I find out that his birthday is in a few weeks. I would be surprised that he lives to his birthday, but I swim in and give him a kiss. And then I have a fish puppet. I put it on his hand. You will eventually see that he can’t hold it up, he must rest it on his chest, and I tell him that his fish and my fish will gossip about a third friend, and you will see that he actually cracks a really funny joke. And somebody had given me a little fish on a keychain, and I tell – I mean, I’m lying – I tell him that it’s a little cellphone, that he can call me anywhere in the world and I will be there for him. So you’ll see that it actually isn’t something that takes any training to do. So let’s try it.
And somewhere during this, I’m going to ask you to keep it running but turn off the sound. There’s the mother. Keep it running, but turn down the sound. Great. The last scene I’m going to show you on this tape is from an orphanage. I think I mentioned that I’ve probably been in over 2,000 orphanages. They always break my heart. I can’t believe that we do not take care of the children. I have been in orphanages that hell cannot be worse, and the Russians are some of the worst. And people have told me, “Patch, what does it matter? You drive up to an orphanage once a year, and you spend two hours in the orphanage, and maybe make them more sad after you leave than good that you were there.†And I understand that, but I have to say that I’m not sure we go to the same orphanages.
You’re going to see me leaving an orphanage with a young girl who for many years when we drive up on the bus, she is right there – by the way, this is my older son – that we drive up and she comes and grabs my hand, and we have two hours of [inaudible] together, and you will see us, the parting, and see at least what it means to me. We can turn up the sound now. You don’t have to be a good skipper as a clown. Okay, that’s enough. Great.
Okay, now I want to say a few more things about care. We can turn off the films. The word care is in crisis in the United States. Probably the word most associated with it is burden. The burden of care. The burden of our elderly, the burden of our poor, the burden of our mentally ill, the burden of our disabled, the burden of our environment, that anytime you have to spend any time caring for something it’s a burden. It’s a duty. It’s not an ecstatic, joyful thing. We’re trying to change that.
It’s interesting in our language – language is so unusual – you take the words give and take. They seem so different, but if you add care to them in English, you have a caregiver, a caretaker, and they’re the same thing. Maybe there’s an implication, and we certainly believe this, that care is bidirectional. That we think that care is an essential human need. In order to be fully human, you need to be caring. That whatever discomfort you may be feeling, make sure that there’s a part of your life that clearly is caring. We think it’s an essential human need and that it is bidirectional, that everyone talks about how Mother Theresa helped the poor of Calcutta, but they don’t talk about how the poor of Calcutta helped Mother Theresa.
I am glad that people have thought I have been caring of them, but I’m real clear that they have been caring of me. That you can see if you look in our society people caring for their parents with Alzheimer’s or caring for their children who are totally disabled, and there’s no burden. It looks like they’re having the best possible life imaginable. This is a possibility.
It’s interesting; we have a phrase in English, “I couldn’t care less.†We also have a phrase, “I could care less,†so grammatically, we’re confused. If you’re an English student, you might wonder which is correct: I couldn’t care less or I could care less. I’ll tell you. It’s I couldn’t care less. What’s interesting is that it’s usually said from a position of strength. I couldn’t care less. Meaning that of all the levels of care, they couldn’t care less than they are caring, and they’re feeling good about that. That’s how dumb some of our population is. We need to care to be human. It is not a duty; it is a privilege. It is a chance to be the ultimate expression of your humanity.
Okay. We have some time for questions or comments, arguments. I am completely open. I have no privacy, so if you dare say it or ask it, I’m ready for you. I also see that there are more people tonight using the interpreter, and so if I had the ability to understand Spanish – alright. Perfect. Isn’t the interpreter doing a great job? They mean well. If you don’t ask questions, I recite poetry. I know four hours of poetry by heart. The interpreter will not try to translate it. You saved us. English or Spanish?
Male 1: Spanish.
Patch: Okay.
Male 1: [Speaking in Spanish.]
