Decus et Tutamen

Decus et Tutamen
–An Ornament and a Safeguard–
Virgil, The Aeneid, Book V

It was done with a minimum of ceremony.  Boxes filled with plastic, each bag encasing an all-too-bright white coat.  Names yelled out, each of us awkwardly clinging to our new posession.  It fit–or at least outwardly it did.

The coat didn’t appear outside of the confines of my closet much for the first year.  Maybe an appearance or two to take a history and do a physical.  The preceptors knew full well you knew little and, mercifully, were patient with you when you reported every slight skin discoloration or the patient’s entire family tree.

But the patients.  They called me doctor.  I’d gently correct them, as I had been taught to do.  But shocked–couldn’t you tell how inept I am?  Each fumble of my hands as I reach for my stethoscope betrayed me; each lie I told as I listened to your heart and pronounced it as “sounding fine” must have been written on my face.  Because the truth was–I didn’t know that.  I knew what I was supposed to look and listen and feel for, but only if you stepped fully formed from the pages of the textbook.  I kept thinking, why do you trust me?  Please don’t trust me.  I’m nothing like the person I’ll report to in just a moment, who somehow knows that the small area on your back is okay, that your heart sounds just fine, and that you’re healthy.

This coat was a lie.  But I still wore it.

* * *

Months passed, and we began the clinical year.  The coat saw daily use now, smilingly reassuring people that, yes, the enveloped person is for real.  Liar.  I blundered left and right, asking questions, palpating, percussing.  That time the harried resident told you to go “work up a fever” on the 14th floor.  It was my first night on call ever.  The coat and I walked into the patient’s room with an air of confidence.  Yes, she looked ill.  Yes, she felt warm.  But why was she even in the hospital?  You didn’t even look at the chart.  Idiot.

The coat should have leapt off me and found someone more worthy.

* * *

Three months more.  A “skin infection,” my preceptor called it.  Huh.  Got it while gardening, stuck herself with a rose thorn.

“Sporothrix infection.

Was that my voice?  A piece of trivia had floated to the surface, some vague association from hours of lecture.

We looked it up.  It was a possibility.  We changed her treatment.

“Good job.  I wouldn’t have remembered that.”

Right.  One trivial piece of information is all it was.

The coat smiled to itself.

* * *

More months later.  Pediatrics, my first love.  Time to see D____, a fifteen-month-old child with multiple congenital problems.  I introduced myself to the parents; ah, a questioning look. They’ve seen through my disguise, haven’t they?

“It’s okay, but you should be warned–he doesn’t really like doctors, he’s been through so much.”

A brave smile, some reassuring words.  The coat comes off, hung on the door.  You’re too powerful an association for a little kid.  Sit on the floor, talk to the parents while he builds fanciful stories out of blocks.  Play with him a little.  Then try to listen to his chest.

I heard the delicate rise and fall of healthy lungs–and a muffled gasp from the parents.  I guess they didn’t expect him to cooperate.  Then again, I’m not sure I expected that either.  But I’m having too much fun, sitting on the floor–so much fun that my hands forgot to shake while his parents watch me gently handle their child.

At the very end, he took my hand as we went down the hall for a sticker–but we only got about six feet before he realized and ran back to his parents.  His parents, who are telling my preceptor that I must have worked some magic because he hadn’t had an exam where he hasn’t cried in months.

I don’t have any magic, ma’am.  I was just lucky.  Magic are all these real-health care providers.

* * *

So I graduated.  Now I was working in Peds.  I had gotten used to the idea of being a student, just in time to stop. The short coat wasn’t so bad, because it at least let those “in the know” see that you really don’t know much.  No license to do anything–except a license to mess up.

But now, somehow, the state seemed to think that I was qualified to practice medicine.  How could they?  Sure, I graduated.  And passed exams.  But didn’t they know that I had been pretending?  How could I wear this long coat now?

Two months in–K_____, a seven-year old with behavioral concerns.  Not quite–her mother had the concerns.  This child didn’t take too kindly to me.  I was used to crying and struggling.  I was not used to her grabbing a stool and attempting to charge me with it.  Or throwing a heavy otoscope handle at me.  (She missed both times, if you must know.)

My supervising physician didn’t really care for behavioral problems–and he wasn’t in today anyhow.  We didn’t have any child psychiatrists or developmental/behavioral specialists in town, eitehr.  The other pediatricians knew even less about these things.  I didn’t know what to do.

I ended up on the floor, holding K_____ in a bear hug, telling her that I didn’t know why she was acting this way, but we’d find some way to help her.  And somehow we did, after some time.  A psychologist agreed to see her, and I hoped it would help, because I had no idea what other resources we had.

I don’t know if I had done the right thing–did I make things worse by holding her like that?  I only could wish that I hadn’t.

* * *

I didn’t see her much for the two years after that–an occasional sniffle or the like was all she came in for.  I never mentioned that episode again.  Looking back, there were resources we found for her that came in handy for so many other kids.  I guess there was some good to being attacked by her.

She was actually turning out to be a well-behaved, sweet child.  A good thing, too–her mother had another baby, one who turned out to have an uncommon metabolic disorder.  A frantic morning of trying to track down mom and baby had ensued after the call from the state labs.  She came in, we changed the infant’s diet.  I spent a good deal of time explaining the disorer in layperson’s terms.  It felt good when I asked her a month later how the visit with the metabolic disease specialist had gone–“They didn’t tell me anything that you hadn’t already covered!”

K_____ came in once to her little sister’s well-child exam.  This was a good two and a half years later–I was sure she had forgotten all about taht day.  The student I was precepting reported to me and we finished up the visit together.  All fairly routine, thank goodnenss.  As we walked out of the room into the hallway, K_____ pulled on my sleeve.

“Mister D?”


Hesitatingly at first, but then with more confidence, “I’m…I’m sorry about that day when I threw something at you.”

A quick look at mom–her expression confirmed that this was uncoached.

“It’s okay, sweetie.  I’m just glad we could help you.”

Upstairs, in a closet, my white coat chuckled to itself.  It knew all along.


Dipesh Navsaria, Urbana, Class of 2005