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Dr. Atul Gawande | 2014 Spring Commencement Address | UNC-Chapel Hill

University of North Carolina at Chapel Hill · 14m · transcribed Jul 2026
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0:03 welcome graduates thank you for including all of us as honores and making us part of the University of the people I even have a cousin Believe It or Not who's graduating this year among you a North Carolina cousin hello Amilia from my wife's side of the family I want to start by telling you a doctor

0:35 story I know this is your graduation I'm going to be talking to you about sick people I'm going to ask you to bear with me and I think you'll see why and anyway this is what you get when you put a doctor between you and your diploma several years ago I was having lunch with a colleague of mine a pediatrician and we got into a conversation about a project he was working on he was trying to create a way

1:03 of measuring the amount of suffering that children with cancer experienced as they went through chemotherapy radiation and other treatments sounds like a great story huh he was thinking if he could design an objective way of measuring the overall well-being of these kids doctors could make improvements that might reduce how much they had to endure the day we talked however he was incredibly

1:33 frustrated he' crafted a set of questions for the kids probing all kinds of aspects of their lives how much pain they had what kind of sports they could play and couldn't play how happy they were and he tested those questions in children treated for cancer and children who were just healthy school kids but the questionnaire didn't seem to work and that's why he was frustrated the ancers weirdly produced almost no

2:03 difference between the two groups here he had six sick kids in wheelchairs oxygen tubing in their noses hair gone at threat of their lives they'd report a bit more nausea and pain than a kid off the school playground but that was about it overall their responses suggested they had almost equal quality of life indeed the sick kids sometimes reported higher quality of life than the school

2:35 kids one question to ask the kids for example can you play basketball and the kids in the wheelchairs the wheelchair kid would say yeah I I can play basketball and the kid off the playground he'd say nah I couldn't play basketball my colleague felt like he had to go back to the drawing board and come up with better questions but but maybe not since we spoke a pile of research

3:06 has emerged showing similar results and it's largely found that the social and emotional quality of life of these kids with cancer is as good as that of healthy children and sometimes better and I've come to think that that puzzling research is telling us something useful about how people all of us flourish in life early earlier this spring St judee's Children's Research Hospital in Memphis published the results from studying 255 children after treatment

3:38 for cancer the average age was just 13 half described their cancer battle as the most traumatic event of their life and the only reason the other half didn't say so was they had actually gone on to face worse one was injured in a driveby shooting that killed their cousin another was was displaced by Hurricane Katrina a third was homeless others suffered the deaths of close family the psychologist had said that

4:10 most of them would likely have post-traumatic stress disorder yet when they were measured later these kids had lower measures of post-traumatic stress than a matched group of children without cancer these researchers found that the experience the kids had had paradoxically strengthened them they developed social connections they had a greater sense of empathy for others that increased emotional strength they found them overall doing

4:41 better not worse than the average child now what was going on here normally if you go through an extended period of suffering pain deprivation violence especially in childhood it damages and weakens you something was different here well it appears the reason these children grew stronger was due to how the world around them LED them to deal with their ordeal

5:11 the hospital had created an environment full of people who cared about them understood them in their difficulties and helped them see beyond their disease to what was worth striving for the children had their family all around and supporting them they were connected with other children in similar and forged bonds of belonging and self-belief these were kids in other words who were helped to find their sense of meaning and purpose as well as find people who could share it with them

5:44 and the combination was so powerful it could carry them through their terrible travails but for many of the healthy kids it ironically remained an untapped source of strength and resilience experiences of terrible adversity can sometimes bring out this kind of flourishing for instance when Neighbors come together after a natural disaster and discover they feel more alive than they

6:14 had but it t doesn't take suffering to find out how potent a feeling of purpose and connection to a community can be and I suspect that you have experienced something very much like that that feeling here in college and discovered how much it can make you grow the aim of college is not complicated it is to learn and try stuff so you can expand as a human being find

6:44 what you care about maybe even figure out who you are and what you're here on this rock for I had by no means figured out who I was or what I was when I graduated from college I would still have some years of wandering before I settled on medicine and writing and family and the other ways I would try to make my difference but it was a special thing to be in a place like this with others who

