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First Day on the Job: Joining the Herd

I introduced myself to a patient as “Dr. Lalley” for the first time yesterday. She had tested positive for COVID-19, so my face was obscured by a shower cap, a riot-gear face shield, the ubiquitous surgical mask, and a more coveted N-95 mask. The rest of me was layered with a yellow tear-away isolation gown, mismatching blue paper gowns, a zip-up jacket one layer deeper, and my own green scrubs, buried by it all. Nowadays, healthcare providers are distinguished only by our height, since even our shape has vanished.


Everyone’s voice is also muffled, so the patient asked me to repeat myself, and I did, nearly shouting.


“MY NAME IS DR. LALLEY!” I pointed to the label I had stuck to my face shield, since my photo ID was deeper than dinosaur bones.


“Oh!” she said. “I hope I remember that. I’ve seen so many doctors, and you all look alike!”


It felt strange to be mixed up with other doctors. Strange, too, to see how easily she believed the title, since it’s hard to believe myself. For so many years, I focused on hitting academic benchmarks so that I could convince others that I was fit for this job, and yet all this time I forgot to convince myself. Now I feel as though I have to earn what I’ve asked for and already been given.


As a medical student, introductions to patients can be long-winded and oddly technical. If an attending announced me, or if I said hello on my own, I often abbreviated my position as “Student Dr. Lalley,” or I used the less-formal-and-therefore-less-official-seeming “Dr. Adam.” A few times, especially in the last months of school, I tried out “Almost Dr. Lalley.” But it never felt real. It felt like shorthand for my actual role, which I felt obligated to clarify at some point, if only to elucidate the hierarchy. Sometimes patients insisted on calling me a doctor anyway. I felt flattered, but in my head, I appended that thought with a mental asterisk: not yet.


We’re still in pandemic times, when everything we do affects everyone around us. Every host is a vector, and we stay home alone out of a sense of togetherness. During my first post-COVID day back at the hospital, I spent much of my time keeping track of what I had touched, not only for my own sake, but also for the entire hospital staff, most of whom I don’t know. I washed and re-washed my hands until I nearly erased my fingerprints, those icons of identity. My phone, which warehouses old childhood photos, my digital wedding album, and details about everyone I love, failed to recognize my thumb. (For those with newer devices, the facial recognition feature is yet another casualty of this crisis, since everyone is masked.)


Just as the public learns more and more about “herd immunity” – the protection of an uninfected person by the crowd-sourced antibodies of everyone infected before – the hospital relies on a herd trust when it comes to prevention. We’re battling an invisible enemy, invisibly transmitted, even infecting invisibly, due to the frequent lack of symptoms. The inconvenience of self-sacrifice is no doubt unnecessary much of the time, but it’s impossible to know. We have to act in good faith, which will occasionally involve washing our hands of no virus, protecting others from no germs, wiping down clean surfaces, and discarding uncontaminated gowns, all on the chance that you might save the life of a stranger with whom you share the same mission.


Being branded as a doctor means joining a different kind of herd. To become a professional, even to be professional, is to cede aspects of your individuality for the sake of something greater, to put aside your own interests and opinions when they don’t serve the purpose of your role. Medicine is a guild with a common oath and common sacrifices that lead to common benefits. For physical exams, we look deeply and directly into patients’ eyes, place our fingertips on their faces, necks, breasts, and bellies. How did we earn this intimacy?


During my third-year medical school psychiatry rotation, I remember listening to three teenage girls who had tried to end their lives. They all admitted to me at the time that they would probably try again if they had the chance. How do we elicit and honor that openness and honesty? When I examine a patient, either in a physical exam or a mental status exam (“the physical exam of psychiatry”), a patient’s trust in me is underwritten by every doctor they’ve encountered before.


In retrospect, it was probably fitting that my patient yesterday mixed me up with every other physician, because I borrow from their professionalism every day, and insofar as I borrow from it, I’m also indebted to it. In a way, the actions of any doctor affect the reputation of every doctor, just exactly as the support I’ve felt as a healthcare worker during this COVID crisis is drawn from a well that has been dug for every pharmacist, EMT, paramedic, PA, nurse, tech, PCA, patient transporter, administrator, unit secretary, case manager, social worker, environmental services employee, food service worker, and other support staff – all of us part of a hospital, state, country, and species fighting against our own attrition. We’re all in this together - past, present, and future.

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