The End of an Era

Yesterday was the last day that I will ever have to wear the short white coat of a student. Before medical school- and having spent no significant time in a teaching hospital- I was unaware that there were differences in rank based on the length of coat. In truth, different institutions have different rules (At Duke, for example, everyone wears short coats until they finish their residency), but in general medical students wear white coats that hit around the hip (and have extra large pockets for the copious things we have to lug around the hospital halls) and anyone with an MD wears a longer coat. There are other details like attendings wear coats with cloth buttons, but such distinctions are more subtle and I'm not sure anyone cares but the attendings.

So, my coat is retiring and thank god because it's filthy! I have actually washed it occasionally, but it's white. How the heck am I supposed to keep it clean? In France, many hospitals have actually banned white coats, ties, and full length sleeves because as you lean over a patient these clothing items can cross-contaminate. I always roll my sleeves up and I take off the coat whenever I can. Not is it only dirty, but it's quite heavy actually. I think medical school is all about developing stronger neck muscles to combat the weight of a coat that really doubles and a back-pack. When I first began clinic rotations during my third year, I was told to carry everything with me, but my back was not going to survive. Like a hiker on the AT, I slowly thinned my loot and got down to the essentials. Little by little various instruments left my pockets. My tuning fork? Haven't seen it for a year. An otoscope and ophthalmoscope? Leave 'em at home now. Reflex hammer? You can use the end of your stethoscope, or your hand, or a spoon off of a lunch tray (just kidding, never done that). The only things one absolutely needs in their coat are: a stethoscope, a pen light, and the intern bible "Pocket Medicine." Beyond that, you are torturing your neck.



So as I left the hospital today for the last time as a student, I was harkening back to my first semester in medical school- nearly 4 years ago- when we were presented with the white coat at a special ceremony. (See picture above with Beth and Steve. Note: the coat is impeccably clean!) Back then Kyle was still in Colorado and I was living with his folks, madly studying flashcards and trying to remember the krebs cycle yet again. What a long way I have come. Now I know the structure of the body (anatomy) and how it works (physiology) and the natural course of disease (pathophysiology). I know what questions to ask when a patient comes in with chest or abdominal pain and I know how to rule out potentially lethal causes. I know how to write orders, how to communicate with nurses and other doctors, and how to safely discharge a patient.

I've come a long way, and despite that, I'll have a huge leap to make in July. The most patients I've ever cared for at once is probably three and I'll have to jump to caring for 10 of my own patients and covering for 30-40 at night. People say that managing is all about learning to be efficient, but I'm nervous that I'll start to overlook the little things. For example, this month three families made a point to thank me for my humanity and for explaining things to them in a way they could understand. This is the quintessential role of a medical student and one that I have cherished. Having a little more free time than the docs makes it easier to have sit-down talks with families and make sure their needs are truly met. I just don't want to lose that in the chaos of residency. I want to be a humanitarian first and foremost. After-all, that's why most of us have gone into this field.

So here I am, poised on the edge of a steep transition, about to start what is supposed to be one of the hardest years of my life. It's difficult to look back and appreciate how far I've come with that looming before me, but I'm trying. I'm thinking back to that white coat ceremony when I said the Hippocratic Oath for the first time and how the years that followed were challenging but greatly rewarding and I can only hope that the next four years of residency will be the same.