Final Exercises 2019: Fontaine Speech

Dorrie K. Fontaine
Commencement Address, May 18, 2019
University of Virginia

Good morning. Mr. Rector, members of the Board of Visitors, President Ryan, Vice Presidents, my fellow deans and faculty, and family, guests and especially the Graduates of the Class of 2019. I am thrilled to be invited to speak with you and share in your celebration today. 

This year, the UVA School of Nursing received a truly momentous award. The very first “Healthy Work Environment Award for a School of Nursing” given by Sigma, the International Nursing Honor Society. Everyone wants to be in a healthy work environment (HWE) where respect for all is what really matters, and the focus is on human flourishing. I have spoken about HWEs in hospital and academic settings for decades and worked on creating one here at UVA so it was quite a moment of recognition. What I find amusing is that while I am introduced as the Sadie Heath Cabaniss Professor (a strong traditional Virginia name), often the one who introduces me, refers to me as the Sadie Heath Cannabis Professor. Easy to do. My new line is that is why we are a Healthy and happy work environment! OK maybe not really.

I am a critical care (ICU) nurse and have been for over 4 decades. My favorite quote about my profession of nursing is from Donna Diers, a former dean at Yale University: Nursing puts us in touch with being human. Nurses are invited into the inner spaces of other people’s existence without even asking, for where there is suffering, loneliness, the tolerable pain of cure, or the solitary pain of permanent change, there is a need for the kind of human service we call nursing.

A signature of our SON and being fully HUMAN is our compassionate care initiative now in its 10th year. The hallmark of this is a focus on being not doing. Doing or learning skills is of course important in preparing a nurse or physician to practice. But increasingly the kind of person you hope to be, courageous in the small moments seems to be most critical today. Being fully present in the moment is not just for future healthcare providers. Businesswomen and men, engineers and architects, lawyers, teachers, policy makers, data scientists all need this focus as well. As we reflect today on leaving, our exit, and arriving, how we hope to Be in the world should be center stage. This is our moral commitment to each other and the world and all citizens with both empathy and compassion.

I wish to speak to you briefly today about Exits, yours and mine. President Ryan mentioned to me in March “that exits are hard” and lent me a book by Sara Lawrence-Lightfoot, titled “Exit: The endings that set you free.” Professor Lawrence-Lightfoot is a McArthur prize winning sociologist and endowed Professor at Harvard University. She is the first African American woman in Harvard’s history to have an endowed professorship named in her honor. Her wisdom in storytelling about exits tells us this: she researched the many faces of “leaving” and found symmetry and wonder in the many narratives. We all leave. We all arrive. Her contention is that we spend much time celebrating new beginnings and perhaps do not appreciate the wisdom found in the exits. Her book characterizes the many ways we exit. Small exits and larger ones like changing jobs/or the end of life. 

The Dalai Lama came to Charlottesville in 2012. A panel was arranged called “Compassion as a Global Remedy for Medicine” and 3 physician colleagues (Pediatric Department Chair/cardiologist/palliative care physician) and me were invited to share some reflections on compassion and listen to his wisdom. I was invited to be on the panel by a friend (Nursing alum) of the Tibetan community because of the School’s work on compassion. Over a thousand people were there from across Virginia and beyond in the beautiful Paramount Theatre.

We had some lively conversation about how we can better care for patients and families with compassion. We were all on stage in lovely armchairs and His Holiness the Dalai Lama and his interpreter were sitting in the middle. He gets up at the end of the hour, and we each stand as he prepares to give us each a white scarf, called a “Khata.” We could see he had them and we were excited to be so close to him. He arises and then he looks to the edge of the big stage---and notices the sign language interpreters at either end of the platform---you know just as we have here. And he takes our Khatas and goes over and gives them to each one---first on one side and then the other…these women had tears in their eyes. Why did they have these tears? Because they thought they were invisible to him, the leader of the Tibetan community.

We worried for a moment that he gave away our Khatas! Will there be enough for us? But no---there were plenty for us. He has these giant eyes behind big glasses and is always smiling. I learned that he practices what he says: paying attention! I learned in a new way what it means to truly notice. And of being kind, in fact he says “my religion is kindness.”

The lesson for me and you, our graduates: What are we failing to notice? Who may need our attention? Who are we taking for granted? With our newfound skills and education and wisdom from this University surely there are things to notice, large and small in new ways. Injustice, someone left out, a family member in distress, an environmental crisis, an unethical/unprofessional action? Noticing is the first step. This is helped along by a focused awareness of yourself and your surroundings. This what we teach in the SON, SOM and increasingly in other schools along with my colleagues in the Contemplative Science Center. Called mindfulness and training the brain to “NOTICE.” Recently I discovered that a few years ago a faculty member was tutoring a housekeeper in my School in Chemistry on her own time. She was trying to pass a course at the community college to gain entrance into nursing. Someone noticed. 