Patch: Have you had this fear? I’m curious how you recognized it. But you’re calling it fear. You’re a medical –
Male 1: Student.
Patch: Student. You know, I think it’s very normal when you enter medicine, you’re thinking, “Oh my god, I’ve got to – life and death is in my hands. I’m going into medicine. There’s so much stuff to learn. What if I don’t know the right thing and kill the patient? What if I don’t ask the right question? Was I friendly enough? Was I too friendly? Was I professional? Was I unprofessional?†All of those things are going around in your head as a medical student, and that’s true everywhere.
In my world, those are indications for you to invite thinking into your life. It’s very helpful in medicine to do a lot of self-examination. Who am I? The profession of medicine has a series of tests and internships to put you to a point to where you can hopefully feel that you know the right technical parts of medicine. Proper diagnoses, proper treatment. I’m not sure that’s what you’re talking about in this question. I think you are talking about that. Okay.
One reason that I always worked with a group of doctors is I like a group of us to tackle a medical situation. I like having more than one voice, because it is complicated. It’s much more complicated when you’re in school than it was when I was in school, and so having – I think one of the first things that’s really important for a medical student or a resident, a physician to do is that if it isn’t totally clear to you, reach out. Reach out to doctors and reach out to nurses. Nurses saved my life as an intern much more than doctors did. And I say that, they saved my life much more than doctors did.
So I think if it’s a force that drives you to be diligent in your studies so that you do learn the information – and it’s interesting, no matter how long you’ve been a doctor, they say you’re practicing medicine, so maybe all your life you’re in practice rather than, “Well, I’ve got it down.†You’re always in practice, that it’s important to keep up with what is happening in medicine, that these forces, these fears – so if you stay caught up, if you are comfortable to calling other friends to help you, if you are past all the examinations, the technical part of medicine should be pretty straightforward. The fears can go away.
If you start caring for a patient, you may have fears more having to do with personality, and that’s why I suggest doctors not to be hierarchical, not to feel separate, not to feel – I don’t like the idea of professional distance. I think that’s an excuse not to be intimate. But I was told to be not so emotionally involved with my patients. Why would I go into medicine if I didn’t want to be emotionally involved? I mean, that’s only my own point of view. But that one nice thing in pediatrics, these friends I’ve met today who are graduating, they had three years. They had medical school, and then they had three years to practice being comfortable, and then they go, “Oh, I’m still not comfortable,†maybe they’ll go into a specialty and have three or four more years of, “Oh boy, I get to work with other people. Whew.â€
So at some point you dive in and say, “I’m going to welcome, I’m ready to receive patients,†and you’re ready to use a phone and say, “Can you help me?†That’s why you get close to your classmates, you get close to the people in your residency, you make friends along the way so that you have – and you don’t feel that it’s a loss of your intelligence or your position to reach out, because there are people I can remember in medical school, students that made big mistakes because they didn’t want someone to think they didn’t know something. You know, be the dumbest student in your class. That’s what I was. Being a person who says, “I’d like some help.â€
And then you just dive in. You know, the fear early on is to help make you really set your course for good relationships, diligent study, keeping current with information, and then you – as a student you’ll feel very different. Sometimes as an intern you already feel like you’re a doctor, that you’re ready to be a doctor, but by the end of your residency – who’s finishing their pediatric residency? Okay, leave your hands up, okay? And this is a time to be really honest. Who thinks by the end of this year, you’re going to be ready to go out there and be a pediatrician? Keep your hand up. Don’t look back there. I think they were from another group. Now, come on. Wait just a second. Okay, you’ve disproved me here. Did anyone leave their hand up? Aren’t you in charge of these residents? Is that right?
Okay, then I want – here, let’s give the microphone – you say what is it going to take between now and the time you finish to feel that? And you can be asking that question yourself. The ones that didn’t raise their hand. Okay, these two here, they didn’t. They put their hands down quickly. Yeah. Tell this medical student what you’re missing in your third year of residency. [Inaudible]. That’s not a dirty word, is it? Okay. Does anyone want to say? Okay, forget those people. Maybe they’re humble.
