White Coat Ceremony Alabama College of Osteopathic Medicine Class of 2022. August 7, 2020.

Distinguished physicians, incoming physicians of class 2022, proud family and guests.

A few weeks ago, I asked Dr. Davenport to help me get some background information on all of you young physicians-your undergrad studies, parents, siblings, hometowns, goals in life, hobbies outside Med school. I finally got the last one last week. After reading all of them, I thought I would take a moment to tell you about myself and make you all realize that there are some vague similarities about our journeys.

I am child number 3 of 6. Growing up in a small poor fishing village in the Philippines, all 5 siblings of mine and I were bombarded on the importance of education and hard work. My father is a retired deep sea fisherman and he groomed my two older brothers to prepare for a hard life as fishermen. When it was time for him to work on me, I had the audacity to get sea sick and conveniently puked my brains out. My mother knew then that a fisherman’s life was not for me. She repeatedly drilled into my brain that I needed to do well in school and become a doctor as a fisherman holding a brown barf bag is not a pleasant sight.

I was accepted into one of the prestigious medical schools in the Philippines and graduated there in 1993. Having graduated there was both amazing and brutal. Amazing in the level of educational and clinical experience that one will have in spite of and because of the sheer poverty. One relies mostly on thorough history and extensive and complete physical examination without much reliance on laboratory and radiographic tests. The majority of patients are unable to afford fancy ancillary testings as they have to pay out of pocket because most people are uninsured. Brutal in the level of constant and painful reminders of the stark divide between the poor and the rich. Before coming here in the US, I did my post graduate internship in the state-owned hospital, the largest training hospital in the Philippines with 1900 beds. This hospital caters to the poorest of the poor and delivers care to vast array of diseases. To this day, I attribute my clinical acumen to my experience in the islands.

I arrived in New Jersey in 1996 and stayed there until 2001 after finishing up my ID fellowship. I still occasionally call and email my two mentors during my fellowship; one just retired after a long successful career in academia including being the Chief of ID Division at Rutgers/Robert Wood Johnson Medical School and the other one, the current Chief. We try to see each other once a year during IDWeek. Which brings me to this event today. There is a lot of symbolism attributed to the white coat-it embodies integrity, wisdom, authority and professionalism. Up to this day, I am still in awe of those two aforementioned professors whom I respect for their clinical acumen and leadership. I would really be in ID heaven if I become even half of what they are in the ID universe.

As you start your medical journey, you will meet physicians with utmost integrity, insatiable wisdom, unmistakable authority and unwavering professionalism. Learn from them. Ask them questions. Get them to think. Challenge them.

We moved to Anniston in 2005 and we have since called this community home. My ID practice here in my adoptive town of Anniston continues to be academically challenging and physically demanding. In addition to balancing work and family life, I have also managed to intersperse training for Ironman triathlon races that I typically do 2-3 times a year. Yes, I am an IronMan. One cannot expect to finish a 2.4 mile swim, a 112 mile bike, and a 26.2 mile run without some sort of training months or even years before the actual race. I have developed some kind of routine. Train (either swim or bike or run or combination thereof) most days. Go to work. Repeat. I had my own steady and comfortable rhythm, or so I thought.

And then kaboom, the pandemic happened. Unless you have been living under a rock the past half year, you know that this viral infection has taken a hold of the entire globe and has managed to throw everyone’s life in some sort of tail spin-including yours truly. ID as a specialty is in the forefront of research, diagnostics, treatment, and public policy and it has been a tumultuous several months. Outside of the occasional deaths, it has been rewarding. Since the start of the pandemic, I have seen a multitude and vast array of pathology not necessarily related to the pulmonary system. It has been fascinating to be able to diagnose extrapulmonary manifestations of COVID19. A middle aged patient who presented with no pulmonary symptoms and minimal GI complaints developed SSR or spontaneous splenic rupture which led to his demise. I could find only 1 case of SSR and COVID19 in the literature and it was from Iran. I would need a volunteer from you here to write that up. A case of COVID19 pancreatitis also showed up few weeks ago. I was able to find 15 reported cases in the literature-9 from Wuhan, China; 5 from Liverpool, UK; 1 from Scranton, PA. Again, I would need a volunteer to write that up. After examining close to 2,000 toes, I was able to finally see one COVID toe a few days ago. I might need to write that up.

Not only is it academically challenging but it is no doubt physically taxing and emotionally draining. Many a night was spent in the COVID wards coordinating care with several physicians and health care workers. Many a phone call was made to family members asking for consent for Remdesivir, Tocilizumab, or even Ivermectin. Many a run or even bike ride was cut short because of phone calls from the ward. There were also a few phone calls made telling family members that their loved one just passed away and regrettably we will not be able to allow them to come to the hospital to personally say goodbye because of hospital-wide limitation of visitation. These and attending meetings with hospital leadership in trying to formulate plans for infection control and prevention, diagnostics, treatment regimens, and clinical trials. These and getting on conference calls with the county officials on public health policy. Those and trying to answer questions from the lay media. These and that and the other and more. Much more. The list seems endless.

Other than my family here, my triathlon trainings help me keep my sanity. Walking our Australian blue heeler, Diego, helps clear my mind as well.

So, why am I boring you with story of my life? And why during your white coat ceremony? Plain and simply because Medicine and its most visible and easily recognizable symbol, the white coat, are intertwined. You don your white coat and all of a sudden you look dignified, you look wise, you look passionate, and you look caring. Our job as healthcare workers in white coats is not only to look dignified but to be dignified, not only to look wise but to be the beacon of wisdom, not only to look passionate but to be the epitome of passion to heal and help, not only to appear caring but to be genuinely caring.

Welcome to RMC world. Some say it stands for Raul Magadia Center. These pandemic days make it seem all the more so. I expect to see all of you equally in the wards and in the hospital library. Let me finish off by quoting Sir William Osler: “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”.

I may have missed my calling as a fisherman, but I am sailing in the ocean of knowledge and I vow to continue to uphold with dignity the profession that has given me the honor and pleasure of being your guest speaker today. Congratulations, class 2022.
Thank you and have a good night.

4 thoughts on “White Coat Ceremony Alabama College of Osteopathic Medicine Class of 2022. August 7, 2020.

  1. We are truly blessed to have you in our medical family! Many lives have been saved by you , the knowledge, fight to heal, the tireless hours you have given our vulnerable, do not go unnoticed. God placed you here Raul, for reasons untold. He carries you through even when you feel defeated! Your Iron Man successes are just a mere morsel of the Man of God and Doctor most approved, you have proven to be. Thank you for choosing our community to serve and to save! Love you in Christ! Mimi Free

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