# If I Could Speak to the Medical Student I Was in Amritsar *A letter to the student in Amritsar, who is entitled to object* Kanwar Partap Singh Gill, MD · November 5, 2026 · Looking Back, Looking Forward Every letter needs an address. The Punjabi word for the one written across an envelope is ਸਿਰਨਾਵਾਂ, *sirnāvāṅ*, and the address on this letter is one no post office will accept: a new medical college in Amritsar, at the end of the 1990s, and a young man somewhere inside it with a textbook open. The letter cannot reach him. Its only certain reader is the man writing it; anyone else who reads it will be a stranger who happened on it through a website. I want to say so at the start, because that fact governs everything the letter can honestly contain. You and your medical school began in the same year. Sri Guru Ram Das Institute of Medical Sciences and Research was started in 1997, on the Amritsar–Mehta Road, with its clinical teaching at the Sri Guru Ram Das Charitable Hospital at Vallah, and by the institute's own account its first batch of MBBS students passed out in December 2002. In Indian English that means they graduated. An American reader, I should warn you, will picture something else entirely: a hall of young doctors fainting in unison. You will have years to learn which English you are speaking, and to whom. An institution in its first years is unfinished in much the way a student is. It has a name to live up to and no record yet to point to. Yours carries the name of Guru Ram Das, the fourth Guru, who founded the city you are studying in, which is a great deal of name for a new college and a new student to carry at once. Neither of you yet has a past that anyone could look up. That is the first unfairness of this exchange, and the largest. I know which of your uncertainties became manageable and which choices later acquired a respectable place in a biography. You know none of it. You have the work in front of you, the next examination, and a future that has not yet agreed to become a story. A man who has already passed an examination can speak lightly about marks. A man whose next opportunity depends on passing it cannot afford the same lightness. Whatever I say from here has to keep that difference in view, or it is not advice at all, only boasting with the dates removed. So let me set out the terms. I will not tell you what you are thinking; you are entitled to your own inner life, and I would rather not enlist you, after the fact, in agreeing with me. I will not give you the names of the places that come later, because a map drawn afterward makes uncertain steps look planned, and you are not living on a map. Where I imagine you objecting, the objection is mine, invented now and offered as invention. And you may answer back. A letter to a younger self that does not let him reply is a monologue with a stamp on it. ## The Same Ward The oldest objection to this kind of letter was raised, and answered, nearly two thousand years ago. Seneca, writing to his younger friend Lucilius in the last years of his life, opens his twenty-seventh letter by putting the objection into Lucilius's mouth. In Richard Gummere's translation it runs: "What," say you, "are you giving me advice? Indeed, have you already advised yourself, already corrected your own faults?" It is exactly the question you are entitled to put to me. What qualifies the man writing this to correct anyone? Seneca's answer is the most honest thing I know in the literature of advice. He is not so shameless, he says, as to undertake to cure his fellow men while he is ill himself. He is discussing troubles that concern them both and sharing the remedy, "just as if we were lying ill in the same hospital." The Romans had infirmaries for soldiers and for the enslaved, and Seneca reaches for one to describe the only footing on which an adviser can stand. He does not speak from the doctor's chair. He speaks from the next bed. Then he goes further, and says the thing a letter like mine would usually prefer to hide. Listen to me, he tells Lucilius, as you would if I were talking to myself; I am having it out with myself, "merely making use of you as my pretext." I find that sentence almost unbearably accurate. A letter to one's younger self is a conversation with oneself conducted through a pretext, and the pretext in this case is you. The man most in need of whatever is said here is the one holding the pen. There is no shame in admitting that, and a good deal of protection. It keeps the letter from pretending that its writer has completed the course he is recommending. But Seneca's confession carries an obligation he does not quite meet. Lucilius's own letters do not survive. He asks, protests, doubts and occasionally pleases his teacher, and all of it reaches us in Seneca's paraphrase, as the occasion for the next paragraph. If I am going to use you as my pretext, the least I owe you is a voice that is not merely a cue for mine. You will have to object in places where I would rather you agreed, and the objections will have to be good enough to change what I say. The image of the ward has a particular rightness for a physician. Medicine is a long apprenticeship in which everyone is at some stage of learning, and the senior people are simply further along in a course that has no final examination. Seniority in such a ward is not the same thing as health. The bed nearer the window is still a bed. ## Only One Side of the Correspondence There is a more famous book of letters to a young writer, and it shows the same silence at greater length, and what the silence does. In the autumn of 1902 a nineteen-year-old