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 even 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. With only a piece of rubber tubing around my neck, what was it that elevated me to an expert, even when it had clearly been stated that I was only a student? Though this was part of my training, and I had been privy to some difficult situations, our encounters were still make-believe. It was an eerie parallel that my first day seeing patients in a hospital coincided with one defined by costumes and playing pretend.
Yet, my access card to patients at Connecticut Children’s Medical Center was not a white coat. The cloth specter would have scared the kids—something I had learned in my outpatient pediatrics clinic. My credentials were subtly announced by a thin adhesive badge listing only my name and the designation “hospitalist.”
Again, I had been given a small white article that would serve as a magic key to open up doors and, potentially, other people. As my classmates and I followed the multicolored hallway, we noticed the “H” in the word “hospitalist” had been misprinted. Laughing, we penned in a stroke to correct 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? More optimistically, I equated it with the feeling that 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 with my fellow students in a conference room near the cafeteria, I could barely contain my excitement. I was already thinking that maybe I could do a residency in pediatrics. I felt comfortable interacting with kids, and the green dinosaurs and other figures painted on the hospital walls made the whole setting feel a little less serious. It was a hospital, yes, but its lack of bland sterility made me temporarily forget where I was.
Dr. Jung, a 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 like maps to get us through the woods—the rows of bedridden kids eating candy in their hospital rooms, locked away from Halloween on the street.
An unexpected wave of nervousness flushed through me as we readied to meet our assigned patients. Jealous that my fellow student Diego had been given a Spanish-speaking patient, I volunteered to go with him. I must admit, with some embarrassment, that I enjoy surprising people with my ability to speak other languages.
Upstairs were more costumes: nurses dressed as ladybugs, doctors in Egyptian robes and children in hospital gowns. But one lucky patient 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.
As the other students peeled away one by one to interview their patients, Diego and I arrived at a closed door. Soledad, a 4-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 opened the door and introduced ourselves from the hallway. I slipped the textured plastic over my head, covering my orange tie and black pants, and entered the room, immediately crouching 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 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: the first being her premature birth, 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 a telenovela on Univision.
In examining her, I was surprised to find that her lungs sounded clear. Soledad was completely 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.
The exam over, 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 then how I might have responded had she been “sicker,” like the young man with cystic fibrosis.
After reorganizing our notes, we prepared to give an oral presentation to Dr. Jung. Despite having had some practice with this in my pediatrics outpatient clinic, I felt some stage fright. 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 student mentor, were nodding in agreement. Once everyone had presented his and her patients, our game of playing doctor came to a close.
On our way out of the hospital, we removed our sticky badges. One of my classmates had 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 its usage, I could not quite define “hospitalist.” I found myself idly wishing the word was actually “hospitalitis”—inflammation of the hospital. Shaking my head amusedly at the thought, I suddenly 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.
Diction, like a mask that covers only part of my face, or my white coat, is another small part of my costume. But 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 and leap into action. To comic book readers, Superman was the costume and Clark was the person. But to Superman, that was his true identity: Clark Kent was the cover-up.
So that begs the question: Which
is my costume and which is me? Superman or Clark Kent?
Benjamin Silverberg is a second-year at the University of Connecticut School of Medicine.