Dear Class of 2020

Be well, do good, and contribute to the benefit of all, says Robert Satcher Jr. MD ’94

screengrab of satcher from video

Robert Satcher Jr.

Due to the COVID-19 pandemic, Harvard University and Harvard Medical School held virtual graduation ceremonies to ensure the health and safety of the Harvard communities. In-person celebrations will take place at a later date.

Distinguished guests and graduating class, it's a tremendous honor to be with you virtually today for your Class Day celebration. I think it's safe to say that nobody expected things to be like this. So I think it's only appropriate that I wear the appropriate personal protective equipment throughout this address.

Read more about HMS/HSDM Commencement and Class Day

I'm not going to mention names or places. But I will use for guidance an incident that happened with the vice president of the United States at a famous medical institution in Minnesota and that rhymes with day-o. But, seriously, I'm trying to be sensitive to the times, at least symbolically. But I'm not going to wear a mask today, maybe just on a future visit to Harvard Medical School.

When Deans Daley and Hundert invited me on behalf of the class to speak at Class Day, I was excited at the prospect of returning to the HMS quad and celebrating with you. But, in an odd way, I think it's appropriate that I'm bringing you greetings from Houston, Texas, virtually.

I'm an HST graduate, as many of you know. So it makes sense that it should be a health sciences and technology alum that is speaking at the first Class Day that is entirely dependent on technology. As much as you treasure your parents, I'm sure that none of you imagined finishing medical school back in your parents' homes on a Zoom meeting without the opportunity to walk across the stage and shake the dean's hand.

There is an air of disappointment to these circumstances. But I implore you to keep your heads up and, most importantly, to keep your microphones muted so that we don't hear what's going on in your house. I also hope that you keep your cameras appropriately focused from the shoulders up as many of you may not be appropriately attired below the waist.

But, seriously, this is a special moment that is the culmination of years of hard work, focused sacrifice and vision. It is a mere 26 years ago when I stepped across the stage to receive my diploma from then Dean Tosteson and never imagined returning in the current capacity. Furthermore, although I don't think of myself as old, I realized that, when I entered HMS in 1996, most of you, if not all of you, weren't born.

It was a much different time then. There was no social media, no FaceTime, no Zoom. So gathering like we're doing today wasn't possible. And I have to admit, I don't remember who the speaker was when I graduated. And I don't remember any of the words of wisdom from that day. 

I also have to say that I don't remember much from any graduation speakers at any level—high school, college, or graduate school. So I've set a bar of achievement for myself in today's remarks that's consistent with my limited but I do believe significant sampling. I hope that you at least remember that it was me talking to you and that we were in the midst of a pandemic. Whether or not you remember anything else that I say is probably too much to expect.

This COVID-19 pandemic has presented us with many challenges and opportunities only previously imagined. As medical professionals, we are uniquely positioned to make a difference for the world moving forward. So it's more important than ever to remember that perception is not reality. The most important thing to do is to try to make a difference and to do the right thing. Far too often, it's become the norm to be selfishly concerned and to subordinate guiding principles rooted in ethics and wisdom in our collective pursuit or obsession to be popular or at least having the facade of popularity as measured by likes or tweets.

Perhaps the best way to bring us all into an enlightened consciousness together is to remember those relevant aspects of the professional oath rooted in the Hippocratic oath that we pledge. And I'll read them. I'll remember that I do not treat a fever chart, a cancerous growth, but a sick human being whose illness may affect a person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure. I will protect the environment which sustains us in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet. I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

So I'm going to share with you two examples from my life experience that might shed some perspective on our current circumstance. And I intend to give you hope as you set forth into the post-pandemic world. As many of you know, I'm also an astronaut. In fact, I'm the first orthopedic surgeon and first oncologist to also serve in this capacity.

I flew aboard the space shuttle Atlantis in 2009, visiting the International Space Station for close to two weeks. I'm one of 14 African Americans and the last one, for that matter, to travel into space. Our mission, STS-129, was a construction mission for which I had the privilege of doing two spacewalks and the incredible experience of seeing the home planet from space.