officer cadet at the Theresian Military Academy in Wiener Neustadt, Franz Xaver Kappus, sent some poems to Rainer Maria Rilke and asked what he thought of them. He had learned that Rilke, years before, had been a pupil at the academy's lower school at Sankt Pölten and had not been able to bear the military life. Rilke answered, and over the next five years wrote him ten letters. Kappus published them in 1929, three years after Rilke's death, as *Briefe an einen jungen Dichter*, and in English they became *Letters to a Young Poet*, one of the most loved books of advice in modern literature. For ninety years readers had only Rilke's half. Kappus's own letters were found in the Rilke family archive in 2017 and published in German in 2019. Until then the young poet existed chiefly as the shape of the answers he received, a hollow in the text where a person had been. Rilke's first letter, sent from Paris in February 1903, declines the request. He will not judge the poems. Nobody can advise or help you, he writes, nobody; there is only one way, and it is to go into yourself, *Gehen Sie in sich*. The fourth, written that July from Worpswede, near Bremen, contains the passage people copy into notebooks: be patient toward all that is unresolved in your heart and try *die Fragen selbst liebzuhaben*, to love the questions themselves; *Leben Sie jetzt die Fragen*, live the questions now, and perhaps one distant day you will live, without noticing, into the answer. The renderings are mine. I love that passage and distrust what it can be used to do. Read from Kappus's side, the correspondence looks different. He had asked two concrete questions: whether his poems were any good, and whether he should be a soldier or a poet. In place of answers he received an education in a sensibility. The education was real and generous. It was also, in a sense, a refusal, and the beauty of the refusal made it almost impossible to resent. Kappus stayed in the army and served as an officer for some fifteen years, and later worked as a journalist and wrote novels and stories. He did not become the poet. It would be absurd to blame Rilke for that, and equally absurd to call the letters a failure. They teach something about the genre all the same. An older correspondent can turn the withholding of an answer into wisdom, and the more beautifully he does it, the harder it is for the younger one to say that he still needs to know. Rilke, for his part, was twenty-seven when he wrote the first letter. His authority did not come from age. It came from having chosen, at some cost, the life the cadet was only contemplating. Mine, such as it is, comes from nothing more distinguished than having gone on living. So here is your first objection, and it is the one Kappus might have made. *You know what happens, and you are keeping it from me. What use is a letter from the future that leaves out the future?* The honest answer is that the parts I could tell you are the parts you could not use. Knowing where you would be standing ten years on would not help you learn the brachial plexus by the end of the week. It might make you careless about the things that seem to lead nowhere, and some of those turn out to be the ones worth keeping. A letter that hands its reader the plot does not make him wiser. It only makes him impatient for the plot. That answer is true, and it is also a little too convenient, because it sounds like Rilke's refusal in plainer clothes. So I will make you a promise in return. Where you have a concrete question that I can answer without telling you the story of your life, I will answer it. Most of those questions turn out to be about method: how to learn, how to answer, how to listen. Those I can speak to, because the answers do not depend on the plot. ## Facts and Their Reasons Learn the material. I say this first because a certain kind of letter to a younger self dismisses examinations as a distraction from real wisdom, and I think that is a vanity affordable only to someone who has already passed them. The person who will one day need you is not helped by your contempt for facts. Some of what you learn will be overturned, and you may as well know it now. In June of the year you finish, a group of hepatologists in Paris led by Thierry Poynard will publish a study in the *Annals of Internal Medicine* with a title that sounds like a joke and is not one: "Truth survival in clinical research: an evidence-based requiem?" They gathered 474 conclusions from articles on cirrhosis and hepatitis published between 1945 and 1999 and judged, as of 2000, which still held. Sixty percent were still considered true. Nineteen percent were considered obsolete, and twenty-one percent false. They put the half-life of truth in their field at forty-five years. That number needs handling with care, because it is easily turned into a slogan about the whole of medicine. It describes one specialty's literature over one half-century, judged by one method. It is not a law that every fact you learn will expire on schedule. But the study contained a second finding that interests me more than the first, and that its authors had not expected. They had supposed that conclusions drawn from better-designed studies would last longer. They did not, or not clearly. Conclusions from studies of high methodological quality survived no better than those from studies of low quality, and the conclusions of meta-analyses fared worse over twenty years than those of individual studies. If that holds even approximately, it changes the reason for learning why a thing is believed. You cannot sort the durable facts from the doomed