The bag kills the fear. The bag is the mindsaver.

Above: retro/vintage flight bags from KLM and Aeroflot, from inretro.net. Below: my bag..

Today, I bought a bag, and I fell in love with my bag.

My bag is a dorky bag. I wouldn't buy or wear it under other circumstances. It's like a wierd zipper-heavy backpack-influenced re-creation of airplane bags that the airlines used to give out in the 1960s, but without the cool retro airline logo design.

REI calls it a "Boarding Bag"; like its predecessors, it's designed to be a small carry-on bag that holds the stuff you want on an airplane journey. Probably only someone who was a little worried about flying would buy such a thing. I didn't buy it for flying. I bought it for the hospital. But I did buy it because I was worried.

To explain this dorky-bag purchase, I must first explain that among medical students, interns, and residents, there are white coat people and there are bag people.

White coat people take their notes and reference books and PDAs and energy bars and reflex hammers and shove them all into the various pockets of their short white coats. The very disciplined or the wildly neglectful can get away with this easily: either you pare your carry-around stuff down to an incredibly small amount of stuff, in which case your white coat can easily handle it; or you simply leave all your stuff at home and try to get by without it. (In which case you never look anything up unless you're sitting at a computer terminal, and you test your patients' reflexes by hitting them with the end of your stethoscope.)

The much more common approach is to jam your pockets full of as much stuff as you can get into them--and at my hospital, the pockets are really big, and durable. A woman at the education office said, "I had students show me how big the other hospitals' white coat pockets were, and then I went bigger." My hospital is nothing if not scrappily competitive.

Unfortunately, this creates two more problems: the gunfighter problem, and the water-carrier problem. Because there is so much stuff bulging out of your pockets, you have to walk around with your arms out, like a gunfighter, or a police officer. Also, the stuff is heavy and usually poorly-balanced, and weighs down on the doctor-in-training's shoulders and back, leading the unfortunate coat-wearer to walk around burdened as if constantly carrying water from a well.

For these reasons I've almost always been a bag person. But my bags are usually too big. For instance, I have a big black messenger bag that can carry a whole desk inside of it, and I'm a little bit of a pack rat, so that by the end of a rotation the bag usually does actually have about as much in it as my desk at home has on it. That means that the bags are heavy, and therefore they solve only the gunfighter problem but not the water-carrier problem.

Worse still, I'm constantly having to leave the bags in places like underneath desks in nursing stations, or in call rooms, because I need to go do something where I don't want the extra weight. Or I take the bags off when I'm examining patients, in which case I end up leaving the bags in patients' rooms. Having to come back into a patient's room to retrieve my stuff is a little embarrassing; it seems like a pretty amateur move, and not very confidence-inspiring, especially in terms of my confidence in myself if not for my patients' confidence in me.

I saw an intern this spring with a bag that seemed to solve these problems. Small enough to keep with him, large enough to carry the right amount of stuff, it looked just right. I asked him where he'd got it; and today, I chose this bag as my version of it.

Afterwards, I kept looking at the bag; looking inside it again to think about what I would put in its pockets; zipping and unzipping its various compartments. I would be able to put private personal things in private personal places, my notes in easily accessible places, and my reflex hammer somewhere handy. I could carry my medicine manual and my energy bars and my headache medicine and a little bottle of water. But the bag won't carry more than that--so I don't think I'll be able to jam it so full of stuff that it will become unwieldy and impossibly heavy, like most of my other bags.

I was so in love with my bag that it became clear that my love had gone far beyond the bag itself. My bag had become my metaphor: it would give me organization, control, and my own little secure space within the hospital, even if it is only about 9 inches by 12 inches by 4 inches. Seeing all of these things in my bag, I realized not only why I loved my bag--or at least, the idea of my bag--but also what I had been fearing the most about internship. I fear becoming disorganized; losing control; and never having a space of my own. The first two might harm my patients; the third will make me crazy. Until now. Now I have my bag. Now I need not fear, and I will not. Because fear is the mindkiller.

khakis and button-down

Today at our hospital's ACLS training for incoming interns, the Harvard boys were clustering together a little more than we should have been. (Knowing myself and the others, the clustering was more social anxiety than it was snobbery, but of course that's a fine line.) More remarkably, of seven Harvard Medical chaps who were there, all seven were in some variation of khakis and a button-down, no tie. I think five had blue shirts on, and two had white shirts. (Or was it four and three?) One of our group of Harvard boys was dressed slightly more casually yesterday, but he fell into line today.

No one else among the incoming interns from other schools was dressed exactly this way. Most were a bit more casual. It was a training, and therefore there was no clear dress code. A few were as formal as we were but in different ways: with different kinds of colors, fabrics, and so on.

