Say yes to everything, Atul Gawande tells Stanford’s advanced degree graduates

Given his life experiences, the advice that writer, surgeon and public health expert Atul Gawande gave Stanford’s advanced degree graduates Saturday is the kind they can take to the bank.

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The Stanford Class of ’87 graduate – most recently a familiar face in the media as a COVID-19 expert – told his now fellow alumni to be “open to trying stuff – to saying yes” to pretty much every opportunity that comes their way. That is, at least until they are 40 or so.

Looking back at his life and career, Gawande said he realizes that this is the path he has followed, all the while paying close attention to those experiences he found endlessly interesting.

“For a long time, this meant that I was drawn in three disconnected directions – to surgery, to public health and to journalism,” he said. “Over and over, people told me I needed to choose. These things don’t fit together, they’d say. And for a very, very long time, they didn’t. All I saw was that each separately added something that fed me. And eventually they each fed one other.”

Socially distanced ceremony

Gawande, a Brigham and Women’s Hospital surgeon, Harvard professor, and best-selling author, gave his remarks as the first of two alumni speakers at Stanford’s 130th Commencement ceremonies this weekend. (Actress, writer and producer Issa Rae spoke at the undergraduate ceremony on Sunday.)

Saturday’s socially distanced ceremony in Stanford Stadium wasn’t everything graduates and their families had dreamed of as each graduate was given only two tickets to share. But it was a ceremony that seemed unimaginable, given the pandemic, even months ago.

For instance, waiting outside the stadium before the ceremony began, parents Hari and Christy Dallakoti from Denver prepared to celebrate their son Andrew’s master’s degree in public policy.

“Something is missing without the whole family here,” Hari Dallakoti acknowledged, but they nevertheless appreciated the closure the ceremony gave them before Andrew returns to his Dallas job in consulting.

A foggy Bay Area morning gave way to sunshine as graduates entered a relatively empty Stanford Stadium that had been adjusted to allow for the social distancing COVID-19 requires. As they entered school by school, they waved to masked family and friends perched high in the upper decks, who waved vigorously back.

No greater honor

In his talk, Gawande stressed that graduates need to pay attention to those experiences that energize them, as well as those that do not.

“You want to pull apart the experience and figure out specifically what lifted you up and what sapped you,” he said. “And then you want to do all you can to organize your life to do more of the first and less of the second.”

The advice seems familiar – until you hear how Gawande has actualized it in his own life. When encouraged to choose among his varied interests, he simply didn’t.

Saying that there is “no greater honor” than being asked to be a graduation speaker at one’s alma mater, Gawande shared the story of his life and career starting with his own graduation and of being confronted – as every graduate is – with the question: “So what now?”

Gawande planned to go to medical school, but he noted, “Your answer might be the same. Or it might be a job, a trip, a move back home. But the truth was that none of us really knew what was ahead for us. Really, how could we?”

In medical school, Gawande switched gears from primary care to surgery once he found he was captivated by what he described as “the surrealness of opening the bodies of living people.”

In turn, surgery showed Gawande the inadequacies of the health care system. He pursued public health training that helped him understand how to design systemic solutions and deliver them at population scale. He is the founder and chair of Ariadne Labs, through which he has worked with state and federal agencies, the World Health Organization and health care systems across the world to improve outcomes in surgery, primary health care, childbirth, serious illness care and epidemics, including COVID-19.

Those experiences led him to be named to the Biden Transition COVID-19 Advisory Board.

Saying yes to writing

Gawande has also famously pursued writing, beginning with a blog he wrote during residency, as well as longer pieces for The New Yorker magazine. That, in turn, led to an offer from a publisher to turn his essays into a book. The challenge terrified him, he acknowledged, especially given that he and his wife, Kathleen, whom he met at Okada at Stanford, had three children.

“So, I stilled my beating heart,” he said. “I kept making time for what energized and motivated me and kept removing time from what drained me and beat my spirit down. This meant doing things that didn’t fit with my plan or the image others had of me. But I never regretted it.”

Among Gawande’s many works is the New York Times best-seller Being Mortal: Medicine and What Matters in the End. The award-winning and deeply moving book addresses the nature of death and the obligations of physicians to their dying patients. His belief in the importance of giving purpose to people nearing death has helped refocus the national conversation on death and dying.

“Surgery showed me the day-to-day realities of illness and our inadequate health systems,” he said. “Writing let me investigate the flaws and way to address them. And public health training showed me how to design systemic solutions.”

And then saying no

Gawande told graduates that his advice to say yes to everything has a caveat: Only do it until age 40. This advice came to Gawande from a friend who believed that, as we age, we know ourselves well enough to focus on what truly matters.

“As you get older, this becomes your advantage,” he said. “You begin to know yourself – your capabilities, your gaps, what really motivates you – well enough to commit to efforts that can take a long time to realize. Years. Decades, if necessary. You become willing to even work for goals that will not be achieved in your lifetime.”

As he wrapped up his speech, Gawande turned to COVID-19, which has been the focus of much of his recent professional activities.

Gawande reminded graduates that, even as Stanford is free to hold an in-person ceremony, the pandemic continues to spread worldwide, claiming lives and causing loss and pain.

He lamented that our nation failed to summon the commitment to adhere to strategies known to stop the spread of the disease, including widespread testing, masks and social distancing.

“Those communities that came together across political lines to acknowledge the threat and fight the fire were able to stop the fire. Our community did not come together,” he said. “The fact that we could not summon the national commitment required – that we have had key leaders who saw political opportunity in undermining that commitment – has been distressing beyond words.”

Leaders, he said, have a choice to drive division and stoke fear or bind people together to confront their fears.

“The difference between the two paths is worth remembering as we each encounter that ‘What now?’ question in our lives, that question about what we individually will commit to next,” he said.

He added, “All of us are seeking our way to express our worth. And everyone does have worth, equally, with everyone else as a human being. We do just by being here in the world. To discover how to express that worth, all you have to do is keep saying yes until you’ve found it. And if you do, you will.”