ones in advance by inspecting their pedigree. The point of knowing the reasons is something else. When a fact falls, as some of yours will, the person who learned its reasons can follow the argument that knocked it down. He can see what was actually discovered, what it overturns and what it leaves standing. The person who learned the fact alone has two choices, both bad: to cling to it, or to conclude that nothing he was taught can be trusted. A fact learned together with its reasons can be revised. A fact learned alone can only be defended or abandoned. There is a practical form of this habit, and it is less grand than it sounds. Every statement in your textbooks has a date attached to it that the textbook does not print. Somebody observed something, in some group of people, at some time, by some method, and the sentence you are learning is the residue of that work with the circumstances washed off. Learning the reasons means, in part, learning to see the washed-off date: to ask, of a confident sentence, who was studied, how many, compared with what, and how long ago. You will not always be able to answer. The asking is the habit. It turns a sentence in a book back into what it was before it was printed, which is a report from particular people about particular patients, and reports can be superseded without anyone having lied. Seneca, in the same twenty-seventh letter, tells a story that will mean more to me than it can yet mean to you. There was a rich man of his day named Calvisius Sabinus who wished to appear learned and could not remember the names of Ulysses, Achilles or Priam. So he bought learning. He paid fabulous prices for slaves, one to know Homer by heart and another to know Hesiod, with a slave for each of the nine lyric poets, and kept them at the foot of his couch at dinner to feed him verses, which he would then break down in the middle of quoting. A hanger-on remarked that he might have bought as many bookcases for less. But Sabinus, in Gummere's translation, "held to the opinion that what any member of his household knew, he himself knew also." I live, in one sense, in Sabinus's household. The answer to almost any factual question you are now memorizing can be retrieved in my time in a few seconds, by almost anyone, from a device carried in a pocket. It would be easy, and it would sound modern, to tell you not to bother. That would be Sabinus's error dressed as progress. What you carry in your own head is what lets you notice that you do not know something, recognize that an answer you have been handed is wrong, and ask the next question at a bedside where there is no time to consult anything. Sabinus's slaves could recite Homer. They could not make him a reader of it. Seneca's verdict on the whole affair is brief: no one can borrow or buy a sound mind. So read the heavy books. Learn the anatomy until you can see it with your eyes closed, and the pharmacology until you can explain it to someone who is frightened. Then, as you learn each thing, ask what it rests on. The second habit is the one that will still be useful when a good part of the first has been revised. ## Across the Examination Table Your second objection I can hear just as clearly. *You keep praising uncertainty. In a viva, uncertainty scores nothing.* You are right, and I will not pretend otherwise. The viva voce, the oral examination that sits beside the written papers in your course, rewards a candidate who can retrieve the answer under pressure and deliver it in order. An examiner asks and wants an answer. The hesitation that might be wisdom at a bedside is, across an examination table, a mark lost. Train for the answer. I would not want to caricature examiners in saying so. Some of the best of them probe precisely in order to find the edge of a candidate's knowledge, and a candidate who can say clearly where that edge lies may do better than one who bluffs past it. And I would not want to flatter the experienced, either. Not every senior doctor handles uncertainty well; some handle it by never admitting it. The examination is not the enemy of clinical judgment. It trains one half of it, the half that commits. What I would add is that the clean answer and the honest pause are two separate skills, and you will need both, in that order. The first is what earns you the right to be trusted with the second. Later you will find that one of the most useful things a doctor can say on a difficult afternoon is some version of *I am not sure yet; this is how we will find out*. It works only when it comes from someone who plainly knows a great deal. From someone who knows little it is merely an admission. Certainty and steadiness are different qualities, and the second is the one worth cultivating. You can be steady while you are still learning. Practice will ask you to become reliable. It will not ask you to be complete, and you should be wary of anyone, yourself included, who pretends to be. The viva teaches something else as well, which is easily missed because it is learned in the stomach rather than the head. Anyone who sits one learns, better than he will ever learn it again, what it is to be examined by someone who holds power over his future. Candidates develop reflexes: to say what the examiner seems to want, to nod at a question they have not quite understood in the hope that it will move on, to agree with a correction they do not follow because disagreement feels more dangerous than error. Keep that knowledge. Years from now you will sit on the other side of a different table, and the title *doctor* will make you an examiner whether you wish it or not. Most of the people you explain things to will never have chosen to study medicine and will have no wish to begin. A person may agree with you because they understand, because they trust you, because they are embarrassed, or because they would like the conversation to be over, and from your side of the table these can look exactly alike. They are the candidate's reflexes, and you will recognize them if you remember having had them. The remedy is not to test people harder. It is to move the burden of the examination onto yourself. A question like *Do you understand?