The White Coat

Every medical student dreams of slipping on that first short, thigh high white coat and wearing it around the hospital wards. The pockets, weighted down with medical stuff like a shiny new stethoscope, penlight, and small medical books (known as "peripheral brains") made us feel like members of the profession despite our novice status.

The medical student coat looks like this and usually has the institution's emblem sewn on to the breast pocket. We had to buy several our freshman year of medical school but weren't required to wear them continuously until our clinical years (third and fourth years). The short coat set us apart from the doctors whose coats were longer, to mid thigh. The pockets, however are the same in all these coats and what we carry in them is fairly traditional with individual variations.

Some of us were so turned on by the symbolism and perceived status of the white coat that they were worn first year whilst  dissecting cadavers.  I have to admit that I enjoyed wearing mine but thought it a tad out there and arrogant when a guy I dated liked his coat so much that he wore it into a Tex Mex restaurant on a Friday night. Oy. I thought he was pretty much of a jerk  back then and things haven't changed. I've seen him at various reunions through the years. He's just older now but still the guy who craves the center of attention no matter what. He's also a neurosurgeon.

The long white coat back in the day was the sole purview of the full fledged M.D., whether in training as a resident or the real deal. Nowadays, lab techs, Xray techs, the occasional nurse  and others wear long white coats. The change occurred gradually and no one seemed to notice or care. The part that hasn't changed is the requirement that medical students wear the short, dorky coats. A rite of passage this and one of many on the journey.

I've worn a long white coat my entire career as a physician.The stuff I carry in the pockets changed over the years. I now carry no money, less food, and the "peripheral brain" took a hike.. The stethoscope, the sole, absolutely required medical tool stores nicely in the lower right pocket. My I phone slips into the breast pocket along with pens and business cards. Lots of docs use their I phone apps as "peripheral brains" these days; amazing what you can look up in a pinch with a hand held bit of technology.

What I've noticed in the last 5 years is a movement away from doctors wearing white coats. My three male colleagues for example, rarely put on a white coat. They throw the stethoscope around their necks and off they go. I'm not sure patients expect to see the white coat anymore. Again, a gradual shift in the look happened while no one noticed or much cared.

I keep up the habit for more than the convenience of hauling around "stuff". And, if my women colleagues were truthful, they might admit to the same second big reason. What could that be you ask?

Check it out: from the back, most well fitting white coats hide the butt really well.  I shouldn't speak for all of my gender in Medicine but I suspect this is the reason you'll find the majority of female physicians wearing a white coat. I'm just saying....

Phlebotomy Part 2

The summer between junior and senior years of college I found myself back in Houston, working as a slightly more seasoned phlebotomist. The job was minimum wage, about 2 bucks an hour but I was fortunate to work the day shift; some of my colleagues pulled 3-11 PM. I made about $1000.00 that summer and stashed it away in the bank.

What did I learn? What do I remember about that summer job?


1. I am not a very good phlebotomist; the easy "sticks" flow smoothly but veins come in all flavors; probably the worst are the ones that roll. There were many, many times I left a patient's room empty handed, returning to the lab to ask someone more skilled technically to go back and do the job.

2. More patients than I would have predicted called me "the vampire" when I told them I was there to draw their blood.

3. We "blood-drawer-ers" sat around in the back of the lab wasting time more than we worked. No wonder we earned minimum wage.

4. I saw my first dead person that summer. Called to draw blood on her roommate, I saw an old lady in the next bed who must have just passed on. No one was making any sort of fuss; likely she was expected to go. Even then, instead of the lancing fear I expected to feel, I was overcome with wonder and calm, a sacredness that comes again and again when in similar situations right up to this day.

5. I ate in the cafeteria most days; the food was fabulous. The sweet potato pie was to die for.

6. I met a cute guy, also a phlebotomist.  He had no money and was on his own financially even though he was a year younger than me. He dreamed desperately of becoming a doctor and was taking  required college courses and working simultaneously.  Although he was a genuinely nice person who worked  hard, he never made it to medical school. I think he became a DEA agent.

7.  I don't remember that we wore white coats. I did wear a badge that I was very proud to pin on my shirt;  so proud that I still have it along with other badges I've worn through the years. I suppose we all like to belong to something larger than ourselves and carry proof of it on our person. "Miss" C. Thompson; today it would probably be the full first and last name with no marital status marker.

8. To this day, I have warm feelings for (most) phebotomists. They are a talented group of people who take pride in what they do. Whenever I get my blood drawn I think back....

Phlebotomy Part I

I spent two summers during my college years working a low paying job at a hospital in the Texas Medical Center (in Houston, of course).

Writing this, it occurs to me how deeply chauvinistic Houstonions behaved when naming their medical center after the entire state of Texas when there were other great medical centers across the state. But, I digress. To be sure, the TMC rocks. I owe my medical school, residency, and fellowship training to U.T. Houston, one of the two medical schools within the great Texas Medical Center. 

As premed students, we were encouraged to use our summers wisely, pursuing volunteer work or employ in some field of medicine. We were advised the summer activities would look good on medical school applications; demonstrating dedication and passion to the goal of a career in medicine.

That first summer, between freshman and sophomore year, I landed a clerical job in the laboratory of Methodist Hospital. I have no recollection of how I got the job; some connection somewhere. I was fortunate to have a sister in Houston who knew people who knew people.

I worked in "the cage", a central area in the large laboratory where a handful of women spent the day answering phones, filing lab reports, providing piles of paper to transporters,  gabbing about coworkers, our lives, and complaining about how bored we were. I was 18 and impressionable. There was not much to be learned from a medical standpoint but I did get an earful of life and mastered the names of some of the most common lab tests.

Over time, I grew restless with the work, eying a group of very young "blood draw-ers" (we didn't call them phlebotomists back then) stationed at the back of the lab, surrounded by blood tubes with myriad colored stoppers, individual  baskets full of supplies: tourniquets, alcohol prep wipes, needles, gauze pads, and tape. I wanted to be one of them; they seemed so cool, confident, happy, and on the ball.

I remember asking the lab director if there was any hope of a transfer out of "the cage" since I was pre-med and all. Fortunately, he thought this a good idea (never helps to ask) and towards the end of the summer, I moved to the back of the lab where all those cool folks sat with their trays of tubes and needles.

Training for the newbie phlebotomist?  By today's standards, laughable. But again, this was (groan) almost 40 years ago. Today, phlebotomists are trained technicians with a certificate. What I recall was several laborious days learning tips and techniques in an informal sit-around-and-listen session with other recent hires. None of us was any older than 22.  Our instructor was a seasoned middle-aged, overweight, slow moving Latino woman named Bea. Bea could draw blood from a stone. She was the best technically but took her sweet time training us. All for the best, I suppose.

We didn't practice on each other. We may have stuck a needle in a piece of fruit to get the flavor of the poke. Maybe she watched my technique once or twice. After that Bea was quick to assign each of us newbies to a more experienced young mentor at the back of the lab. And, off we went to draw blood on hospitalized patients.

Gloveless.

Who knew about the risks blood borne infections?