is simple. It was the end of my vacation and I woke up one morning and could not see out of my right eye.” I thought for a moment and then asked her where she had gone on her vacation. When she said she had traveled to East Africa a new list of possible diagnoses entered the picture. After surgical removal of the blood in her eye we were able to identify a bot fly larva in the retina that subsequently was destroyed with a laser. I confess I am not certain why I asked her where she had gone on her vacation except it seemed to be the most important aspect of her statement. Moreover, she and her family were extremely nervous so I had to say something. I often finding myself pondering how much a St John’s education prior to my medical training would have improved my skills as a physician.
In concluding these remarks I would like to tell you a story that I believe highlights the breadth of options that your St John’s education provides you. When I was chair of our department of ophthalmology I was anxious to expand our research activities. I knew that a very innovative retinal surgeon was unhappy in the university where he was employed. He was working on an exciting prototype of a retinal prosthesis that could be implanted directly in the retina of blind patients. I thought he would be an outstanding addition to our department. I called him and asked him if he might be interested in joining our faculty. After several conversations it became apparent that both he and his wife were excited about the possibility of relocating to the Bay Area. Yet, I could not make a formal offer to this internationally famous retinal surgeon until he gave a research lecture not only to the clinicians but also the basic scientists in our department. I knew this potentially might be a deal breaker.
In the past 30 years the top medical schools in the country have become major biomedical research centers and not simply professional schools were future physicians are trained. In many departments basic scientists now outnumber the clinicians. In our medical school the standing of basic scientists has been further enhanced by the fact that five Nobel Prizes in Medicine and Physiology have been awarded to UCSF basic scientists since 1989. We would need to convince our basic scientists, a tough audience, that this retinal surgeon was qualified to join the UCSF faculty.
To highlight our problem let me say that as a clinician I see basic scientists as having much in common with Sanskrit grammar. They love the passive voice especially in journal articles- “A new gene has been discovered” or “The sample was divided into equal aliquots”. New discoveries are often named with mind-numbing compound nouns- proto-oncogene, macrosquare- wave jerks, or proximity-luminance covariation. I must admit that most basic scientists would respond by asserting that clinicians lack the precision and concern for detail so characteristic of Sanskrit texts. The tension between these two faculty groups is never more apparent than in research seminars. I discussed this issue with my new faculty candidate but he assured me he could deal with it.
You can imagine how stunned I was when he began his research seminar with this story: “A surgeon is walking beside a river when he suddenly sees a man struggling as he is swept down river. The surgeon jumps into the river, swims to the man and grabs him under the chin and pulls him to shore. A few minutes later the surgeon while continuing his journey up river hears the calls of two men who are drowning in the turbulent river. The surgeon, being a man of action, jumps into the river, swims to the two men and holds one with his right arm and the other with the left and drags them to safety. A few minutes later the surgeon resumes his walk upstream but almost immediately sees three men being swept downstream in the river. He jumps in the river but realizes he is unable to pull all three of them to the shore. He looks up and sees a basic scientist walking upstream on the other side of the river. The surgeon calls out to the basic scientist and pleads with him to jump in the river and help with the rescue effort. The basic scientist replies, ‘No, I am going to walk upstream and see who is throwing these guys in the river.’”
What are you going to do with it- your St John’s education? No doubt some of you firmly believe you have your future planned out in detail; others of you in a candid moment might admit you haven’t a clue. For myself, I like to think that at St John’s I learned to swim more effectively while also being encouraged to walk up river more often. I envy the many opportunities that await all of you. Congratulations again. There are great adventures and challenges ahead. What will you do with them? Ah, that will be an interesting story.
Dr. Hoyt received his bachelor’s degree from Amherst college, and his MD from Cornell University Medical College; he served as Intern in Medicine at Stanford University and as a Resident on Neurology and then in Opthalmology at University of Californa in San Francisco. He has served as a flight surgeon in the US Navy, as a lecturer at the University of Sydney, and from 1978 to the present he has practiced medicine, taught, and performed research at at the University of California, San Francisco, where he is currently Emeritus Professor and Chair of the Department of Opthalmology. He has authored over 170 peer reviewed scientific articles, among other publications. In 2010 he received his Master of Arts in Eastern Classics from St. John’s College. A classmate reported that he was an anchor of the group, widely respected by his fellow students. He is now a member of the Presidents’ Council of St. John’s College.