* invites the candidate's nod. A request like *Tell me how you would explain this at home, so I know I have said it properly* puts the explanation, not the listener, under scrutiny. It is a small change of grammar, and it can make it safe for someone to show you where your account went wrong. You already have four languages, Punjabi, Hindi, Urdu and English, and you live in a city where a single conversation can move between several of them. Remember that, too. Your clearest words for frightened people will usually be ordinary ones, and a good many of the best will not be in English. ## Cultured People There is a letter of advice I find more searching than Rilke's, partly because it is less lovely. In 1886 Anton Chekhov, then twenty-six and two years qualified in medicine, wrote from Moscow to his elder brother Nikolai, a gifted painter who drank, drifted, borrowed and complained that nobody understood him. Constance Garnett's translation of the letter appeared in 1920. It opens with praise: Nikolai is kind to the point of softness, magnanimous, without envy, and he has talent, which in Chekhov's arithmetic places him above millions. Then comes the single failing, which Anton names as an utter lack of culture, and a numbered list. "Cultured people must, in my opinion, satisfy the following conditions," he writes, and the conditions follow. They respect human personality, and are therefore kind, gentle and polite. "They do not make a row because of a hammer or a lost piece of india-rubber." Their sympathy is "not for beggars and cats alone." They pay their debts. They are sincere, "and dread lying like fire," and do not lie even in small things. They do not disparage themselves to rouse compassion. They do not care for the false diamonds of knowing celebrities. If they have talent they respect it. The list ends in a plea: "What is needed is constant work, day and night, constant reading, study, will.... Every hour is precious for it.... Come to us, smash the vodka bottle, lie down and read." And then, at the very end: "I expect you.... We all expect you." Three things in that letter matter for this one. The first is what the list contains. It is made entirely of conduct. There is nothing in it about prizes, posts, reputation or what Nikolai might one day become. Its items are the size of a hammer and a lost eraser: how one behaves in a shared room, whether one pays what one owes, whether one lies about small things. A list of achievements tells its reader where to arrive. A list of conduct tells him how to walk, and that is the only kind of advice that does not depend on knowing the future. The second is the direction in which the advice travels. Anton was the younger brother. The letter runs up the gradient of age, not down it, and nobody reading it wonders by what right he speaks. The right comes from attention and from love, and from the fact that he plainly holds himself to the same list. Advice does not need seniority. It needs a writer who is visibly still subject to what he says. The third is harder. The letter did not work. Nikolai did not reform, and he died of tuberculosis three years later, in 1889. The list is also, read at this distance, not entirely kind. There is a younger brother's impatience in it, and a note of the prig, and at least one item a modern reader winces at. A letter of advice can be true and still fail its recipient, and it can be loving and still be a little pleased with itself. What the list did accomplish was to put in writing, at twenty-six, a standard its writer would have to meet. It reads now less like a prescription for Nikolai than like a description of the man Anton was trying to become. It bound the sender at least as tightly as the addressee. One item on the list I have taken as a warning for this letter. *They do not disparage themselves to rouse compassion.* A letter to the younger self tempts its writer toward a particular performance: the rueful catalogue of mistakes, offered in a tone that invites admiration for the honesty of the confessing. Chekhov names that move precisely. It is striving after cheap effect. So I have resisted giving you a list of my errors, partly because you could not use it and partly because I would be enjoying it too much. Chekhov's plea for reading has another edge, too. He does not tell Nikolai to read Turgenev because it will improve his painting. He tells him to read because a cultured person reads. I would say the same to you about the parts of your life that the syllabus does not touch. Keep a language used for its own sake: Punjabi poetry read because it is beautiful, not because a patient may one day need the word. Keep a friendship that has nothing to do with marks, and an interest with no professional use at all. I cannot promise that every ordinary pleasure will one day reveal a hidden benefit to the people you treat, and I would rather not try to argue that it will. That argument concedes too much. It turns a life into equipment. A life should contain things that are allowed to matter without having to prove they made you a better doctor. ## What You Could Teach Me The conversation should travel in both directions, and this is the part of the letter I find hardest to write, because it requires me to imagine you asking the questions instead of answering them. Suppose the student asked whether the older physician still allows himself elementary questions: whether he will still say, in front of a colleague or a patient, *I don't know what that word means*, or *Why do we do it this way?