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Playing Dress-up October 31, 2006

Posted by Benji in Journal.

            My first day to play dress-up doctor actually coincided with Halloween.  It wasn’t the first time I had donned the garb of a physician, however.  I had made my premiere in the fabled white coat (size 44) last year, just prior to taking the Hippocratic Oath with my classmates.  Soon after, I purchased a blue Littmann Cardiology III stethoscope, and – presto! – I was a doctor.  Or, at least, I looked the part.  Besides the cliché of wanting to help people feel better, there was little substantive knowledge behind the costume.  Regardless, there must have been some change, for when I stripped off the white coat to work at my pediatric clinic assignment, I was still – incorrectly – called “doctor.”  Children and their parents let down their guard and exposed themselves to me, both with their honesty and with their flesh.  What was it that, with only a piece of rubber tubing around my neck, elevated me to an expert, even when it had clearly been stated I was only a student?  Though this was part of my training, and I had been privilege to some difficult situations, our encounters were still make-believe.  I thought it was an eerie parallel that my first day seeing patients in a hospital was on a day defined by false costumes and playing pretend.

            My access card to patients at Connecticut Children’s Medical Center was not a white coat (a cloth specter that would have scared the kids – something I had learned in my out-patient pediatrics clinic), but a thin adhesive badge listing only my name and “hospitalist.”  Again I had been given a small white article that would serve as a magic key to open doors and – usually – other people.  As my classmates and I followed the multi-colored hallway, we noticed the “H” in the word “hospitalist” had been misprinted.  Laughing, we penned in the first stroke of the letter on each other’s nametags.  I quietly mused on the significance of only having part of the word show up properly: Were we going somewhere without knowing where we had started?  Were we running around with our heads cut off?  (Something that probably wouldn’t have garnered much of a response on Halloween.)  More optimistically, I thought maybe it was like feeling I had earned the first half of the “M” in “M.D.,” having completed my first year of medical school.  Three more to go.

            Sitting down in a conference room near the cafeteria, I could barely contain my excitement.  I was already thinking how maybe I should do a residency in pediatrics.  I felt comfortable interacting with kids, and the green dinosaurs and other figures that had been painted on the hospital walls made the whole situation feel a little less serious.  It was a hospital, yes, but its lack of sterility made me temporarily forget where I was.  Dr. Jung, a pretty young physician dressed as Little Red Riding Hood, walked in, handing us guides for our upcoming oral presentations on the patients upstairs.  Indeed, the photocopied papers were maps to get us through the woods – the jungle of kids in costume, locked away from Halloween on the street, but still eating candy in their hospital beds.  We were both caged: the children were too sick to leave, and I, if not escorted, could get locked in the stairwells.  There was no escape for either of us.  An unexpected wave of nervousness flushed over me as we readied to meet our assigned patients.  Jealous that Diego had been given a Spanish-speaking patient, I volunteered to go with him.  I must admit (with some embarrassment) that though I have a fondness for Latino culture, I also enjoy surprising people with my ability to speak another language.  I don’t think it’s incorrect, either, to try to contradict expectations made my first impressions.  My Germanic features were another part of my costume: what you see doesn’t always give away what’s behind it.

            Upstairs, more costumes: nurses dressed as lady bugs, doctors in Egyptian robes, and children in hospital gowns.  One lucky girl was healthy enough to put on overalls and stuff her pockets with golden straw.  Her thin frame made her a perfect scarecrow, but as she stepped out from the shadow of her room into the fluorescent-lit hallway, her frailness became apparent.  Angling myself to peer into another room, I saw a teenager curled up in his bed, coughing from a genetic disorder that filled his lungs with mucus.  My eyes were wide with sad curiosity.  I had read about cystic fibrosis, but to see its effects 10 feet away certainly was very different.  I realized this was the first time I had been witness to truly sick kids.

