Monday, April 13, 2009

96 Tears? No, 100 Lab Coats

When it comes to counting, ? & The Mysterians have nothing on me.

I entered medical school in the late summer of 1984. Almost 25 years later, I have much to look back upon, and as a result of a headlong rush through those years, many holes in my memory. Unlike a hunk of Swiss cheese, however, sometimes little things will jarringly cause me to fill in a few black holes in my cerebral RAM. SWIMBO sent me hurtling backwards in time with a simple little recent comment ---

"Good Lord, look at yourself! Get some new lab coats! NOW!!"
Indignant and hurt (how could she say that about my.....comfy, wrinkled and coffee-stained coat?), I pulled out the best retort in my quiver --- "Er, yes dear."

But it got me thinking. I am very old fashioned, and as a surgeon have always worn a lab coat in the hospital, either over scrubs or over my regular clothes. In some ways it may seem a silly convention, but I feel as naked without my lab coat in the hospital as I do without my helmet on my mountain bike. And I have been wearing one since the beginning of my third year in medical school.

Please, don't get me wrong. My inner fashion barometer tells me every morning that blue jeans and a very obnoxious Hawaiian shirt is just the thing to wear to work. However, SWIMBO has kindly arranged my clothes in such a manner that I can almost never fail to find some combination that has a greater than 50% chance of matching. Sort of like Garanimals for the fashion-challenged adult. But once I get to my office, the need to put on that white coat is as basic to my nature as is the urge to finish rounds before going to the OR in the morning.

So, SWIMBO's comment got me thinking. How many lab coats have I worn over the past 23 years? Perhaps the more salient question would be, how many lab coats have I ruined over the past 23 years, with coffee spills, rips when the pocket holes were caught on doorknobs, volcanic eruptions of pus while opening wound infections, ink stains, and the like? I'm putting the number at somewhere between 70 and 100, and given my severe coffee enslavement, 100 may be the more accurate estimate.

The first was thin, with buttons that had a tendency to fall off during the most embarrassing moments, such as when I had to present a patient's history and workup to the smartest man in my then known universe after a sleepless night of work. It had no embroidery or markings whatsoever, but had pockets that were ridiculously large enough to hold :
  • a stethescope
  • a pen light
  • a reflex hammer
  • a copy of the Sanford guide
  • a well-worn copy of the Washington manual
  • at least 3 pens
  • scrap paper; lots of scrap paper
  • most importantly, a copy of the Scutpuppy Guide to the Lands, an indispensable guide book to Parkland Hospital, its idiosyncrasies and Byzantine method of operation, and its navigable hallways, along with a few helpful Spanish phrases (download it here for fun and exciting reading!)
  • lunch
I am sort of a big guy, and was fortunate to go to not only to The Best Medical School in the Country®, but also one which did not require students and junior residents to wear short, short-sleeved lab coats. Those things have a tendency to make one look like Bozo the clown when he's trying to dress down to the level of a real doofus. And that, I believe, has always been the point in those institutions ---- to single out the junior level folks, sort of like fraternity hazing on a prolonged scale. Since I was a Γ Δ Ι in college, that sort of crap really pisses tees me off.

So, my big white lab coat with oversized pockets did me well for about 8 weeks, which was the length of my first rotation as a 3rd year medical student --- internal medicine at Parkland Hospital. This was followed by 8 more weeks in internal medicine at the Dallas VA Hospital, and by the time 16 weeks was up, "white" was a term that could only be used in the past tense when referring to that rag.

During the remainder of my time in medical school, I variously soiled and destroyed more than a few other coats, but arrived in Salt Lake City in the summer of 1988 freshly married to a woman doggedly determined to ensure I would show up for work cleaned and pressed (even if I didn't end the day that way). Somewhere along the way, she was kind enough to order me a plush, thick, 100% cotton lab coat embroidered with "Aggravated DocSurg, M.D." in dark red. It was great. Sort of made me feel like Navin Johnson ("The new phone book's here! The new phone book's here!"). Just like Navin having his name in the phone book, however, having my name on my coat made me a target for potshots for attending surgeons who needed to pimp someone, but who weren't always sure what everybody's name was.....except for that guy with his name out there for God and everybody else to see!

Fast forwarding through the 6 years of residency, each pristine and embroidered lab coat was donned with the hopefulness of Pig-Pen as he steps out of a bathtub. The results of a week's worth of work ended up generating the same level of disarray as Pig-Pen's entry onto the playground. Somehow, my attendings managed to maintain a razor-sharp crease and a zero "smudge quotient" on their lab coats. Surely, once I was out in practice, I could do the same!

Well, the "dirty" little secret I discovered was that the attending surgeons had the luxury of having residents do most of the scut work, and they could hang their bracingly white coats in their office after rounds (and no, I'm not complaining, only making an observation). In practice, well, I have no residents! So, while I may be able to afford a few more coats than I used to, they still get just as coffee-stained and worn out as ever.

Trashing at least 5 coats per year since starting practice in 1994, I suspect I have crested the century mark for lab coats through my career. It ain't over yet, so I suppose I need to start buying in bulk.