Dr. Rebecca's Coat: Blood, Sweat, & Ink

A handful of cotton swabs. Two different detergents. An enzyme cleaner. A bucket.

Two wash cycles.

One white coat.

Dr. Rebecca's white coat, to be specific.

This is from when Dr. Rebecca's coat was new. Sarah, our niece, has a white coat too, so that she can play doctor, nurse, veterinarian, chemist, or whatever else goes with white lab coats!

While I will never stop believing that the color choice for a doctor's coat is ridiculous, let me tell you how I spent my morning and why I did it.

My helpmate's white coat is in rough shape. She's working with an ear/nose/throat clinic right now, and a patient with a severe nose bleed sneezed on her. I'll spare you details beyond that, but a white coat suffered the consequences.

When I started spot treating that (a service I don't normally provide since I'm a terrible med wife, but I had time today and Rebecca doesn't), I noticed other stains. And I started reflecting on what all the stains mean. Here's the story:

Blood stains and other bodily fluids are obviously part of a doctor's work day. They spend their time saving lives. That's messy. They're there for the most vulnerable health moments, asking incredibly personal questions, palpating, listening, sometimes having their clothes marked, and more often, carrying marks on their hearts from the stories they've heard. Rebecca once listened to the story of an elderly WWII veteran as he explained his experience in the war. By the time she finished summarizing it for me (minus identifying details), she was in tears. I was in tears. She had offered him options, but he was actually there for something else and told her that he had learned to live with the trauma and nightmares that had never gone away.

The blood washes out. The story stays.

What other stains did I find?

Sweat stains, around the collar and underarms. Rebecca is required to wear a white coat over her other clothes on some shifts, regardless of the temperature and regardless of how fast she has to move. So she sweats from running codes, standing under surgical lights, and making difficult decisions. She's worked shifts as long as 30 hours without sleep or shower and comes home exhausted. The sweat stains are harder to get out than the blood stains, and I can never make up for her stress and exhaustion. It's the price of US residency.

The hardest to get out, though, are the ink stains. I may not manage it. A huge portion of Dr. Rebecca's job is paperwork, so she keeps pens in her pockets, along with little notebooks or scratch paper. Though she does slightly less paperwork now that she has proceeded partway through residency, a large percentage of her day is still spent taking notes, filling out forms, and fighting EMR and insurance companies.

She could do less of this, perhaps, but she knows that her patients benefit from properly completed paperwork, and often, there isn't anyone else to do it. People don't realize how much bureaucracy and administration is involved in a doctor's work - the stock photos show them interacting with patients, performing surgery, or in the lab - but we've created a medical system in which documentation and paperwork often determine the quality of subsequent patient care. And residents bear the brunt of that, especially primary care residents, especially family med residents. Rebecca got her start in medicine filling out patient assistance forms to get uninsured, rural, low income patients prescriptions from pharmaceutical companies, not standing in ORs observing. So while she has no love for paperwork and would rather be providing direct patient care, she is good at paperwork and takes pride in completing it well, even if it means bringing some home after a full day of work (or even over-full day).

When we're dreaming of our lives later, moving to Canada comes up often. We loved Montreal when we were there a few summers ago. And she knows that she would do less paperwork as a doctor there, without losing income. Why? Because a huge percentage of US health paperwork is related to insurance or lack thereof, and particularly the proliferation of different private insurance providers and plans.

The ink is the most soul-sucking of the stains. She chose medicine to heal people and knew she would work hard doing it. She always accepted that there would be blood and sweat stains on her white coat. I don't think she realized how much time and energy paperwork would take.

And so, I've come to realize that ink is not only a stain on her coat, but a blot on our nation's ability to care for the vulnerable among us.

I need more than cotton swabs and enzyme cleaner to fix that.