We retired the space shuttle shortly thereafter, but have recently, if all has gone well, began launching astronauts into space, again, from U.S. soil. And my colleagues Bob Behnken and Doug Hurley should be now safely aboard the International Space Station after launching from Cape Canaveral on the maiden voyage of the SpaceX Dragon spaceship. It's taken 10 years and lots of effort and faith that the post-space shuttle program gap is finally over. 

And it's also notable that it was 50 years ago when one of the most memorable moments in spaceflight history occurred. We all remember the phrase, "Houston, we have a problem," which were words spoken by Apollo 13 astronaut John "Jack" Swigert via radio communication to NASA mission control center in Houston, following the discovery of an explosion that crippled their spacecraft.

For history buffs, the words that he actually spoke were "OK, Houston. We've had a problem here." And, when I think about our current situation with COVID-19, it's entirely possible that the astronauts aboard the space station may have heard these words, "Space station, we have a problem here in Houston." Mission control is probably looking for a way to get aboard the space station to avoid coronavirus.

We all know how the Apollo 13 story ended. And it should give us hope that this pandemic on the home planet will end. Although the astronauts did not visit the moon, all the crew returned safely to earth. The nation and the world were transfixed as mission control and the crew of Apollo 13 discovered and responded to the problem which robbed them of the opportunity to land on the moon and, most urgently and importantly, called into question whether or not they would survive.

They adjusted their orbit using a contingency burn that had fortunately been previously researched and calculated by NASA flight controllers and engineers. Onboard consumables, oxygen and water, were conserved as the explosion resulted in an oxygen leak. The crew, including James Lovell, Jack Swigert, and Fred Haise, still hold the record for furthest travel in space away from Earth, about 250,000 miles, since the moon was further in its elliptical orbit around the Earth than during other Apollo missions and because Apollo 13's closest approach to the moon was further from the moon than in other missions.

Because of the quick thinking of the crew and mission control and the ability to analyze, diagnose and correct in real time, the crew survived. So on April 17, 1970, the astronauts splashed down in the Pacific Ocean, 600 miles southeast of American Samoa, successfully concluding the six-day mission nearly ended by disaster. The explosion of the oxygen tank in their service module had robbed their command module of power and oxygen, forcing them to take refuge in the lunar module.

Through the judicious conservation of resources and expert guidance from the teams at mission control, the spacecraft designed to support two men for two days kept three men alive for four days. It was a modern-day saga and testimonial to courage, intelligence and judgment in life-threatening circumstances. It sets an example for the collective power of teams and the incredible ability of a crew that worked well together.

The well-being of every individual involved was preserved in advance by this collective effort. Now, in this drama, engineers led the way by providing the alternatives that allowed the crew and mission control to identify a pathway to success. And we, as health care professionals, have a similar opportunity today to lead the country and the world to post-pandemic success by defining the alternatives that will allow public officials to make the correct choices and to lead discovery and innovation in finding a cure and better ways of preventing disease spread and, on an individual level, to care for those afflicted by coronavirus and, equally as important, to provide hope.

One of my favorite quotes from Malcolm X, who had a way of putting things that is unforgettable, he said, "There is no better than adversity. Every defeat, every heartbreak, every loss contains its own seed, its own lesson on how to improve your performance the next time." There's a couple others I want to share with you that are both inspiring and appropriate, "Comfort and prosperity have never enriched the world as much as adversity has." That's by Billy Graham.

And here's one to remember in these times of social distancing, "Keep your nose out the sky, keep your heart to God, and keep your face to the rising sun." That's by Kanye West. We cannot lose sight of the big picture in our pursuit and passion for promoting health care. The new moniker of both health and wellness could not be more apropos.

What's also become evident during this pandemic is that everyone is not equally impacted. We've now become well aware of the disproportionate impact of COVID-19 on certain groups, especially African Americans who have died disproportionately in this pandemic. The reasons for this are well understood if not universally agreed upon. Namely, the pandemic has also served as a spotlight on underlying deficiencies in our society, providing a truth serum of sorts to collective denials rooted in historical and institutionalized injustices.

The health care system in this country amongst many other things is still not fair. Specifically, it is still contaminated with racism. This racism is baked into the system as innumerable examples have illustrated.

