The white coat serves as a daily reminder of the Hippocratic oath

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My classmate and I looked at each other with amusement and embarrassment as we learned that all medical students would now be required to launder their white coats at the hospital. After several complaints that medical student’s white coats did not appear as “white” as they should, the university decided to take matters into their own hands. I looked down at my own white coat, which was due for a cleaning. To my unrefined eye, it appeared clean and white — but was it, really? I knew too well the microscopic jungle that was undoubtedly milling on its surface. In fact, a 2019 systematic review found that white coats are breeding grounds for bacteria — up to 42 percent tested positive for gram-negative rods, with up to 6 percent testing positive for MRSA. Dropping it into the washer, I threw in an extra detergent ball and turned the water heat to high.

This email arrived just before I had the privilege of attending this year’s white coat ceremony. The day that medical students receive their first white coats is perhaps the most anticipated ceremony of medical school. The white coat that physicians and those in training don every day is a symbol of what it means to be a physician. As I looked around at the newly coated M1 class proudly wearing their crisp, clean, MRSA-free capes, it brought me back to my first day of clinicals, when my coat, like theirs, was a blank canvas.

It was my first day in the hospital, and though I had prepared for two years for this moment, I couldn’t have felt more insecure. “Come on, Julia, you passed STEP, you can do this,” I attempted to reassure myself as I glanced at my reflection in a mirror in a hospital hallway. Yet despite my best efforts, feelings of imposter syndrome crept into my subconsciousness. I fiddled with my jacket, smoothing my collar, unbuttoning and rebuttoning it.  Standing at 5’ 2’’ with a “youthful” face (I am told), I feared my patients wouldn’t trust in my abilities to contribute to their care. Yet with my white coat, I felt a sense of confidence. I couldn’t help but feel relieved that though on the inside, I was terrified, outside I did look the part. Like a soldier about to enter battle, I hoped my short white armor would protect me and instill my patients’ trust in me.

I looked down at my bulging pockets, laughing at how cliché I surely appeared. Equivalent to freshmen in college twiddling their lanyards, it is a running joke that medical students over-stuff their pockets with unnecessary items that seasoned physicians later go on to shed. Like every M3, I had desperately stuffed my portable locker with a rainbow of tools I felt I could not do without. Depending on the rotation, items were added and removed—reference guides replaced with loose-leaf as history questions became second nature, reflex hammers exchanged for gauze and shearing scissors — yet my coat stayed full. By the end of each day, my coat felt heavy, pulling down on my shoulders and neck. Was it my coat, that gave me such a backache, I wondered? Or rather was it rather the metaphorical weight that I carried on my shoulders every day – the worry of studying for shelf exams, of retaining endless facts, of wanting to perform my best for my residents and most of all for my patients?

As my armor, my white coat would not only protect me from fluids and germs that working in a hospital inherently exposes me to, but safeguard me from emotionally difficult moments. Many times, I hid behind my chalk-white shield for this purpose. And with each passing week, my white coat slowly began to change colors.

The first time I delivered bad news, its oak threads soaked up shades of salty blue, as the tears of a sobbing mother soaked my shoulder. She was just told her beautiful 36-month-old baby would never regain full cognitive function after a tragic anoxic brain injury. I held back my own tears, yet inside I broke for my sweet, innocent patient and her family, their lives forever changed.

On my first trauma call, my white wall was metaphorically splattered with crimson red—a motor vehicle collision tragically taking the life of a young woman. On that night, I was grateful for not only my coat but my mask and eye shield, hiding my inner shock from the team. Memories of my patient’s life as a promising college student, her family’s grief, the pained look on my attending and chief resident’s faces as they collected themselves to care for the second passenger still struggling for life, were permanently inked into the tapestry of my pearl cloth.

Yet my mosaic was also embroidered with beautiful images. The name of the first baby I helped to deliver on OB is etched across my chest. Stitched on my sleeves are the smile lines that formed around a man’s eyes when he thanked me for listening to him talk about his anxiety. Pinned to my shoulder is a photograph of a wrinkled, soft hand with prominent blue veins—this image warmly reminds me of the elderly Italian woman whose hand I held when I told her she would be sent home from the hospital in time for Easter. I look down at these colorful moments often for strength.

Soon, my peers and I will be dawning professionally bleached, pressed, crisp white coats, free of germs and stains. Yet I’ve come to realize that despite how many times I wash it, my short white coat is not white at all –  it is a Pollock – a splattered montage that captures the myriad of human experiences that define my medical school journey. It serves as a daily reminder of the Hippocratic oath I took, pledging to remember that medicine is not only a science, but an art.

Julia Tartaglia is a medical student.

Image credit: Shutterstock.com

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