7:14 were also trying to figure out their spot in the world I suspect you too had those Late Night Dorm conversations that random tutor or Professor who took you under wi and believed in you the encounters with people and ideas you never never imagined I arrived at College to find I was sharing a room with a long-haired born again Christian Humanities major and an Air Force Roc electrical engineer we were on paper totally

7:47 incompatible but before you knew it we joined together to put on a Wednesday 2 a.m. College radio show that was doomed within a month because none of us wanted to get out of bed for it we ran what turned out to be an illegal business from our room supplying the dorm with Twinkie soda and beer for pizza money I joined a campus Amnesty International campaign for political prisoners and at one point nearly traveled to communist Poland on some

8:17 cockamamy scheme we came up with to get illegal writings out from prisoners there only to chicken out and I think you've had your own inadvisable experiments too but because they gave you a sense of direction and connection to others they are a big part of the reason why despite the slogg CL of course work the all nighters the sometimes failures and personal setbacks that's why most of you will

8:49 long remember college and Carolina as among the best years of your lives [Applause] ultimately it turns out we all have an intrinsic need to pursue purposes larger than ourselves purposes worth making sacrifices for people often say find your passion but there's more to it than

9:20 that not all passions are enough just existing for your desires feels empty and insufficient because our desires are are fleeting and insatiable you need a loyalty the only way life is not meaningless is to see yourself as part of something greater a family a community a society and that is the best part of what college has allowed you to

9:50 do college made it easy it gave you an automatic place in the world where you could feel part of something greater the supposedly real world you are joining does not you face certain traps in moving on from here one ugliness I think of the real world is its Readiness to have you define your purpose in terms of an enemy and I'm not talking about Duke I'm talking about those we compete

10:22 with or simply disagree with the purpose for far too many is lest to build something better better than to destroy the other side no tactic is too low as long as you can get away with it more and more of public and private life seems defined by the strength of one's power rather than the strength of one's ideas and it's surprisingly seductive you'll find when you get out there we all find victories easier to come by

10:51 when they're about knocking others down instead of winning them over but we also eventually find these are empty satis factions our other tendency especially when faced with this kind of nakedly adversarial world is to narrow down focus on just your own material needs and success why get involved in more when it so often involves dealing with the antagonistic and the unkind it's so much simpler and less messy to hold

11:22 ourselves back and stay removed in our own private realm the trouble is is you will wake up one day asking yourself why it's so unfulfilling to Simply exist you cannot flourish without a larger purpose and that's Lucky in a way because our society cannot flourish without your reaching for a larger purpose either but what purpose people and their experiences

11:54 again offer a clue and what people find is that they have no more Transcendent experience experience than getting to see and help others find their own purpose to achieve their own potential and your parents and teachers today can tell you a little bit about that incredible feeling the lasting wonder and beauty of places like this is their commitment to building people up rather than beating them down and our great hope is that you carry that ethos with you into the rest

12:25 of your life one thing came to realize after college was that the search for purpose is really a search for a place not an idea it is a search for a location in the world where you want to be part of making better making things better for others in your own small way it could be a classroom where you teach a business where you work a neighborhood where you live the key is that you find yourself

12:54 in a place where where if you stop caring if your greatest concern becomes only you you get out of there you want to put yourself in a place that sus who you are links you to others and gives you something Beyond yourself worth making sacrifices for for me that place happened to be a hospital I liked having the privilege of getting to know people so intimately as a doctor and learning skills they needed

13:26 and could depend on me for I also like the kind of person being in a hospital forced me to be things in a hospital don't always work the people you take care of aren't always Pleasant or certainly happy but everyone has to matter everyone deserves respect and our effort to understand them and help them achieve whatever well-being is possible for them after all isn't that what we want for ourselves if so then that has to be what

13:58 we seek for others whether they're a 90-year-old with Dementia or a 13-year-old with cancer nobody here knows where the place for you will be but graduates we do know there is a place for you in fact there are likely many of them you're going to even create some of those places yourselves and the world is going to benefit from that this is the reason why we're so

14:28 excited for you today and the reason you too can be glad to be moving on from here congratulations to you all thank you for all you're going to do and thank you for making me a tarheel

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