White Coat Ceremony Reflections
From the Class of 2022
Not Just a Badge of Honor
Day 1 in my white coat:
The keynote speaker of our white coat ceremony held the arms out allowing me to slip into my new pearly white coat for the first time. I remember feeling humbled and grateful for the opportunity to represent such a noble profession. One of prestige and promise.
Some time after Day 1:
“Of the sleeves, I remember their weight like wet wool on my arms.” The beginning of Marvin Bell’s The Uniform describes what I felt when I put my white coat on to see patients for the first time. It was still humbling, and I was still grateful... but there was something new that I hadn’t noticed the first time it was draped over my shoulders. It was its heaviness. Ironic because I was standing on the shoulders of so many. To carry this load is a gift and a privilege. A dream of every black parent. I was now a black man in a white coat. A rarity. A sparse dichotomy.
Every day up until May 25th 2020:
I try not to dwell on my blackness when I’m in my white coat. This is a defense mechanism to avoid the crippling truth that race permeates just about every aspect of American life. Well, at least it does for me. So instead of dwelling, I use it for empowerment especially now as rotations and match day ominously lie ahead.
Those words hold the same value today as they did when they were written months ago. Just more relevant I suppose. It’s a shame that it took the death of one for all to see in order to breathe life into an uprising against a system that wasn’t built for me. Mr. Floyd could have been me or any black or brown person walking the streets of Philadelphia.
Instead, I’m lucky enough to be here. But I must confess... when I started this journey, the white coat was in honor of those who had gotten me here and dedicated to family members who had fallen victim to the ugliness of disease. My reconciliation with those tragedies was making my family proud. But I’ve come to realize that the white coat means much more. It is a tool to be used in the constant battle with the ugliness of overt and systemic racism to promote health, especially in underserved black communities. It is a tool to be used to erase the blackness-is-a-"risk factor” rhetoric that is so pervasive in medicine. It’s a tool to be used to help bring equity to a broken system. It is a tool not just a badge of honor.
Striving Ahead and Remembering Home
I wonder if my grandfather, helping his father fish in the rocky waters off the coast of his small, rural Irish village where he shared a one room home with his 13 siblings, ever imagined his granddaughter would be a physician one day. I wonder if he, when he got his first pair of shoes at the age of 13 and had to move to the city of Galway to work at a small pharmacy to send money back to his family, ever imagined his granddaughter would be the one writing the scripts one day.
I wonder how my grandmother, who found happiness in being gifted an orange for Christmas as a child in her poor, rural Irish village, would feel if she were alive to attend my white coat ceremony and medical school graduation. I wonder what she, having immigrated to the US to work as a maid in the Mayor of Boston’s home, would feel if she knew her granddaughter would one day be caring for the lives of others.
My grandparents, despite their struggles, established a life in the US in which their children could thrive and prosper. I fortunately grew up in a middle-upper class home, with all of the opportunity in the world at my fingertips. Just a few blocks away from my home, however, were the public housing projects where most of my friends lived. The children of hardworking Dominican and Haitian immigrants, their parents were not able to help them with homework, college applications, or FAFSA. Once ignorant to our differences, as I grew up it became all too apparent how different the trajectory of our lives were.
I think of Ariana, who had no choice but to work after high school to help pay rent, as her mom had suffered a leg amputation from uncontrolled diabetes and was unable to work. I think of Bruso, who turned to selling drugs to try to support his family and build wealth, who was shot to death over a drug deal gone wrong. I think of Rizzo, who overdosed just two weeks ago as he self-medicated his traumas with Percocet, and who never fit our societal image of an “opioid user”, so he never thought to seek help.
I can never forget where I come from – where my grandparents come from – and the opportunities I have been afforded because of their hard work, suffering, and sacrifices. I can never forget the friends I grew up with, who were never afforded the same privilege and opportunities as me, but who deserved them all the same. My white coat represents everything my grandparents went through, all of their trials and tribulations, so that I could be here today. My white coat also represents the privilege and vessel in which I will serve and hopefully help improve the lives of those who suffer and struggle because of the societal barriers that keep them from fulfilling their full potential and achieving good emotional and physical health. I owe it to Ariana, Bruso, Rizzo, and so many more.
They See a White Coat
Leah A. Goldberg
They see a white coat.
They see a cloak of knowledge and privilege and access.
I see my family tree.
A great grandfather who at 6-foot-1 worked in the coal mines from dawn to dusk.
A grandmother who worked both the afternoon and night shift in the local bubble gum factory so that she could send her kids to school in the morning.
My mother, the first in her family to go to college, who taught me what it means to exist as a professional woman in this world; who teaches me what it means to be soft in a world that is hard and what it means to stand up in the face of seemingly insurmountable obstacles.
I know what it means to see a white coat when you hear bad news. I know how hard it is to detach that glaringly bright coat from a life changing moment. I have felt the painful impact of the white coat changing my own life.
I have seen my white coat slumped upon my bedroom chair like any other sweater, and I have seen others’ starched and fresh and telling me news I didn’t ever want to hear.
When I wear mine, they see armor, but I do not feel protected. I am not saved from either giving or receiving devastation. I am human, I am fallible, I am mortal.
They see a white coat. I wish they saw a person.
Putting on a white coat means becoming both a leader and a servant. It means being in charge and taking decisive action while providing support and advocacy for my patients and their communities. I hope that putting on my white coat will never lose this meaning.
Putting on a white coat means stepping out of my comfort zone. It means acknowledging my quiet and reserved nature while making an effort to be more open and inviting for my patients while still being genuine and true to myself. I hope that one day, putting on my white coat will mean stepping into my comfort zone, like greeting a dear old friend.
