Last night I was asked to give an address at the National Honor Society of from my old high school. These are my comments.

There’s a saying in medicine: “Every system is perfectly designed to achieve the results it achieves.” For example, if half the patients admitted to a certain hospital die, it’s because that hospital is set up perfectly to have a fifty percent mortality rate in the patient population it serves. Or there’s a murderer on the loose, if it’s an episode of Grey’s Anatomy. One of those. But where I’m going with this—the system stuff, not the serial killer side-track—is that what you’re about to hear applies to my history and mine alone. My interaction with the world so far has been perfectly designed to get me to this point. Your results may vary.

Step one: Live. I know that some of you are certain that your life will really start in May, after you graduate from Skyline. I know some student in college right now thinks her life will start as soon as she graduates from college. I know medical students who are positive that once they begin their orthopedic residencies, their lives will officially be underway. I know that somewhere there is an endocrinology fellow that thinks his life really starts when he opens his practice this coming July. And I definitely know people my age who are counting the days til their kids are off to college, planning on turning their oldest kid’s room into a gym or a movie theater. All of them are wrong.

You heard in my intro that I went to school for a very, very long time. Let me put it in perspective. When I graduated from Skyline after thirteen years in this building, I wasn’t quite halfway done with my education. I was eighteen when I got my diploma in May of 1994. When I walked out of the University of North Carolina for the last time in June of 2008 I was almost 33. I had never made more than minimum wage. But here’s the thing: I would have turned 33 whether I’d gone to medical school or not. Someday you will turn 40, if you’re lucky. You can spend the time between now and then talking about how great your life is going to be once it starts, or you can accept that you are living your life right now.

Out of my med school class of ~175 people, I know of two who died after completing their training: Shelley was an oncologist who died in 2015 at age 40 from a rare cancer. She was kind and patient. Weesam was my classmate at K-State and at KU Med. He was also the most encyclopedic source of knowledge about K-State football I’ve ever met. He was a vascular surgeon at Stanford when he died of leukemia at age 34, only a year after completing his training. Shelley and Weesam lived noble, meaningful lives that so happened to have been mostly taken up by their training. There is nothing wrong with that. They both lived. They didn’t wait to get a diploma or to walk across a stage or for the passing of some arbitrary date to declare their lives started. School, if that’s the direction you decide to continue, is life. An entry-level job is living. Some of my fondest memories--and it goes without saying, some of my saddest--are from high school, college, medical school, residency, and fellowship. The years since then are the whipped cream on top.

Step two: When someone offers to help you, accept. As a student at Skyline I was surrounded by people who showered me with kindness and expected nothing in return. I turned down so many offers from people who wanted to help me. I had no interest in Scholars Bowl. I turned my nose up at help with test prep. I thought I was the smartest person in the room most of the time, in spite of overwhelming evidence to the contrary. I wasn’t in National Honor Society because my grades weren’t good enough. I wasn’t much better in college. I don’t think many doctors advertise the fact, but many of us have to apply to medical school more than once to get in. I was one of those people. When I was a junior at K-State, I applied to a new program at KU called “Scholars in Primary Care.” It was an early-acceptance program for a limited number of students who agreed to practice primary care (think Family Medicine, Pediatrics, and whatnot) in an underserved area, like a small town or the inner city. My interview was in Garden City, and to say it was a disaster would be an understatement. I sat at the end of a long conference table with six or eight people seated around me. They peppered me with questions. They were local family docs, a professor from the junior college, an assistant dean of the medical school, and some others. I think one of them may have been a preacher. I’m not sure. At one point, they asked me about my future legacy, and I told a rambling story that not only missed the point of the question, but managed to make fun of golfers. To a room full of doctors! I did not get accepted to medical school that day. It could’ve been the unabomber haircut. I don’t know. The bowl cut in my senior picture out front was not the low point of my hairstyle story. At least I never had my brother’s perm. But I digress. It was not my proudest moment. I was not the smartest person in that room. But because this was an early-acceptance program I got a second shot later in the year. I was offered interview preparation help by the pre-med program at K-State, and I took it. In the fall I got another interview in Kansas City, and I managed, I think, not to offend any of my interviewers. One of them asked me what I would think if a student with grades and scores worse than mine, but who had a certain background that the school was looking for, got in ahead of me. This was a way harder question than anything about legacy or golf. I answered that if the school was looking for people to work in certain communities or do certain jobs, I knew that I wasn’t a good fit for all of them.

