Published on 5 May 2026
The Last Lecture I
By Joseph Sung MD, PhD
Recently, I read a book entitled “My Last Lecture” co-authored by Randy Pausch. Randy was a computer science professor at Carnegie Mellon University who, after being diagnosed with terminal pancreatic cancer, delivered a now-famous lecture in 2007 titled “Really Achieving Your Childhood Dreams.”
In this book, Pausch reminds us that life is more than systems and outcomes; it is also about meaning, relationships, and humanity. His lecture is essentially an act of medical humanities in practice — storytelling, reflection, and emotional truth in the face of illness. It reinforces the idea that how we live and connect matters as much as what we achieve; exactly the spirit we are trying to instill in our students.
Medicine is a profession built on knowledge, precision, and discipline. You will spend years mastering anatomy, memorising protocols, and refining clinical judgment. You will learn how to diagnose, how to treat, and how to manage complexity. Yet, amidst this relentless pursuit of skills and competence, there is a quieter question that is rarely asked: What truly matters in life, and therefore, in medicine?
For medical students, and indeed all practicing doctors, his message carries particular weight. Because while you are training to save lives, you must also understand what makes life worth saving.
Achievement is not the Goal — Meaning is. Modern medicine is deeply achievement oriented. Exams, rankings, publications, fellowships—these markers define success early in your career. It is easy to internalise the idea that excellence is measured by accumulation of knowledge, credentials, and recognition. Pausch challenges this notion. His reflections suggest that achievements are not ends in themselves, but by-products of something deeper: a meaningful life lived with purpose and integrity. He spoke about his childhood dreams. Not because he achieved all of them, but because pursuing them shaped who he became. The lesson is subtle but profound: it is not the outcome that defines you, but the process of striving with sincerity. In medicine, this translates into a shift in perspective. Being a “good doctor” is not merely about technical mastery or career progression. It is about becoming the kind of person patients can trust with their vulnerability.
Obstacles are not Barriers — They are Tests of Character. Pausch famously described obstacles as “brick walls”; not there to stop you, but to show how much you want something. Medical training is full of such walls. Long hours, emotional fatigue, difficult patients, systemic inefficiencies, and moments of self-doubt. You will encounter situations where you feel powerless, frustrated, or even disillusioned. It is tempting to view these as external burdens. But Pausch invites a different interpretation: these challenges are opportunities to reveal your character.
When I was a junior fellow, I devoted myself to work. After each day of clinical duties, I continued my research in the lab until late at night. Despite my dedication, my seniors and the head of Gastroenterology felt overshadowed by my efforts and didn't value what I did. Eventually, I decided to leave and pursue a PhD study in Canada, cutting my salary by two-thirds and living alone in a harshly cold country for three years. Even with these challenges, I realised that scientific research was truly my passion, and I accepted the sacrifices it required. Looking back, those years were both the most difficult and rewarding of my life. They broadened my perspective and gave me entirely new insights into academia. “It was the best of times, it was the worst of times”, put so aptly by Charles Dickens.
When you face steep challenges, will you become cynical, or compassionate? Detached, or present? Methodically efficient, or humane? The difference between a technically competent doctor and a truly great one often lies not in knowledge, but in how they respond to these “brick walls.” Patients rarely remember your differential diagnosis—but they will always remember how you made them feel being cared for.
To be continued…