Putting on a white coat means becoming the person with the answers. It means I am responsible for someone's health, and they are expecting me to solve their problems, and maybe even save their life. Putting on a white coat is putting on the pressure of that responsibility. I hope that one day, putting on my white coat will feel more like putting on a favorite sweater or a warm cozy blanket on a cold rainy day.
At this point in my training, putting on a white coat can sometimes feel like putting on a costume that doesn't quite fit, like maybe it was made for someone else. It can feel like getting on stage and saying the lines I've been rehearsing while everyone tries to play along. I hope that one day, my white coat will finally fit and I can say the role of Negene McLennon, M.D. was always meant to be mine.
No Whitening Needed
I’m afraid to wear my white coat every day.
When I think about what a white coat means, I recall a track off of Ruby Ibarra’s album: Circa 91. An immigrant from the Philippines, Ruby moved to the US as a child with her family. Her musical work speaks to the Filipino diasporic experience.
The track is called Brown Out.
A prelude starts, played on a guitar strummed in chill, fingerpicked fashion. It’s joined by a breeze skipping though California palm leaves, by the laughter of children at a playground, and by the low hum of cars on a distant street. A mother’s voice calls out in Waray, a central Philippine regional language.
“Come inside or you’ll get dark. You’ll get ugly if you get dark. Hurry up.”
A lofi sample beat overlays the guitar as the music swells; the first lines proclaim:
“They teach me to erase that brown, subconsciously I lose my crown
‘Til I don’t even recognize the person that’s inside me now”
The first time I heard those lines, I cried. I was sitting on the SEPTA Broad Line, on those bright Tang-orange colored seats, sometime in my post-bac year in Philly — 2685 miles away from my home in California, 8522 miles away from the Philippines, the home of my parents and ancestors. I had a feeling, even then, that I was entering a white institution, filled with white skins, and white coats, and white mentalities. I felt so out of place then; and despite progressing so much, I still often feel out of place now.
I’m a three time med school reject, who spent three years freelancing, filmmaking, and pursuing creative odd jobs. I would tell folks all the time: I want to be a director and a doctor, and they would laugh.
But more importantly, hardly anyone here looks like me. I’m one of the only Filipino males at this school. And in terms of role models, I’ve seen one Filipino faculty in the hospital system. We’re not accounted for in public health research, and even the one public health stat of Filipinos being at higher risk for disseminated coccidiomycosis erases the long history of Filipino migrant farm labor and activism in dusty farms all over the West coast in the 1920’s through the 60’s.
Later in the song, Ruby Ibarra raps,
“I look in the mirror then all that I see
Is a version of me that they want me to be
Plus all of these lies I adopted see
I’ll never be what they want me to be”
A later verse goes,
“I whiten my skin ‘cause it’s all that I see
No image of me represented to be
Myself so I’m looking for ways I could be
Exactly like people they teach me to be!”
There is a rampant colonial mentality in Filipinos and Filipino Americans even today, a white superiority masked as culture. Bars of whitening soap are marketed to the masses, advertised to whiten the skin of naturally brown and black Filipinos, all to chase a beautiful Western, European whiteness.
I don’t whiten my skin. But putting on my coat every day will remind me that I’m quote unquote “moving up.” Like bars of whitening soap, my white coat will hide my skin, and every day, as I learn on my rotations, I will pursue an image of me that I’ve never seen. An image of me that I won’t recognize. An image of me swathed in white. It makes me afraid I’ll lose myself. I’m afraid that in becoming better at the practice of medicine, I’ll slowly become the System of medicine.
But wearing the white coat makes me want to step up; to defy these fears; to embrace the mentors and folks who have helped me thrive thus far; to let my believers know that their faith isn’t misplaced in me and to open myself to constant accountability and evolution; to be the image that I never got coming into medicine.
And god, I hope my brown skin and mind shine so bright, my white coat becomes invisible.
My White Coat, My Cape
The day my white coat was bestowed upon me, I felt great pride;
In all the hard work and dedication towards my future finally paying off
In seeing not only my dreams, but also those of my family coming to fruition
and in feeling the awe-inspired stares as my classmates and I dawned our capes.
As soon as I put on my white coat, I could feel people look at me differently;
Treat me differently.
People I had never met before put so much trust and respect into me.
It’s an incredible privilege that comes with its own inherent power.
As if the great physicians who came before me had sewn their power and wisdom into the very fabric of my coat.
And with great power comes… well you know the rest. (RIP Uncle Ben)
My white coat is not only laced with great power,
But also generations of prejudice and experimentation which have tangled into knots within the deep recesses of its pockets and inner linings.
These knots weigh down my coat, and serve as a constant reminder to patients who have been hurt and discriminated against by the medical community
– People of color, Indigenous people, people of the LGBTQIA community, and so many more –
That trust needs to be earned, and never freely given.
So it is up to me, and my classmates, as the future generation of physicians,
To work with our patients to untangle these knots,
And rebuild that trust.
To wear the cape or to not wear the cape? That is the question.
According to a wise costume designer who pointed out the tragic deaths of
Thunder Head, Strato-Gale, Metaman, Dynaguy, and Splash Down,
Wearing a cape can be dangerous.
It creates a divide between the patient and myself, and sets up a dynamic in which I hold most if not all of the power.
It’s hard to say whether I will continue to wear my white coat as I progress through this journey.
I’ve definitely worked hard enough just to earn it.
But my knowledge and power do not come from it,
And neither does my ability to form meaningful, healing relationships with my future patients.
Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.firstname.lastname@example.org