Faculty Peer Reviewed
Mr. H was an 85-year-old former merchant marine and self-proclaimed lothario who presented to the VA emergency room with a six-month history of lymphadenopathy, a six-week history of cough, and a two-week history of decreased exercise tolerance. The physical exam was remarkable for impressive lymphadenopathy in the anterior cervical, posterior cervical, submandibular, axillary, and inguinal regions. A CT scan of his neck, thorax, abdomen, and pelvis revealed a pulmonary embolism and diffuse lymphadenopathy.
I must admit, that as cynical a person as I am, after my white coat ceremony, the first thing I did was to throw on a pair of scrubs, my stethoscope, and my coat for an ironic, but still self-congratulatory, Facebook profile photo. I couldn’t help but feel proud of surviving the ritual flogging that was medical school admissions to stand on stage and receive a little piece of symbolism of my own.
The problem was that the white coat was a symbol that held too much power for me to wield. The first-year medical students attended narrative sessions which were meant to expose us to the patient perspective of the healthcare field. Mine were held off-campus and I was forced to make the trek to the cancer center in full-on “baby-doc” garb. I hated this. I felt conspicuous and stupid. Sure, my coat was white, but it was also very new and very stiff.
And very short. It was nothing like those I always remembered doctors wearing, long coats flowing behind them like superhero capes. To doctors and nurses, I was branded a medical student. A horrifying thought. They could take one look at me and know that I was altogether useless. To strangers on the street, I might be seen as a doctor. Another horrifying thought. I walked to my sessions acutely aware of my surroundings, practicing unlikely scenarios in my head. “I’m sorry, I’m just a medical student. I can’t use a pen to give your husband a tracheotomy, but I can list the essential amino acids if you think that will help.”
By second year, I still hadn’t shaken the uncomfortable feeling that the coat gave me, but I was getting better at faking it. I had figured out the magical formula of the OSCEs. “Standardized Patients” was a term that translated plainly to “desperate aspiring actors.” They all had an emotional story to tell, so just nod and smile, ask plenty of open-ended questions, and follow up on emotional cues. “Oh, you just moved in from Washington? Tell me how you’re feeling about that.”
I fake-doctored so well that I made a fake-patient cry. My concern about her dramatized domestic violence victimhood was just so real. The problem was that it wasn’t real. I was only so comfortable with OSCEs because I was keenly aware of the fact that it was all a game. I wasn’t really a doctor and they weren’t really patients, so it didn’t really matter. But in the hospitals during our bedside teaching sessions with actual patients, I still felt conspicuous and stupid and clumsy.
Then I made the horrendous decision to start my third year with the big one: Medicine. At Bellevue, to boot. Now my white coat was not only obviously short, stiff, and unflattering, but its pockets were filled with tools I rarely had a reason to use. How often would I actually need to whip out that otoscope? At the end of every day of that first horrible week, I’d hang up the coat and stethoscope in my locker and head out the door with a sigh of relief that I no longer had to carry the burden of being even remotely responsible for things that might happen. I’d enter my apartment, collapse on the couch, and sob uncontrollably like a crazy person.
But then, the days didn’t seem so horrible. Uncontrollable sobbing turned into minor dramatic tearing, which faded to cool indifference. One Friday after I had contributed to the actual care of an actual patient, I walked home with a broad smile on my face. The following week I was leaving from one of our many afternoon lectures. I realized that I was walking down First Avenue with my white coat on and my hands in my pockets like I owned the thing. It had happened. I had settled into my role as a doctor-in-training. Sure, I didn’t have the clinical knowledge or the skills or the experience yet, but damnit, I was a medical student. I was going to be a doctor. Hold that chin up high!
This brings me back to Mr. H. Lovely, sweet Mr. H who spoke like an old-timey gangster and declared that he would take me away from all this. My medical team at the VA was mostly female, an interesting dynamic shift from my testosterone-filled Bellevue team. Every day for a week my team, clad in white coats and toting stethoscopes, would visit Mr. H on rounds, update him on the proceedings of the day, which tests would be done, and what the implications of the results could mean. We would refer to each other as “doctor,” as I suppose doctors often do. He would flirt mercilessly, sending us all into self-indulgent giggles.
One day last week I passed him as he was walking down the hall, so I stopped to chat with him. After some light flirting and many “my dears”, he expressed aggravation at the time he had spent in the hospital, especially since he was absolutely convinced his symptoms were from eating too much “shell-food.”
“Listen. I don’t know if yous goils are studyin’ to be nurses or what , but if you could go to a library or somethin’ and find out what’s going on, that would be a big help. ”
Such is life. I smiled, patted him on the back, and bid him a good night. As I shouldered my backpack and readjusted the collar of my white coat, I realized that I hadn’t bothered to correct him. Truth was, I didn’t need to. I had spent the first two years of medical school worrying that people would mistakenly recognize me as a doctor. Now, what people saw when they looked at the white coat didn’t matter. I knew what it meant.
Kristen Mattei is a 3rd year medical student at NYU School of Medicine
Peer reviewed by Ishmeal Bradley, section editor, Clinical Correlations
Image courtesy of Wikimedia Commons