My uncle, former U.S. Surgeon General David Satcher, who also spoke at HMS Class Day 20 years ago, established ethical guidelines for informed consent in clinical research that stem from the infamous Tuskegee experiment. For those of you who don't know, from 1932 to 1972, African American men were intentionally infected with syphilis by the U.S. Public Health Service and not told of their condition nor offered treatment in order to "observe the natural history of untreated syphilis."

The African American men in the study were only told they were receiving free health care from the federal government of the United States. So the disproportionate impact we see today on African Americans from coronavirus has roots and is occurring because those who make up the health care system continue to have racial bias and because those who are subject to this bias are logically wary and non-trusting of the medical system.

And it's not only because of the Tuskegee experiment that ended in 1972. This ongoing racial bias has been demonstrated over and over again from everything to symptoms associated with heart attacks and African Americans’ not being taken seriously, resulting in tragic and preventable deaths, to abnormally long waits in emergency rooms and to the undertreatment of pain in cancer patients as these symptoms are not taken as seriously as in other ethnic groups.

Moreover, because of economic disadvantage, there is not equal access to health care for African Americans. In sum total, it's a vicious cycle of neglect that cannot be ignored and must be rectified. We're all collectively responsible for correcting these problems. And there is a special and larger responsibility for the privileged groups and those who are in leadership positions.

The results on African American and affected communities are already devastating as measured in all metrics of public health prior to the pandemic. The pandemic has only accelerated the recognition of these inequities. So the only questions that remain are, number one, can we handle the truth? And, number two, what are we going to do about it?

Which brings me to the final point—we have absolutely no reason to feel that we cannot do anything about the current situation. You are soon to be graduates of the best medical school in the country and probably worldwide. Your voices are not only important but are sorely needed. 

Here's a quote from Michelle Obama, "You should never view your challenges as a disadvantage. Instead, it's important for you to understand that your experience facing and overcoming adversity is actually one of your biggest advantages." Coming from HMS and HSDM, I certainly hope that you believe in your abilities to effect change.

To add perspective, I'm going to end on this. I retell a story of my great-grandfather. It's always inspired me and is the best way that I remember that you shouldn't allow yourself to be cowed into inaction by fear or what can seem to be insurmountable odds.

He grew up in Alabama as a sharecropper when times were even more openly hostile to African Americans. There were Jim Crow laws. And whites could get away with murdering African Americans if they chose.

But he had high hopes for his children, including my grandfather. And he emphasized education. He decided that all of his children would finish high school and possibly attend college at a time when there were vanishingly few opportunities for African Americans to pursue basic education, not to mention college and higher education.

This, of course, was frowned upon by the local white community. And, because of his intelligence and unbeknownst to white buyers, he understood the value of his crops. So one year, when they offered substantially less than what they were worth, my great grandfather let it be known that he knew and demanded a fair price. For this offense, the local townspeople decided that he would be lynched, as was far too often the case in those days.

Now, as good fortune should have it, their plans were overheard and relayed to my great-grandfather. He had an agonizing choice to make—stay at Anniston and potentially be killed or leave without being able to secure the fate of his family. Well, he chose the latter as it is at least a better chance of making a difference for his family. Better to be alive than dead.

So he left by foot in middle of the night, walking 60 miles to Birmingham, followed by a combination of hitchhiking, odd jobs and walking, to get to Cleveland, Ohio, where he resumed working. The impact on the family was real and lasting. None of his kids went to college.

However, the message that he taught was received. Never give up. You use your intelligence and ability to make a difference. So all of his kids carried on with that goal. And his son, my grandfather, owned his own farm and land rather than sharecropping and conveyed the message of education to his children. All of his children finished college with several obtaining advanced degrees.

So, if my great-grandfather could persevere and see his legacy realized in the face of such overwhelming adversity, I, you and we certainly can do the same or perhaps better. As former President Obama recently said, "Injustice like this isn't new. What is new is that so much of your generation has woken up to the fact that the status quo needs fixing; that the old ways of doing things don't work." 

So be encouraged. As HMS, HSDM graduates, you have earned this moment. Now, more than ever, you have the tools that are needed to make change. So, I implore you to be bold and have a vision that isn't clouded by cynicism or fear. You can remake our health care system and remake the world. Thank you.