MIND ON THE RUN
Removing Blood from the White Coat
By Anthony Kovatch, M.D., Pediatric Alliance — Arcadia
“The credit belongs to the man who is actually in the arena; whose face is marred by dust and sweat and BLOOD; who strived valiantly: who errs and comes short again and again: who knows the great enthusiasms, the great devotions, and spends himself in a worthy cause.”
— President Theodore Roosevelt
Musical accompaniment: “When They Begin the Beguine” by legendary songwriter Cole Porter (Sung by Johnny Mathis)
When they begin the beguine
It brings back the sound of music so tender
It brings back a night of tropical splendor
It brings back a memory ever green
I’m with you once more under the stars
And down by the shore an orchestra’s playing
And even the palms seem to be swaying
When they begin the beguine
Such was the mood. The universal glow of pride, esteem, and exultation of the nascent future were palpable throughout the solemn morning ceremony and into the evening celebrations. It was the traditional White Coating Ceremony launching the careers of 270 student-doctors — the 2022 class at Kansas City University School of Osteopathic Medicine. To a man, the diverse, multi-ethnic, “ever so green” group of honorees, hailing from virtually every state in the country, including Alaska and Hawaii (and Canada as well) had already gone through medical school in college to prove that they could cope with medical school in medical school. All had survived the convoluted process into which acceptance to medical school has evolved; their “fortune cookie” revealed the true destination, the pain of their previous empty fortune cookies no longer even a memory.
They had been well-educated in the importance of the humanities and of collaboration (unlike my own generation and the previous generations of “giants” upon whose shoulders all physicians stand). The infatuation with the medical career prevailing in the auditorium stirred up in my mind the fatalistic love song of Cole Porter: “When they begin the beguine… it brings back a memory ever green.”
As the celebration was concluding, the master of ceremonies jokingly remarked: “Your coats will never be so white again as they are this day!”
The inaugural White Coat Ceremony — or more correctly, White Coating or “Knighting” Ceremony — took place in 1993 at Columbia College of Physicians and Surgeons in New York City. The founder, Doctor Arnold Gold, a pediatric neurologist, intended the public donning of the short white coat on the medical student as a symbolic rite of passage into the sacred profession of medicine and a “pledge of allegiance” to its venerable code of ethics, the Hippocratic Oath. Many other branches of the medical field have since “followed suit.”
The corresponding Osteopathic Oath solemnly states:
I do hereby affirm my loyalty to the profession I am about to enter…
to preserve the health and life of my patients,
to retain their confidence and respect both as a physician and a FRIEND,
who will guard their SECRETS with scrupulous honor and fidelity.
However, as the names of the noble 270 were recited in litany, my mind wandered to more philosophical spheres. Time inexorably marches on and this day the profession has lost many of its friends and has had to disclose many of its own dark secrets.
Metaphorically, medicine is a “blood sport.” Just like bullfighting. Running guru, Doctor George Sheehan, has said that running is a blood sport, as is facing death. The analogy is obvious in every marathon run, in any being who is facing the suffering of terminal cancer, with every physician since the beginning of time agonizing over matters regarding life and death or over decisions weighing aggressive treatment versus “watchful waiting.”
(Football is rarely a blood sport — but it can be.This iconic photograph of New York Giants quarterback Y.A. Tittle in the Pittsburgh Post-Gazette shows the Hall of Fame quarterback bloodied and concussed after being sacked by the Steelers in a game at Pitt Stadium in 1964; blood dripping from his bald head, the event symbolically marked the end of Tittle’s illustrious career.)
Medicine is infiltrated with contradictions. The medical student wonders: Although I am of the intellectual elite, will I be able to keep abreast of my peers and to live up to the high standards of my school? The intern worries: As I work 36 hours straight without sleep for continuity of patient care, will I pass out from exhaustion or physically or mentally decompensate? The practitioner agonizes hourly: Am I competent to manage this scenario, and have I satisfied my patient who has placed all trust in me, as well as the corporation to whose rules I must be compliant? Can I figuratively stop all bleeding and weeping all of the time?
We all face the same insecurities and trepidations: Am I a “good doctor”? What the hell IS a “good doctor”? Do I suffer from burnout? Where will I find my life-sustaining self-esteem after I retire? Has my quest for fortune and fame unwittingly caused the corrosion of my original lofty ideals and aspirations? Can I be spiritually “resuscitated,” like author AL Cronin in his autobiographical novel, “The Citadel”?
Have I won or lost my race — my blood sport? How do I get the blood stains out of my white coat?
The music takes a downturn:
What moments divine, what rapture serene
The clouds came along to disperse the joys we had tasted
And now when I hear people curse the chance that was wasted
I know but too well what they mean
So don’t let them begin the beguine
I only wished I could stand up within the audience, run to the stage and (like the fool I have become) untimely grab the microphone and give the noble 270 their first and last lecture on the art of medicine:
“Blood is easily removed from a white coat by soaking with hydrogen peroxide (or, if not available, by cold water, as I learned years ago from my wife). Similarly, blood stains on the psyche are not indelible — they are far more difficult to remove, but can be cleansed by self-compassion, deflection of focus from oneself to others, and by loving whomever will allow you to love them in return. The solution is simple, but can be impossible without ‘a little help from our friends.’
“Many years from now you will have absolutely no idea as to the whereabouts of these short white coats — they will have been dirtied and frayed from hard work and sweat, but will still be glowing from the embers of today’s conflagration and free of blood and of regret. And very importantly, you will recollect the oath you all took today:
“I will look with respect and esteem
Upon all those who have taught me my art
(Never forgetting that our patients are also our professors and friends, and, sometimes, even our confessors)
As the song of our career comes to an end”:
O yes, let them begin the beguine, make them play
Till the stars that were there before return above you….
And we suddenly know what heaven we’re in
When they begin the beguine”
(We’ll get by with a little help from our friends!)