A year ago, a nursing PhD student, Tori Tucker along with our Nursing History Center Director and our associate dean for diversity noticed that in the mid 1950s and for 9 more years, African American women who wished to become nurses were excluded from attending UVA School of Nursing during segregation. They instead were taught at the Jackson P. Burley High School in a Licensed Practical Nurse (LPN) program. The head of our School partnered with Burley HS to establish the program. Tori and colleagues planned the “Hidden Nurses” project and found 34 of these nurses, many now in their 80s and 90s. With a grant from the Jefferson Trust, last month 25 came back to the SON auditorium for a celebration and to march across the stage and receive a certificate of recognition and an apology for their exclusion. President Ryan says we should be great and good. He enabled us to induct all these nurses into the Alumni Association in front of hundreds of their tearful and joyful families. Someone noticed. And we stood up to this injustice.

Several years ago, a fellow nurse in the emergency department at UVA Medical Center, Jonathan Bartels, was struck by the suffering of his colleagues, other nurses and physicians after traumatic or unexpected deaths. It happens often in the nation’s over 6000 hospitals. When health care providers do everything they can to save a life…and they cannot, it evokes feelings of anger, sadness and sometimes even depression. Jonathan saw this firsthand as an ED nurse and as part of our Compassionate Care initiative, he vowed to do something.

Consider a 7-year-old girl hit by a car and brought in by the rescue squad to a busy ED. The trauma team does everything they can to save the girl, and they cannot. The team rips off their gloves at the end of the resuscitation attempt, walks away from the room and into the hallway and what is there? More patients to see who need help. No time. Need to shake it off. So, Jonathan developed The Pause. A compassionate intervention for his colleagues.

The team (docs, nurses, respiratory therapists, a chaplain) are invited to just stand in silence around the stretcher or bedside for only 45 seconds. And honor the life of this patient, who no one knew, but was someone’s daughter, sister, loved one. And honor the good work of the team and each other. Not religious but if you wish to say a silent “Hail Mary” that is fine! We have even had family members be there. Imagine how meaningful to them? 

It is catching on not just at UVA but around the nation and the world in over 100 hospitals and 4 continents. It provides a sense of healing and closure for this end of life EXIT, the final exit.

Why is this important? The brief ritual values the life of our patients/their families/ and affirms the good work that each team member tried to do. Jonathan’s work has gone viral.

So, Notice and Pause.

Pausing is important today because we are all rushing all the time. We think we can multitask but the neuroscience researchers say no as it hurts the brain.  Pico Iyer notes in his Art of Stillness, that we now have the urgency of slowing down. Pausing can lead to wise and thoughtful action, even new ways of Being. Examples: What might it mean to pause before you say something unkind? Before you proceed instinctively and forget to notice and listen to a new voice, maybe a counter to your preconceived ideas? 

In 2002, I was teaching at Georgetown University and was recruited to the University of California, San Francisco (UCSF). I had an 11-year-old son and my new dean said “perfect time to move “(she meant before he starts high school). Sumner, my son entered 7th grade in San Francisco and every day my husband and I heard “I had a good life, why did you move me?” Painful. But by 8th grade he had found Haight Ashbury, bought an electric guitar and joined a little rock band. Life was good. By senior year in high school at St Ignatius, he truly loved SF. In March of his senior year, his favorite teacher, Mr. Castro told the class one day: “OK here are the 3 C’s for going to college, first, go to CLASS, second, don’t do COCAINE, and 3rd Use a CONDOM.” Well. The students loved this and told their parents what Mr. Castro said. The parents were a little whigged out. Not the moms who were nurses as they thought this was pretty good advice. But again, a Catholic School so lots of attention. (Mr. Castro told me recently he did get in trouble and is now an administrator, so there).

I have turned his 3 C’s into my own as I end here.

I offer these 3 C’s for a possible wise exit strategy from UVA. 

CONSIDER a grateful stance: thanking others. Notice who may need our appreciation or who could be overlooked who needs our thanks. Every night consider three things you are grateful for, even simple ones like a great conversation, someone told you that you did a good job. Write them down. I tell our nurses to do this on the way home from clinical as so easy to recount all you did NOT do. 

CULTIVATE compassion and kindness toward others. George Saunders in a Convocation speech at Syracuse University years ago spoke of regrets in his life. Number one was failures of kindness. (mentions a story of his 3rd grade where a little girl was bullied and he stood by and did nothing every day until she left the school). He talks of high kindness and low kindness periods, so increase the highs he says. Remember the stories of the Dalai Lama and the Pause and know that compassionate action starts with noticing and then pausing for wise action.

CELEBRATE the wonder in exiting with style and grace. Be courageous despite your fears and anxieties. I know you have them. I do, too. But you have survived well and likely thrived. 

Nursing puts us in touch with being human. I was lucky enough to have chosen a profession 4 decades ago that put me in touch with being fully human. Whatever your degree today I wish the same for you. This approach in considering BEING not just the DOING will help create real meaning in your life.  All your faculty and administrators and staff at UVA as well as your families here wish this for you. 

As I reflect on my own “exit” I am reminding myself to notice, pause and act with wisdom and grace as best I can.  I join you in this exit today as a fellow traveler. We are all fellow travelers. Wishing you a memorable and graceful exit and wonderful arrival.