One of Them

It's still as white as it used to be. I must admit, though, this is not a "good" thing. If your "white coat" is still "white," it means you haven't lived in the trenches. You're a newbie, a novice. You haven't been on the wards, you haven't changed a patient's dressing or pulled a drain. A good white coat should have a respectable amount of stains and splotches, and remnants of old spillages of blood and pus (even after being laundered). It can't be obvious though; that would be unacceptable and unprofessional. You shouldn't be able to read the stories those stains could tell unless you look very, very close. But the coat can't exactly be "white." It should be a shade off.

But my white coat is still white. I am proud of that. It's not that I haven't lived in the hospital. To be honest (will you keep my secret?), it's my own little rebellion. Any opportunity I have, I don't wear it. My attending physician isn't wearing hers? Mine gets left at home the next day. About to examine a patient? I hang it up by the door. Beginning rounds? My white coat rests gently on the chair where I finish writing my morning notes.

There are two reasons I detest that thing. The first is pure vanity. It doesn't fit me. All medical students wear the "little" white coats, instead of the long cape-like lab jackets that adorn real doctors. Those are trim and fitted. Mine, though, because of my Inspector Gadget-like arms and slender torso, is ginormous. I had to purchase one that would fit Shaquille O'Neil just so the arms were long enough. And in the front, I could fit three of me. Because of my height, it is especially short. It rides up to my belt. So I don't like it, and I'm too cheap to buy a new one.

The second reason, though, is the real impetus for my mini-revolution. For me, the white coat is the divider: the "Us vs. Them" statement. It is the one thing that a patient cannot have and a physician can. "It's ours! And ours alone!!" The lab coat is what distinguishes the patient from the provider. When I walk into the clinic with a stethoscope around my neck instead of a tie, free of any outside garment, I feel more connected. My attire says, "Hey, I'm still one of you! I'm not one of them yet. You can trust me." And I like that. I'm a human being, not some all-powerful demigod, to whom thou shall not speak. The coat yells, "Heed my words, for they are written in stone." But why? We are all fallible. We are all human. In some ways, we are all patients and all doctors of our own bodies. So why wear the coat?

Truth be told, this thinking is most likely the product of the environment where I grew up. There are no doctors in my family. There are no health care providers either. I met some great docs in my younger years, but I also met some physicians I couldn't stand. Ones with poor bedside manner. Arrogant. Entitled. I actually began medical school with a negative view of physicians (and I've had classmates who reinforced this view). As I've entered this new world, I have seen both: the wonderful, the caring, the human, juxtaposed with the disdainful, the power-hungry, and the money-driven. Now I need to be fair, the white coat doesn't put you in one category or the other. It has just always represented the latter to me. It symbolizes the medical community as an institution, not as its good actors. So every chance I get, I ditch the coat, leaving it out of sight and out of mind. That is why my white coat is still white.

Another admission: there actually are some good reasons to wear one. Pockets. Lots of pockets! So many wonderful pockets. In the left chest pocket I horde pen-lights and patient notes. My Surgical Recall resides in the right pocket near my waist. The left side pocket holds my trauma shears, reflex hammer, and other pointy objects. And the inside pockets hide my secrets... granola bars, tic-tacs, and cheat-sheets. The only problem with these pockets is that they aren't very sturdy. I've had to sew up the outside waist pockets because my pointy tools were cutting through the fabric (I, of course, used silk suture from the OR to sew the pockets back on, in order to practice - unfortunately the suture was black).

The white coat is also a good barrier from bodily fluids and from house staff questions. I was vomited on once, and I was pretty happy to be wearing a protective garment over my nice collared shirt and khakis. Also, when you are wearing a short white coat, the house staff knows you aren't a resident; thus, they don't ask you the important questions about their patients (they already know you don't know the answer). In fact, there have been occasions when I wished it was obvious who I was, just to avoid the awkwardness of my own naïveté...

So it's still pretty much as white as it used to be. But only sort of. The parallel black rows of silk that line the bottoms of each outside pocket are noticeable. It is clear that an amateur has altered the fabric. If you look very closely, you will see a yellowish discoloration on the right from vomit, though it is very faint. From a few feet away, you still can't tell the coat has been worn. Maybe not a lot, but it no longer appears brand new. Something, or someone, hides within its protection.

The more I scrutinize the coat's exterior, the more I realize I am changing. I am slowly, quietly becoming one of "them." A pure white coat means you are still living in the world of the classroom. You don't know the harsh realities of the hospital, of the operating room. You have yet to discover what it feels like to be on the other side of the fence. The coat does not yet define you. A worn white coat means something else. Despite confidence in my ability to win my rebellion against this transition, my white coat is beginning to say otherwise.

Slowly, I am becoming one of them. But I'm not sure what that means.