I’ll tell you, I only did one year after medical school. I’m a general practitioner, because there was so many ethical compromises, and working in an American hospital, I couldn’t do it. I couldn’t work around rude doctors. I couldn’t. The amount of rudeness, 90 percent of the doctors were rude, arrogant pricks, and I couldn’t work around them. They were telling me to be a different person than I am, and then one day in my internship I said, “I know enough.†You know, I’m never going to be a super subspecialist. I’m a family primary care doctor, and that I know enough, and I know enough to look up in a book if I’m scared or make a phone call, and that I was ready. I never looked back on it. I’m not sorry. I am glad I quit the residency because I couldn’t, you know, too many assholes. I know there are none here, but there are a lot in the United States.
And so you have to come to grip, you know, in the same way when you’re dating somebody you have to come to grips. Am I ready to date? Are you looking at her? Are you dating? Is he ready to date? Okay, you don’t have to answer. But I mean, with everything, you wonder am I ready to play [inaudible]? I’ve been practicing for one year. Am I ready? And whatever it is you’re wondering am I ready, am I ready, everyone’s going to have their own – what I don’t recommend is that you don’t have a big judge going, “You’re never enough. You’re never enough. You’re –“ you know, have good judges. Have relaxed judges that care about you and they care about you being a good doctor. I don’t know you, but I trust – just seeing you here this evening, you’re going to be a wonderful doctor. You’re going to really care about your patients.
And we make mistakes, you know? If every doctor was honest, we make mistakes every day. When you only have eight minutes with a patient, you make a mistake every single time with a patient because you don’t have time to ask all the right questions. You don’t have time to comfort them. So every day, all day long you make mistakes as a doctor. You apologize, and you go to your books and you try to learn. Well, you go to the internet now, probably, and work with a group. I always work with other doctor friends and nurse friends and just say, “Let’s all talk and see what’s happening.†Oh, you residents, put your hands down. Make them do another year, okay?
Just what is it? What is it about – all of them put their hands down. There’s something important here in what they’re saying, and it’s not about the training here at the hospital. There’s something really uncomfortable to me in thinking that you are six months away from completing your residency, and – oh, eight months. Yeah, that extra two months will help. So you’re eight months away from your pediatric residency being over, and you’re not sure you’ll be ready. Can’t one of you say, “I’m going to be ready?†Okay. Next question. Okay.
Male 2: Let me try to practice my English. First, I am thankful with you, with your message, and with the organizers of this conference. It’s very interesting for me. I’m a pediatrician. I’m actually working in the world of [inaudible] for patients. That’s the field that I am interested just now. I am really happy to be listening what are you saying to us today here.
Really, I want to make you many questions, but I may maybe just think one or two, so you are have trouble for many countries [inaudible] the world. I have seen many places, and first of all, I want to know have you ever find someplace where people in hospitals and medicine used to play with children, the doctors used to [inaudible], or maybe it’s similar [inaudible] that many times doctors don’t have difficult to play with children to have [inaudible] attitude with them.
And the second question is you have made a very political position about care, a philosophical one, and what do you think about healthcare reform and what your work has to do with that [inaudible].
Patch: Okay, that was that opinion. Okay, thank you. You know, it’s interesting now in the United States, there’s a degree you can get in college called child life specialist. You actually can get a master’s degree. When I grew up, that was called a playmate. Child life specialist. What I don’t like about that in the same way that I don’t like that – when the hospital has a clown group that comes in, maybe they think we don’t have to be playful and funny. Maybe when they have a child life specialist, they think we don’t have to play with the children.
