5. The Mirror
Looking Inside My White Coat
The Mirror: Looking Inside My White Coat
The field of medicine is ripe with stereotypes. We’ve probably all been in a conversation with someone about a topic where someone exclaims, “I’m not a brain surgeon or anything, but…” as a way to set the bar on what authority looks like. Or my favorites–a few of us have been in the room with physicians who compare a particular specialty with another job or object. Internal medicine doctors used to be called “fleas” because of their persistence in treating apparently hopeless medical conditions. Neurologists are compared with puzzle solvers (“show them the lesion, then show them the door!”) who cannot treat the patient with the lesion. And my personal favorite (he says facetiously), heard by a classmate rotating through surgery: “I’d rather my son be gay than a pediatrician.”
Yes. Really.
He clearly had an issue with doctors who wore stuffed animals on their stethoscopes…” Or maybe it was something much more disappointing”, I remember thinking.
My challenge, as you’ll appreciate shortly, had to do with my internal biases and how I had to overcome them to choose my medical specialty.
Understanding what it takes to be a doctor happens very slowly at first, then very quickly. I remember fondly (now!) the end of our clinical skills course. There we were, a bunch of medical neophytes in white coats. From our stethoscopes that smelled of virgin rubber to our starched, short white coats whose pockets were overflowing with reflex hammers, flashlights, tuning forks, and otoscopes, we exuded newness and naivety. Dr. Victor McKusick, a true giant in medicine, was chatting with us. “This is when the real learning will begin,” he said with enthusiasm unbefitting his otherwise deliberate nature and slightly hunched over posture. “I recommend you each carry one of these,” he said as he handed us a deep blue, pocket-sized, three-ring journal. “You should make an effort to learn from each patient, and then learn new things about each disease you encounter every day. Put it all in here. This book will become your study guide as you complete your clinical rotations.” He then proceeded to pull a clone of our journals out of his much less white, much less starched, and much less overstuffed coat pocket. I remember the quiet. This was the father of modern medicine, giving us the secret to becoming the doctors we all wanted to become. I picked up a journal, wrote my name on it using a black marker conveniently placed by the journals, and somehow managed to stuff it into an impossibly full pocket in my white coat. I looked ready for my first rotation, which would be internal medicine over the summer. And importantly, I was reassured by the nervous looks we all were suppressing to look ready.
By my third medical school clinical rotation, I’d been exposed to a bewildering variety of patients. I’d performed cardiopulmonary resuscitation on a man with HIV, I’d obtained a urine sample from an inmate with a severe mental illness who looked like a character from a horror movie, and I’d stuck needles in every body part that can be stuck without causing serious injury. And I wrote it all down in my handy journal. As I write this, I’m thumbing through my blue journal! There’s the page with the differential diagnosis of eosinophilia, complete with an acronym told to me by a resident (NAACP, of all words!) Then lots of patient stories. Oh….then, as I turn a slightly discolored tab, there is the story of Mr. S.
One of the common phrases we all heard during our clinical rotations was “see one, do one, teach one” to summarize the learning approach on the front lines. Frankly, it felt barbaric at the time. Watch someone do something you’ve never done once. Then try doing it the second, third, fourth time until you can do it without supervision a couple of times. Then….voila! You’re the supervisor watching someone else do it. This learning strategy required a little bit of deceit. What patient wants to know this is your first time trying something on them? Hopefully, it goes well, you gain your confidence, etc. But sometimes….
Mr. S was a heavy, imposing, “salt of the earth” sort of man, wearing a flannel shirt, sleeves partially folded to the mid-forearm, and a pair of well-worn blue jeans. I introduced myself and shook his hand–a baseball mitt-sized hand with the roughness, nicks, and cuts you’d find on a construction worker, which he was. As I was taking his history, I had flashes of him cussing like a sailor, beating up people he didn’t respect, and breaking up fights on the construction site. But he was nothing like that. He was quiet and very friendly. He answered questions, treated me with respect, and, when it was clear I was worried about him having pneumonia, asked very appropriate questions. I excused myself to discuss his case with the senior resident, who listened, then asked me, “What is his blood gas showing?” He hadn’t had one. “OK, then,” the resident said, “Go get one and let me know the result.” I’d performed one successful arterial blood gas, which we call an ABG. It’s a procedure that requires a steady hand, patience, and a bit of luck. Today would turn out to be an unlucky day. I sat next to Mr. S, his arm outstretched. I cleaned and prepared it, then felt for the critical landmarks. His arterial pulse was so strong it literally made my finger bounce on his arm. And yet, as soon as the needle punctured the skin, his artery spasmed, making it impossible to obtain the needed blood specimen. This happened two separate times. I was all alone at this point with Mr. S, when I looked him in the eye and said I was going to have to try again on the other side. He’d winced in pain with my second attempt, and I was visibly shaken when it failed. He rather calmly extended his other arm.
When I failed to obtain the blood specimen a third time–an attempt I made while fending off the butterflies in my stomach–I looked at Mr. S. He was nervous, and perhaps a bit frustrated. I excused myself to go get another syringe. The senior resident asked me how it was going, and I said, “Not well.” His response? “Well, go back in there and get it. I’m busy.”
