Winning the lottery

Editor’s note: The following column was originally published online in The ASCO Post, July 10, 2019. It is reprinted with permission from The ASCO Post © 2019, Harborside Press.

I was born at the beginning of World War II in a country halfway around the world from the fighting. As a child, I was immune to the carnage. My father was too old to be included, although his elder brother had been killed in World War I. Thousands of families in many countries lost a father, a brother, an uncle, or a friend. Today, I think about what might have been. The one great certainty over which we have no say is where and from what womb we were delivered. Then and now, I could have been born into famine and dead before the age of three.

Why don’t we realize our good fortune? I never recalled being hungry or unable to go to school. I was privileged to get an education with help from a scholarship. I was healthy, got vaccinated, played sports, and had no serious illnesses. I am embarrassed to think how much I took for granted and how little I did to take advantage of the abilities and talents I was given.

Perhaps it is time for those of us who inherited an accident of birth and then an education to contribute to those less fortunate.

False humility is wasted energy. Yesterday is gone, today is here—soon to be gone—and tomorrow is unknown. We take education for granted, and we complain about the cost, but what is the cost of never being able to read or write? But for the accident of birth, I may never have been able to read or write. I was not born deaf or blind, so I did not have the challenge that so many have overcome with grace, charm, courage, and insight, accepting their disability and contributing nonetheless.

Perhaps it is time for those of us who inherited an accident of birth and then an education to contribute to those less fortunate.

I entered a prestigious residency as a foreign graduate with some suspicion but little prejudice. To say there was no discrimination is naive. I was a white male; there were few (if any) women or people of color in surgery. I did not need a parent who was on the faculty, albeit I recognized that would have done me no harm. Today, I go to conferences every day in my own institution and watch food left over and thrown away. In our current climate, I hope it wasn’t paid for by industry.

There is a lot of sadness in the oncologic world, but most of the time we are not the recipient but the observer. How do we balance the gift of giving against the pain and grief we see?

I take for granted that I can go to the opera. A new Broadway play is financially challenging, but that too is available if I am willing to give up something else. Hardly a sacrifice, as I walk by a homeless man; am I supposed to feel guilty that I was given such privilege? No, but I should acknowledge that I started with many advantages. So far, I do not think I wasted those advantages. I worked hard but could have done much more.

There is a lot of sadness in the oncologic world, but most of the time we are not the recipient but the observer. How do we balance the gift of giving against the pain and grief we see?

Time to pay it forward

This commentary should touch a chord for those reading it, but will it? It may be true for you and me, but it is not true for everyone. Perhaps it is time for those of us who inherited an accident of birth and then an education to contribute to those less fortunate. So many places to start. As a favored immigrant, I should be empathetic to a civilized immigration policy. I should not be asked to choose between “open borders” versus “circle the wagons and fight off the marauders.” There is a certain irony in the latter debate, as we now come from within the circle we created to attack a perceived enemy, forgetting how our forebears attacked the initial inhabitants of this land. Dare I even imagine a civilized debate on health care and not be asked to choose between “Medicare for all” versus “no health care for 30 million?”

True humility starts with acknowledging privilege. How can I convince my young trainees to understand their advantages? Do they realize that not just they, but their children and yet unborn grandchildren, will inherit this accident of birth and be surrounded by others of equal talent and privilege? How do I convince them to use their intelligence, their education, and their freedom from want to better other lives? How do I convince patients that I am on their side and will help them confront the tyranny of the bureaucracy in addition to the malevolence of their disease?

We should all be on the same team. And we have the ultimate privilege—we are alive, and we have time; our patients may not. We cannot do much from beyond the grave. A signed open check in a coffin is still a blank check.

We have been given much following this accident of birth. How can we justify winning the lottery when we did not buy our own ticket?

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