A couple weeks later I got a letter of acceptance. I was proud. My mom and dad were proud. Here’s what I didn’t know at the time: I was very likely the beneficiary of a kind of affirmative action for farm kids. My application was fine. I had a decent GPA, and I was on my way to graduating with honors, and I got a decent score on the MCAT, the medical school entrance exam. But now, after having served several years on the Admissions committee at KU and interviewing maybe a hundred applicants, I know that dozens of students with identical resumes and scores as mine get turned down every year. I sincerely believe that the reason I was admitted over kids like them was that I had an interesting background that was under-represented in the medical school. When I was in college in Manhattan, there were farm kids everywhere. Everywhere. Aggieville. “Ag.” You know what I’m saying? When I was at KU, there were maybe ten of us, including my wife and I. Does that matter? It depends on what perspective you take. If I look at the problem from the point of view of a wealthy doctor’s kid from Sedgwick or Johnson county who missed out on med school in spite of pretty good scores, it looks like a miscarriage of justice. My own kids are the wealthy children of doctors in Sedgwick county, and if they’re in that situation in the future, I suspect I’ll be annoyed. But from my point of view, I accepted the help I was given, and I’ve gone on to be a fairly competent physician who pays taxes and stays out of trouble. No tragedy was suffered by anyone. Side note: I still hate golf.

Step three: Know when you’re into something that doesn’t fit you before you get stuck. When I was a Senior at Skyline, once I knew where I’d be going to college, my dad asked me if I wanted to rush his old fraternity. I knew nothing about fraternities, but I was game. I went to Manhattan a couple times, and to Wichita once to a greyhound race, and it was okay. It felt weird, like I was trying to be somebody I wasn’t, but I met a couple nice guys. I figured that since I was a “legacy”--that’s what they call the descendants of fraternity or sorority members--I would get in and make friends, and my dad and I would have something to talk about. What I hadn’t counted on was this: They. Hated. Me. Well, “hate” is maybe too strong a word. I don’t think any of them wanted bad things to happen to me. They just didn’t want me in their fraternity house. They wanted to paddle someone else. So I had to make an embarrassing, last-ditch, emergency effort to move into the dorm. I was placed on an “Ag” floor (this was K-State, after all). I was a little bit bitter about that part; remember how I was the smartest guy in the room? I wanted nothing to do with farming, and I thought my experience might be narrower somehow that way. But I made friends on that ag floor that I keep today. One of them lives next door to me, on purpose.

When I went to college I was a journalism major. I liked writing, I love the sound of my own voice, as you’ve probably figured out, and I still consider journalism a very important pursuit, even if it is kind of a hard way to make a living. But toward the end of my freshman year, I was in a class where the professor was teaching techniques about sourcing and finding stories. He kept saying, over and over, how aggressive good journalists need to be. I couldn’t imagine myself being that person. I’ve been on the business end of a couple journalists in my career, and I wouldn’t switch places with them. I don’t like confrontation. I sweat when I’m nervous. I’m sweating right now. One day after that class I was walking through a random building looking at posters (we didn’t have smartphones then), and I saw an advertisement for the school of Human Nutrition. I knocked on the door of the department chair (like a good little aggressive journalist) and asked her about the degree options. That same day I went to the registrar’s office and changed my major. And that fraternity? My sophomore year my dorm hall put together a basketball team. Our starting five included a starting K-State running back at guard and a future second-round NFL draft pick at defensive end playing forward. We played that fraternity in the all-university playoffs and crushed them.

