My ridiculously heavy white coat (4/12/11)
Every day before I go to work, I don a white coat – all doctors, clinical officers and medical students wear one as our identifying uniform. The absolute best thing about a white coat is the number of pockets – I don’t carry a bag because in my coat pockets I have hospital protocols, an otoscope/ophthalmoscope, pulse oximeter, reflex tendon hammer, patient note cards, tape measure, keep-the-TB-out face mask, thumb drive for teaching, glasses, hand gel, emergency chai money, beeper and small umbrella (because you can guarantee it will rain at some stage most days). I could pretty much camp out for a week and survive if I got locked out of home. Or at least set up an ad hoc clinic.
The absolute worst thing about a white coat is the number of pockets. My white coat weighs a ton. And as soon as I put it on in the morning, I feel weighed down.
It’s interesting, the weight I carry at work. The weight of feeling that I’m not knowledgeable enough, that when the new ICU doctor calls me for advice on a child, I may not know the answer or I may not be skilled enough to put in a needed central IV line. That one of my decisions may make a child worse, that my lack of understanding of Kiswahili and Somali means I may miss subtle but important cues. That I am spending too much money doing tests on a child, that I am not doing enough. That I am trying to do more than I am able by not referring enough children for specialist care, that I am referring too many because I should be more able to manage these conditions.
The weight of having to decide to take a brain injured 2 year old child off the ventilator right now, knowing they will probably die, because there is a 30 year old bleeding to death in the next ward who may actually make it if this bed in ICU becomes available for her. The weight of wondering, was the brain injured when the baby came in, or could it have been because of something we did or something we missed?
At the end of the day, it’s a real discipline to take off my white coat. To not wear the heaviness home, to leave my coat in the laundry where it belongs. It’s really easy for me to keep my pockets full at night, on the weekend, to forget that I can empty those out and feel the lightness of being at home, away from work, and to be fully available to my husband, kids, friends and distant family.
Tomorrow, there is a very good chance that all of our interns will be on strike as part of a national call for better wages, as well as our Kenyan doctors who are employed by the government. This will leave us, especially overnight, overwhelmed by calls usually fielded by our junior doctors, and possibly overwhelmed by patients who come to us because we will be one of the few hospitals that still has any doctors working at all. And over December, we are all attempting to take some leave – which means the workload for those of us remaining escalates.
The trick, our medical director has been encouraging us, will be to not make our white coats heavier. To realise that the pockets are full already – and that we may need to be comfortable with that. To realise that we are not capable, nor should we be, of providing 100% of what we really want to provide with the resources we have. To realise that we need to prioritise how much of the load we are mentally shouldering, for it to be OK to say, I may need to spend less time micro-managing this child, to be prepared for some things to slip through the cracks and for it to be OK.
And then to take our white coats off at the end of the day.