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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Tuesday, April 10, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. A short white coat is the hip-length garment worn by medical students to signify their place in the medical hierarchy. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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Under the mandate of Harvard Medical School's recently unveiled New Integrated Curriculum, my professors draw connections with fresh gusto, whether it is between disciplines or from benches to bedsides.

For one such integrated experience during my physiology course, I accompanied classmates to the intensive care unit at Beth Israel Deaconess Medical Center one day last month. Eight of us gathered in a meeting room outside the unit so that our professor could tell us about the patient we would observe and discuss, in an attempt to heighten our textbook appreciation of the lungs and kidneys.

As he finished describing a 45-year-old woman's unrelenting multi-organ failure and led us into her room, I mentally prepared myself for the sight. It wasn't my first time in the ICU -- I had been exposed as a candy-striper in high school - but it was the first time I could bring any real medical knowledge to bear in such a setting, and it was a daunting prospect.

The patient's face was pea green from liver failure; a labeled rectangle of scotch tape was affixed to her left cheek as if it were an inanimate object. I stared dumbly at her lying there, machines taking over for virtually every function of her organs. She seemed a bridge between the cadaver that first appalled, then hardly fazed me in anatomy class last fall, and the patient whose medical story I had solicited in a practice interview the week before.

Pausing little for reflection himself, my professor began to quiz the group on her heart function and prompted me and my classmates to do quick mental calculations of her breathing volumes. In these moments of first-year naivete, it was a glimpse into my third and fourth years in the clinics, and the ritual of being "pimped" by medical superiors - that is, questioned on medical knowledge in front of patients and hospital staff. Wondering whether she could hear me in her comatose state, I swallowed my sense of futility and started to do the math.

I was connecting my textbook learning with the patient case in front of me, certainly. But I was also helpless to do anything with that connection to actually help her, and my presence in that room - my integrated learning experience - seemed an impediment to any hope she had to survive. Despite my rational understanding that I was being trained to treat future patients like her, I felt uneasy to be using her for pedagogic ends, and dreaded the thought of her loved ones walking into the room.

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