Step four: Try to take a generous interpretation of people. When I was an intern in Spokane, Washington I admitted a twenty-something guy to the hospital with a gruesome arm injury and a gunshot wound to the calf. He’d been running from the police. First they tased him. Then they shot him in the leg. When those things had failed to slow him down (meth is a very interesting drug), they sicced a dog on him that tore the skin from his upper arm.

That night, as I was busy with a thousand other things, as medical interns tend to be, I kept getting paged with requests for pain medication. This is a tough situation. The guy had plenty of reasons to be in pain, and I wanted to treat his pain, but he was also a methamphetamine addict in the midst of withdrawal, and I didn’t want to give him so much medication that he might be in danger. Or more importantly for my ego, I didn’t want to be his one-stop shop for narcotics in the hospital. So after the fourth or fifth call I went to see him.

Understand that sleep deprivation is a little like having kids. You might say you want five kids. But you don’t even have one yet. So don’t tell me you want five until you have four. And you might tell me you operate just fine on a couple hours of sleep a night (free medical advice: you don’t), but until you’ve experienced 36 hours in-house call, don’t pretend to know what kind of decision making you’ll be prepared to do once that happens. Anyway: I went to his room and asked what else I could do for him. I did not ask nicely. He proceeded to tell me what a substandard doctor I was, and how maybe I should have chosen a different career. What happened next is a little fuzzy, with the rage and the sleep deprivation and whatnot, but he and I ended up kind of wrestling around the room. Me in green scrubs, grappling with a recently tased patient with an open arm wound and a fresh gunshot wound who also happened to be in methamphetamine withdrawal and likely intoxicated on narcotics. You’ve never seen that on Gray’s Anatomy. Or maybe you have. Either way it was ridiculous. I knew it was ridiculous as it was happening, but I was reminded of that fact the next day in a tense meeting with the hospital administrator. Lesson learned. What should I have done differently? I should have taken a more generous interpretation of his actions. I should have recognized that however bad my night had been, his had been way, way worse.

Step five: say yes to things. Real, physical things. You’re going to hear a lot of people in the next few years tell you how important it is to “network.” As if you can go to a cocktail party and make magical connections with people that get you admitted to law school or employed somewhere. Well, maybe you can, but I’m the guy who couldn’t even get into his dad’s fraternity. So you can imagine how well I handle “networking” with a bunch of strangers. But when I was a freshman on the ag dorm floor in college, a guy I didn’t know that well asked me if I wanted to help decorate a homecoming float. Decorating a homecoming float was maybe in my bottom ten things I wanted to do that day, somewhere between becoming a Celine Dion completist and having a boil lanced. But I did it. And it was only a couple hours of work for a couple of days. Eventually I was a groomsman in that guy’s wedding, and now he owns a company with over two hundred employees.

Later in college, because I’d changed my major from journalism to Human Nutrition, I met a girl. She asked me if I wanted to join a band of students that went around teaching groups like fraternities and sororities how to keep from getting sexually transmitted diseases. Again: not the way I had envisioned spending most nights in college. But I did it. And you know what? Teaching a bunch of sorority girls how not to get an STD was about the most fun I’ve ever had. Then the girl told me she was going to med school. And because I’d changed my major to Human Nutrition (and thus met the girl) I’d already taken all the prerequisites for medical school. My point here is that if you do things with people you may make a friend. Or better, you may eventually meet a group of people trying to make the world better, who speak a common language, who have a set of shared rituals, and whose cause you want to join. Like I said, I took the MCAT and I eventually got in to med school. Then I married the girl. So maybe I’m giving you a best-case scenario. But the rule applies even to my current life. A few weeks ago, Melissa Jacobs asked me to come speak to Skyline’s National Honor Society. And here’s what I got out of it: instead of a night at home watching Office reruns, I got to spend the night with a group of really interesting people who share a love of baby blue, who have a set of shared rituals, and who want to make the world a better place. All because I said yes.