R.I.P. White Coat

Miranda Machacek, M4, Class of 2020

I laid my original white coat to rest at a beach in Auckland, New Zealand after my final day of an international clinical rotation.  White coat disposal ceremonies are a tradition I must confess I have greatly anticipated. I had grown to resent that coat and what it meant.  Its characteristic short length was an immediate signal to any healthcare professional in the hospital that I was a student – perhaps to some savvy patients as well.  I frequently felt the weight of the “student” label while walking through the hospital. The real or imagined looks of patients, nurses, residents, and attendings that said I was a temporary time-waster at best and utterly incompetent at worst.  

This was a particularly frustrating experience for me entering the wards after having just graduated with my PhD.  Grad school is a gauntlet of failure that beats you down and watches to see if you’re just the right amount of crazy enough to get back up and try it again the next day…and the next…and the next…and the next.  Over the years you become a master experiment designer and trouble-shooter. You’re the person more junior grad students come to with questions about a variety of techniques, machines, and reagents. You find yourself arguing with your mentors about why you should or definitely should not spend your time and energy doing an experiment.  Although it’s a steady and slow creep, one day it dawns on you…you are an expert in that field. You have opinions and theories based on your hard-earned results and—wonder of all wonders—they hold significance in the academic arena. 

To then descend from the heady heights of grad school, don the short white coat, and enter the wards created some friction in me.  The daily reminders of what I had forgotten since I was last in medical school 4-6 years ago; constantly being interrupted while trying to present a patient;the sad, stark reminders that–compared to someone’s socioeconomic status, race, or ability to obtain health insurance medicine is an astonishingly small piece in determining how healthy someone is.  The constant grind of these reminders chafed. And let’s be honest, chafing is no one’s friend.

So I had looked forward to saying a final goodbye to that piece of my required hospital attire.  Good riddance. Like a cartoonish villain, I pictured myself maniacally laughing with glee.

I wanted to give it a proper send-off though, so I waited until the final day of my international rotation when I left early to spend the afternoon at the beach.  I figured a garbage can overlooking the teal water and volcanic islands of Hauraki Bay was as good a spot as any to let it rest in peace. As expected, emotion swelled up in me as I was about to let it go.  But I hesitated for a second. It wasn’t glee I felt. Surprisingly, a bittersweet sadness bubbled up. As much as I was excited to let go of this dorky, stained encumberment whose pockets were often over-stuffed with pens, notecards, surgical dressings, and pocket guides, I realized that while at times it seemed to sell me out, it had done other things too.  

It had brought me a nervous excitement the first time it was slipped onto my shoulders in that time-honored ceremonial gesture of entrance into medical school.  The crisp, starchy way it hung on my shoulders had filled me and my family with pride that day. And within mere weeks when I was seeing patients, I imagined its bright whiteness helped distract my patients from how green I actually was.  

It lends me an authority that to this day befuddles me.  When I put on that white coat, it’s somehow not inappropriate for me to lay my hands on any part of someone’s body or ask as equally probing personal questions.  A crime or social faux pas in any other circumstance is perceived as helpful, even healing, in the presence of the white coat.  

My coat was there for the good, the bad, and the cringeworthy.  It was there when I inadvertently dismantled and scattered the parts of the sphygomanometer bulb all over the floor while being video-taped with a standardized patient.  Both the actress and I choked back our laughter as I anxiously scanned the floor, picked up and assembled the pieces, while also attempting to maintain a normal, professional conversation about her health concerns.  

It was there when I innocently questioned a patient about scars on his arm and he nonchalantly replied they occurred when he was tortured by his native country’s army.  You know, normal Tuesday evening banter.  

It was there when I incorrectly informed a patient with a common condition resulting from unbalanced vaginal flora that she had an STI and her partner should come in for treatment too, perhaps single-handedly breaking up a relationship.  

It was there when within seconds of meeting a patient she was sobbing, sharing how she lost her house in a fire and was living out of a motel.  Struggling to maintain employment and now without her usual health insurance, she was unable to fill her lithium prescription that helped maintain her mental health.  She’d been off lithium for a couple of days and felt so terrible she could barely drag herself to work. The coat was there when I felt powerless, unable to break her out of the horrible cycle of poverty and health problems compounding on each other.  

White coat, you were there when she thanked me profusely for listening;when I learned how often the greatest gift we as medical students (or really anyone?) can give is to listen fully and compassionately.  How often a few simple questions bring some relief by unleashing the dam of held back tears and worries. You were also there that night, when I trudged from the clinic up the hill to my apartment feeling some shame and inadequacy, thinking—not for the first or likely last time—that my patient deserved a better clinician than me.  But it’s also true that your very presence hanging in my closet day in and out reminded me of something else. You—with all your gravitas and authority and responsibility—had been given to me. And not everyone is given a white coat. The mysterious, almighty medical school admissions committee had deemed me fit to wear you. And you’ve been there as whatever truth of my inadequacy as a physician has become less true over the years.

Dear white coat, you lived a hot, sweaty life—that’s my bad.  However, I did launder you regularly, a kindness I observed was not bestowed on all your siblings.  You were there from the beginning and you saw some stuff along the way. That’s for sure. Thanks for being with me through it all.  

R.I.P White Coat…July 2012 – February 2020