            The other students peeled away one-by-one to interview their patients, and Diego and I were the last students left.  We arrived at a closed door.  Soledad, a four-year-old girl, waited inside with her mother and father.  Hypervigilant to the prospect of communicable disease, the hospital staff had put her on “droplet precautions.”  A red cart outside her room contained disposable blue plastic smocks and yellow facemasks.  Ah!  My costume!  Unwrapping and untangling the hospital couture, Diego and I introduced ourselves from the doorway.  I slipped the textured plastic over my head, covering my orange tie and black pants, and immediately crouched down to be at Soledad’s level.  With my mouth covered, it was nearly impossible to show her I was smiling, let alone get her to give one in return.  I hoped my eyes, at least, were expressing a friendly warmth.  I tried to give her a high-five, but despite her mother’s encouragement, she stared at me blankly.  My small bag of “tricks” already used up, I shifted my attention back to Diego, who had been interviewing the father.  Diego’s crisp words contrasted mine: He was serious and efficient; I stumbled over my Spanish and got lost in the chronology of Soledad’s illness.  Despite my desire to interact with the patient and make her feel more at ease, I recognized the utility of Diego’s approach.  Grudgingly, I gave up on getting Soledad to smile and focused my attention on her father.

            This was the fourth time Soledad had been in the hospital: first for being born prematurely, then for a rare form of liver cancer, and now twice in the last month for pneumonia.  Though she had vomited last night in the emergency room, Soledad wasn’t in pain – she was just bored.  Silently she squirmed on the bed, positioning herself to get a better view of the telenovella on Univision.  In examining her, I was surprised to find her lungs sounded clear.  Soledad was totally apathetic to us revealing the scar on her abdomen, even though Diego tried to garner some rapport by noting he had a similar scar.  Apart from the hospital location, the history and physical exam were like any other I had done before.  The difference was just that we were invading the patient’s space, rather than her entering our office.  I felt a sense of accomplishment as Diego and I escaped the hot plastic outfits, washed our hands, and thanked the family for their time.  Outside the room we looked briefly at Soledad’s chart, confirming the vitals we had taken were accurate and recording the ones we hadn’t taken.  I wondered how I would have responded had she been “sicker,” like the young man with CF.

            After reorganizing our notes, we prepared to give an oral presentation to Dr. Jung.  Despite having had some practice with this in my pediatrics out-patient clinic, I felt some stage fright – that my words would again escape me when it came time to speak.  No option, I thought, but to just jump into it.  Indeed, I had to trust in my skills and not psych myself out.  As I spoke, I took solace in the fact that both Dr. Jung and Alexa, our Fourth Year medical student mentor, were nodding in agreement.  Once everyone had presented their patient, our game of playing doctor came to a close.

            On our way out of the hospital, we removed our sticky badges, part of our costume for the day.  One of my classmates folded hers over so that her name and “hospitalist” were on opposite sides, leaving one identity to be shown and the other to be hidden.  It finally occurred to me that I didn’t know what “hospitalist” meant.  Later, reflecting on the symbology of the day – in other words, the symbolism and the rituals associated with it – I looked up the suffix “-ist.”  Though “biologist” was an easily-accessible example of the suffix, I could not quite define “hospitalist.”  Wishing the word were actually “hospitalitis” – inflammation of the hospital – and shaking my head amusedly as I thought this, I found the answer: “-ist,” one who is engaged in, or one who believes in.  Ah, so a “hospitalist” is someone who believes in the institution of a hospital…  It’s someone who works in a hospital.

Diction, like a mask that covers only part of my face, like my white coat, is another small part of my costume.  Fancy words or foreign tongues, they are something I can, personally, hide behind, though my role in medicine shines through.  White coat or not, my future career is not something I can take off.  I am primed like Clark Kent – when I need to, I can revert to my alter ego.  So that begs the question: which is my costume and which is me?  Who is the real man?  Superman or Clark Kent?



1. Doug - November 9, 2006

Another amazing post. My $0.02 on it all:

Perhaps a clear mask can be invented that would allow patients to see their doctor’s face.

I was struck by your reference to a patient’s room in a hospital as “[their] space.” I had never considered that when a person is assigned a room in a hospital, however temporary, it becomes a place they might feel safe (again, however temporary). Any time the door opens, “something” is going to happen to interrupt their safety.

Do you believe in the institution of a hospital? I’ve never asked myself that question before, but I have always thought of a hospital not as a place to get better, but a place that makes people sick. Sterile (out of necessity), unhealthy, unwelcoming, unpleasant.

I have often felt that people adjust to their surroundings. When you go to the hospital, you are Superman. When you leave, you revert to your alter-ego self. You are both, but one more than the other depending on the circumstances.

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