When I returned, looking a bit defeated, I’m sure, Mr. S. looked at me, looked at his now bruised wrists, and asked me if someone else could give it a try. It took everything I had not to sprint out of the room. Eventually, my senior resident came in, and after two more attempts, was able to get the blood gas from Mr. S’s femoral artery.
The lesson in my journal under his name was clearly written right after that adventure. It simply states, “Know your limits and act on them.” I know exactly what that feels like now.
So went my medical school clinical rotations.
By the end of that rotation, my absolute white lab coat had taken on an ivory patina. I’d long ago realized that my stethoscope could double as a reflex hammer. Nobody ever carried a tuning fork unless they were doing their neurology rotation. My pockets looked less like a hoarder’s stash and more like a chef’s mise en place—every item earning its place over time. I was starting to believe I would be as likely to kill someone as anyone else in my class. And just in time, because I had to decide on a clinical specialty for my residency.
By then, I was committed to being a physician scientist specializing in what was called medical informatics, which is defined as information management to support medical discovery and practice. I knew I could be any sort of doctor I chose to be–my grades were good, and I was getting great feedback for my clinical skills and my basic knowledge of medicine. But I also had come to realize how neurosurgeons differed from internists. The choice of specialty was more based on a sense of fraternity and belonging than anything more erudite. For me, surgery felt…wrong. I didn’t find the lack of long patient relationships enjoyable, and the people seemed more interested in the operating room than the clinic room. My two favorite rotations were internal medicine and pediatrics. Internal medicine represented every lay person’s view of holistic knowledge and “sleuthing.” One of my attendings in internal medicine even smoked a pipe in between seeing patients!
Then there was pediatrics. Even thinking about me as a pediatrician made me smile. It was like choosing between the sophistication of a cheese plate and the delight of a piece of cheesecake. The cheese plate—internal medicine—was sophisticated, respectable, and always invited to the serious tables. It offered complexity, nuance, and a chance to pair well with big conversations.
But pediatrics? Pediatrics was cheesecake. Bright, joyful, unapologetically sweet. It made me light up inside. Some thought it was too soft, too simple—but I knew better. It took creativity, patience, and grit to earn the trust of a toddler and translate medicine into stickers and stuffed animals. Plus, I didn’t mind crying children, and I worked well with families. I also cherished the idea of saving the life of a person whose life was ahead of them. And pediatrics was no less complex a field than internal medicine.
In the end, my heart knew I wanted the cheesecake. But, like looking at myself in a mirror, I could not avoid realizing another fact.
All my life, I’d worn the labels that signaled “lesser”—sometimes pinned there by others, sometimes sewn in by my own choices. I was the Black kid in an all-white neighborhood, navigating sidewalks where I never quite blended in. I raised fish, geckos, even an octopus—creatures as misunderstood and fascinating as I sometimes felt. I pledged the so-called “nerd” fraternity, where others laughed while we built, questioned, and quietly thrived. So when it came time to choose a specialty, the pressure to pick prestige over joy felt familiar. Internal medicine was the sharp suit: buttoned up, serious, invited to the important rooms. Pediatrics was the bright sweater with dinosaurs on the pockets—warm, disarming, often underestimated. And after a lifetime of proving I belonged, I hesitated. Could I really choose yet another path that others might see as second best?
I could think of only one way to make this decision. I spent the two most challenging months of training doing a sub-internship in internal medicine. I was basically treated the same as one of the first-year residents. I worked alongside one of them, admitted patients, wrote notes, suggested tests to order, and spent a lot of time caring for our patients. I started this in June, which is the month most first-year residents are happy to give the subintern all the work they’ve had to deal with in the previous 11 months. I did my second 4 weeks in July, which is the month when the second years most depend on the subinterns to teach the interns about the hospital system and the nuances of being the sous-chef–the one who does the real work–of getting patients admitted, cared for, and discharged.
The experience could not have gone better! By the end of the rotation, my residents and even Dr McKusick himself worked to recruit me into medicine.
It was right after rounds one day that Dr. McKusick walked through our floor and pulled me aside. “Kevin, I’ve been hearing quite a bit from the senior residents about how much you became one of the interns within a few weeks of this rotation. They and I are wondering if you plan to apply to our residency program? It’s tough, and one of the most competitive in the country. But I think you’ll get strong letters based on your experience on the Osler subinternship these two months.” And then, he winked at me.
I was beside myself. I’m sure I had goosebumps, a puffed-out chest, and probably a slightly reserved kid-on-Christmas grin as I thanked him and assured him I’d be hoping to stay at Hopkins.
I just didn’t tell him that at that very moment, I’d decided on pediatrics.
On my next rotation in cardiology, my first day, we saw a patient for a new-onset heart murmur. I talked with the patient and family, and sat down on the floor to listen to the child’s heart. I was still wearing a somewhat wrinkled and irreversibly stained white coat with my well-used stethoscope draped around my neck, now with a stuffed animal clamped to the tubing. I suppressed the kid-on-Christmas grin, but I definitely felt the joy.