* Suppose he asked why knowledge acquired with such effort so often becomes a reason to stop listening, as though a man who has learned a great deal had earned the right to hear less. These are imagined questions, not claims about what I actually thought as a student, and I do not want to credit the young man in Amritsar with virtues he may or may not have had. Their purpose is to keep the future from occupying every seat in the exchange. What I can say without inventing anything is that the position of a student has certain properties, whoever occupies it. A student has not yet learned which questions are considered embarrassing, and so he sometimes asks the good ones. He reads the textbook's account of a disease before he has seen many people who have it, which means he sometimes notices when a case does not fit the account, because the account is all he has. He is examined constantly, and so he knows, more exactly than he will ever know again, where his knowledge ends. And he has not yet acquired routines, which means that nothing he does is yet done without thinking. Every one of those properties erodes with experience, and most of them erode for good reasons. Routine is how a physician gets through a day without exhausting himself on decisions that do not need to be made afresh. Knowing which questions are embarrassing is part of knowing how to behave. But the erosion has a cost, and the cost is precisely the student's advantages. The experienced eye has stopped seeing some of what the inexperienced eye cannot help seeing. The routine that saves effort also saves attention, sometimes where attention was needed. This is where Rilke's advice comes back, in a direction he did not intend. *Live the questions now.* He wrote it to a nineteen-year-old, but a nineteen-year-old hardly needs telling; nothing in his life is yet answered, and he lives among questions whether he likes it or not. The person who needs the advice is the one who has converted his questions into routines, his uncertainties into protocols and his early wonder into competence. If anyone in this exchange should be learning to love the questions again, it is the man in the bed nearer the window. So I would like to think that you could teach me something, and that it would be this: how to stand in front of something I do not understand without hurrying to make it familiar. I do not know whether the young man in Amritsar was good at that. I know that the position he occupied made it easier than the one I occupy now. ## The Paper You Will Be Given There is one object I can tell you about without giving away the plot, because it exists now and does not yet exist for you. It is a sheet of paper stating that you hold the degree of Bachelor of Medicine and Bachelor of Surgery. When it comes you may think of it as a conclusion. It behaves more like a passport. It will be copied, attested and checked, again and again, by institutions you have not yet heard of, and looked at by strangers far more often than by you. People will verify its seal and its dates and the name of the college, and the young institution on the Amritsar–Mehta Road will be asked, in effect, to vouch for you by people who have never seen it. There is a particular irony in that for a student in a new college. A first batch carries a reputation before the reputation exists. Nobody yet knows what your degree is worth, because no one holding it has yet been seen at work, and so, without anyone asking your permission, you and the people in your year will become the evidence. Later students will point to what you did, or will have to explain it. That is a constraint, and a heavy one, and I would not dress it up as an inspiring thought. It is simply one of the conditions under which you are studying, and it is one more reason the lightness about marks that older people can afford is not available to you. What the paper cannot record is anything about what you became while earning it. It certifies that certain examinations were passed. It says nothing about whether you learned the reasons along with the facts, whether you kept the candidate's knowledge of what it is to be examined, whether you learned to say *I am not sure yet* steadily, or whether anything in you that was not useful survived those years. That part is not written down anywhere. It is also, I should tell you, not finished. The paper marks the end of a course. It does not mark the end of anything that matters about the person holding it. ## A Little Written Punjabi letters used to close, often enough to make it a formula, by asking the reader to understand a great deal from the little that had been set down. One common form ran ਥੋੜ੍ਹਾ ਲਿਖਿਆ ਬਹੁਤਾ ਸਮਝਣਾ, *thoṛhā likhiā bahutā samajhṇā*: take the little written as much. It was a convention, said whether the letter was short or long, and like most conventions it was wiser than it sounded. It admitted that a letter could not hold everything its writer meant. And it handed authority to the reader, trusting him to supply what the page could not. Every letter of that kind crossed time as well as distance. It was written in one season and read in another, by someone whose