As I heard my name called and walked towards the stage, I could feel my sympathetic system kick into high-gear. I had the symptoms of dizziness, diaphoresis, palpitations, GI distress, and perhaps even a subtle tremor. Over the past year I had observed these symptoms in many of my patients. In the psych ward, I witnessed them in a patient with PTSD as he had a panic attack in front of me. In the emergency department, one patient displayed these symptoms because of urolithiasis and another because of a heart attack. And now here I was having them.

Over my left shoulder, I heard Dr. Richards whisper, “Congratulations, John.”

I continued up the stairs to where our program director, Chris Bruce, and clinical medicine instructor, Dr. Jones, stood waiting for me–their smiling faces almost floating above the black robes that hung on their shoulders. I remembered how at times I had been frustrated with these people, but I had come to love and respect them all the same. During two of the most difficult years of my life, they had shared remarkable wisdom and experience. They had taught us everything from diagnosing a TIA to speaking with somebody about domestic violence. Their lessons came from very rich careers and they shouldered a lot of responsibility in educating us. Their methods were those of “tough love.” They did it, though, not only for us, but also for all of the thousands of patients we would see in our careers.

The walk across the stage, itself, was a single heartbeat. I smiled holding my degree while a bulb flashed, leaving scintillations as I blinked my way back down the stairs. I found my chair and then sat into a world of disbelief. We had done it. We had survived the gauntlet. Against all odds, we were physician assistants.

It hadn’t felt final until that moment. Throwing a party on the last day of class didn’t have the same momentum, although my friend Joe made an unforgettable video of the class that, I admit, made my eyes fog up. But there still was a week of packing and hanging out with friends, as I readied to transition to the “real world” for the third time in my life. Also, the distractions were plenty.

My parents and my fiancee, Tiffany, came to visit. Having been separated for 6 months prior to this reunion, enjoying time with them was kind of like learning to walk again. We did the typical Hershey tourist stuff (there isn’t a whole lot else to do there), visiting Chocolate World, the theme park, and the zoo. I was excited to show them the hospital, although my stories about the campus weren’t as exciting out loud as they were in my head (here is where I studied on weekends… here is where I studied during lunch… oh, and here is where I studied after class!).

It was somewhat odd, juxtaposing these two worlds. I had been so far away from Tiffany and my family that it often felt like I was leading a double-life. As we walked through the campus library together, I still had to shake away that atmosphere of deadlines and stress that I associated with the place. It was almost symbolic, though, to make that final trip through the hospital with the people I had relied on most to keep me sane. Like a victory lap, just me and my greatest advocates.

I suppose there is not much advice to give about graduating. Be sure to hang out your gown several weeks ahead of time so the wrinkles fall out. When classes are over, take some time to RELAX (yes it will come back to you). Build some final memories with your classmates (you will miss them more than you think). Study, but don’t stress about the PANCE exam (you just spent two years preparing for it). And don’t go out for breakfast only an hour before graduation (I was almost late!).

A final word. As you grip your degree and smile tremendously into a blinding flash-bulb, you may mistakenly feel a sense of finality. But as you well know, graduation is not an end. On the contrary, it is a beginning. You have embarked upon a life-long journey of learning (and teaching). School was nothing more than a guide on how to navigate the course. So as you head out into your future career, don’t expect the road to get any easier. It will be more rewarding, but just as challenging. So don’t forget to pack your sense of passion or to lean on the people who have thus far supported you each step of the way. You will need them as much now as before. The career of a physician assistant is an arduous journey, but it is filled with worth-while adventure.