I haven’t found a happy hospital in the world. I’ve looked, I’ve challenged. I keep thinking somebody is going to show me one. I will be very happy, but I haven’t found one. I haven’t found a place where people feel the doctors are having enough time with their patients. And you know, when you don’t have enough time, it’s like let’s say you’re a single mother with three children, and you’re working two jobs because you’re not getting any help from the father. Basically, your mother job is cleaning the house, cleaning the clothes, cooking the foods, making sure they have breakfast, immunizations, and the first thing that goes is play. It’s not held in high regard. I would say even there’s a lot that would say it’s unprofessional to play, unprofessional to be funny as a doctor, unprofessional to hug your patients, to kiss your patients, to be vulnerable, to cry with your patients.
So that ethic is out there all over the world, and there are people trying to defend that idea. It sounds like you’re trying to break down that idea. So I don’t know places where doctors are well known for playing on the floor and enjoying their life on the [inaudible], and I don’t know how many thousands of hospitals I’ve worked in – many, many – and I’ve not seen that happen. I have seen individual doctors and nurses take a break and enjoy what we’re doing, and look like they’re natural in doing it.
I mean, one of the reasons that we have created our hospital is that we wanted a funny hospital. We wanted a loving hospital. We wanted a hospital where there was no power over. No one was the boss. And we’ve kept to those dreams a long time because we thought it was valuable to show one in action, and when we show one in action, they’ll see that one of the reasons that doctors will work for practically no money is because of that climate, because of working in a playful environment, an environment where you have time with the patients and that sort of thing. And I don’t know anywhere where that’s become the nation’s or a particular hospital’s style.
They have this thing called patient-centered care. It sounds good on paper. I don’t know many places that have taken that idea very far. Sometimes they feel they’ve taken it very far if on pediatrics they wear colorful clothes. So there’s a long way to go, and I’ve known medical students and residents who were kicked out of school for being unprofessional, and when I get their letters full of tears and they tell me what they did, they were just trying to be human. And so what a weird thing that in our profession, which is a profession of humanism, of care, of being people with people at their most vulnerable moments, that somehow we’re supposed to keep a distance from that.
But there are a lot of things in this society that are weird to me, and so I’m going to guess that they’re also weird to you. Let’s change them. Oh, yes.
Female 1: In your career, I’m sure you have to – you break all the rules, all the normal rules. I would like to know what has been the biggest challenge that you have faced throughout your career.
Patch: The biggest challenge. You know, I don’t actually have any personal challenges. Once I decided at 18 to make me, I’ve just been making me. I mean, the challenges I face are the most horrible challenges. I come from the number one terrorist nation. My country has murdered a million Iraqis. I feel I know what it must have been like to live in Germany in 1934. You know, when I look at the political structure of our nation, you know, the homeland security patriot act [inaudible] six of the ten bill of rights. Americans don’t even know what the bill of rights are.
I watch people on TV say things I can’t believe this is my nation. You know, I have a passport. If I could, I’d burn it right here on the stage. There’s no more meaning for countries. The 20th century was the last century of countries. It’s transnational corporations now. I mean, for me, the worst thing that ever happened in history is market capitalism. Market capitalism is destroying everything, and it has an ethic around it that allows it, and it owns the TV stations so it sells this idea to children.
So I try to wonder, given the millions of things we could study, the huge numbers of things we could be doing with our life, how is it that anyone has time to sit down on the couch how many days a week to watch multi-millionaires play with their balls? Sports. I mean, if you don’t think [inaudible], you have been tricked. When you sit down and watch multi-millionaires play with their balls and think you’re engaged in some way, I’m sorry. You know, we are destroying our environment at a level that is embarrassing. We’re still debating in the United States about global warming because we can have a snowstorm.
We are working a lot trying to stop child sexual slavery. 20 to 50 million men a day have sex with a child in sexual slavery. 20 to 50 million every day. So when you ask me about challenges, those are challenges to me. I don’t have any challenges. I don’t think I’ve had a challenge in my adult life. I’ve had a lot of opportunities, but for the young people in this audience, nothing I read says you have any hope to reach my age.