circumstances had moved on since the writer last had news of them, and the formula quietly acknowledged that the reader would know things the writer could not. A letter to a younger self is only the extreme case. It arrives, if it arrives at all, in a time the writer has already left. That is the spirit in which I would like this letter to end, and it is the opposite of the spirit in which such letters usually end. Rilke wrote at length; Seneca wrote a hundred and twenty-four letters; Chekhov's list ran to eight conditions and an "and so on." The temptation of the older correspondent is always to say more, to close every gap, to leave the younger one nothing to work out. I would rather leave you a good deal to work out. You are going to have to anyway. So I will not end with a list of destinations, which I have promised not to give you, or a list of mistakes, which Chekhov has talked me out of. I will end with commitments, which have the merit of binding the writer as much as the reader. Work seriously, and learn the reasons along with the facts. Keep your curiosity, which is a different thing from your ambition and tends to outlast it. Tell the truth in small things. When you are examined, give the clean answer; when you are the examiner, remember what the candidate felt. Keep some part of yourself that has no use. Leave room for the person you will become to surprise you, and do not let him become so sure of himself that you could no longer recognize yourself in him. I cannot promise that I have kept these. I am still in the ward. What I can say is that writing them down to you has the effect Chekhov's list had on its writer: it makes them harder for me to forget. The pretext has done its work. Chekhov ended by telling his brother that he was expected. I find I want to turn that around. You are the one entitled to expect something of me, and the only place I can meet the expectation is here, in the present, where the letter is actually being read. That is all. Go back to the books. They are heavier than this letter, and for the moment they are more use to you. ## Evidence and Editorial Note **Documented findings.** Public biography: upbringing in Amritsar; MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, 1997–2002; Punjabi as first language, with Hindi, Urdu and English; later postgraduate training and practice in the United States. "Passed out" meaning graduated: standard Indian English usage. Seneca, *Moral Letters to Lucilius*, Letter 27 ("On the good which abides"), including the objection, the image of the shared hospital, the confession of using the addressee as a pretext, and the story of Calvisius Sabinus: Richard Mott Gummere's Loeb translation, read on Wikisource. Rilke's ten letters to Franz Xaver Kappus (1903–1908), Kappus's position as a cadet at the Theresian Military Academy in Wiener Neustadt, Rilke's schooling at Sankt Pölten, publication in 1929, the discovery of Kappus's letters in 2017 and their German publication in 2019, Kappus's later career, and the places and dates of the first (Paris, 17 February 1903) and fourth (Worpswede, 16 July 1903) letters: the Wikipedia article "Letters to a Young Poet" and its cited sources; the German phrases are from Rilke's public-domain text, in the author's own rendering. Chekhov's 1886 letter to his brother Nikolai: Constance Garnett's translation in *Letters of Anton Chekhov to His Family and Friends* (1920), read on Project Gutenberg; Chekhov's medical qualification in 1884 and Nikolai's death from tuberculosis in 1889: standard biographical sources. Poynard T et al., "Truth survival in clinical research: an evidence-based requiem?", *Annals of Internal Medicine* 136 (2002): 888–895 (474 conclusions on cirrhosis and hepatitis, 1945–1999; 60 percent true, 19 percent obsolete, 21 percent false in 2000; half-life 45 years; no clear survival advantage for conclusions from studies of better methodology; lower twenty-year survival for meta-analyses): the PubMed abstract. Oral (viva voce) examinations as part of MBBS assessment in India: general, well-documented practice. The closing formula ਥੋੜ੍ਹਾ ਲਿਖਿਆ ਬਹੁਤਾ ਸਮਝਣਾ: a common convention of Punjabi letter-writing, given in one of its forms. **Vendor representations.** None. **Recollection and tradition.** The author's dates of study and languages are his published biography; Guru Ram Das as the founder of Amritsar is Sikh history from standard reference sources. The letter is a present-day literary construction. It describes no classroom, examination, teacher, classmate, routine or event from 1997–2002, does not state what the student thought or felt, and does not say where he would go or when. The student's objections and questions are imagined by the author now, as a device, and are not recollections; the observations about the position of a student are general, not claims about the author's own qualities at the time. **Analysis and forecast.** The readings of Seneca, Rilke and Chekhov, the interpretation of the Poynard study's methodological finding, the advice on learning, examination and explanation, the reading of the degree as a passport and the closing commitments are the author's personal views as of November 6, 2026. **Independence.** This essay is not sponsored by any institution, company, health system or technology developer. ## Related reading - [Khalsa College, 1995](https://personal.kpsgill.com/essays/khalsa-college-1995/) - [The First Time Someone Called Me Doctor](https://personal.kpsgill.com/essays/the-first-time-someone-called-me-doctor/) - [The Last Day of Residency](https://personal.kpsgill.com/essays/the-last-day-of-residency/)