I didn't dress this way before. I lived in San Francisco and wore jeans to work; when I bleached my hair my workplace credibility as a community organizer went up, not down. My lab boss in Bethesda wore all black clothes (except she wore bright yellow clogs) because she didn't want to be bothered with the problems of matching colors; no dress code there either.

Harvard changed me. Harvard somehow made me think that I should dress this way. And I think we tuned ourselves to each other: we looked more alike the second day of training than we did the first. But clearly, long before this training, without anyone explaining it or demanding it of us, we all became the guys who wear the khakis and the open-collar blue shirts.

"It's what I'd wear if I was coming over here to meet with my research advisor," said A, one of my co-terns. I said, "Of course; me too." On some level, we both felt--well, what else would you wear? In fact, I had semi-consciously run through the differential on both mornings before the training days, looking in my drawers and my closet. I thought about a dark plain polo shirt but it seemed some combination of too casual and too golf-y. Jeans were out of the question. Definitely not a t-shirt. Not even an untucked short-sleeved button-down. I don't own any brightly-colored button-down shirts; if I did I wouldn't have chosen them. Yet other men there made all of these fashion choices, and others like them.

When I told her about all this, Ms. Hemodynamics said, "Well, sure. That's part of why they were recruiting you guys."

"But I find this distressing," I said. "That somehow the institution has taken my aesthetics and eccentricities and ironed them out of me."

She understood this; but she thought my clothes were still the right choice. And of course, my program had been recruiting her too.

This I believe... (a few short posts in one)

I believe that:

* Scrubs is the most realistic medical television show of our era, and an informal but long-lasting and multi-city poll I've been taking of other medical students and residents suggests that many agree.

* Scrubs are the clothing of the hospital as factory floor--the hospital as a production process with teams of workers working together--and their persistence and popularity suggest that more and more healthcare workers see their work in roughly those terms.

* Ties should be eliminated from the work clothing of male doctors, and I used to think they would disappear because we would follow the "creative" sides of the business, research and technology worlds. But I have come to think that I will wear a tie for a long time to come, and so will most of my colleagues. But perhaps not mostly for the reasons of "respecting patients" that most of us will use to explain the choice. We will wear ties because part of what the doctor is offering is the power he will wield on your behalf. We will not admit the extent to which this power is an illusion, perhaps even a dangerous one.

* Women in medicine will continue to struggle to find the right outfit that expresses what it means to be a doctor, without clear rules and with much criticism for breaking unclear rules. Men in medicine should continue to struggle to find the right outfit that expresses what it means to be a doctor, but they will stick to clear rules and not give it enough thought. Transgendered people in medicine will be too cautious to innovate in the workplace.

* The trashy semiotics of medicine--the television shows, the clothes--are more important than they first seem. They are the visible signs of unspoken ideas of our culture.

Scrubs, part...?

Staying at a friend's house; in the morning, D, a 3 and a half year old person who addressed me while wearing her princess dress, noted that I was wearing my jammies. "Yes," I said, "They're my jammies, and I also go to work in them."

Pause. Look of trying to figure out whether I am scamming her, followed by optimism that in fact I am being serious and that there are people who go to work in their jammies. I call Ms Hemodynamics who is with R and G, all of whom also go to work in their jammies. It's pretty amazing, when you think about it, that we all go to work in our jammies.

White coats at protests? Maybe not.

Photo: Treatment Action Campaign and Student Global AIDS Campaign protesters at last year's International AIDS Conference, part of a coalition opposing Abbott Laboratories' approach to access to AIDS drugs.

I'm going to be taking part in a global day of action to condemn Abbott Laboratories for their attempt to block compulsory licensing of one of their AIDS drugs, known in the United States as Kaletra. This is an important medicine for people with AIDS, and Thailand wants to produce generic versions of it for impoverished people living with HIV and AIDS, who could not otherwise afford it.

The Bangkok Post has an editorial which lays out the legal issue from a Thai point of view. This one is pretty stark: Abbott is deliberately trying to roll back agreements about international trade rules, because the company doesn't like them.

There's more to say about Abbott, but I'll save that for now. In the meantime, I am now wrestling with a less important problem familiar to all 4 or 5 regular Hemodynamics readers, and a problem that afflicts all casual activists who only attend protests now and then: what to wear.

On its face, this is a silly thing to spend much time worrying over. But protests in the television age, and even more so in the digital image age, require careful attention to symbolism. And it turns out that as a future doctor I've got a lot of symbolism to think carefully about.

Medical students have often worn white coats to protests, as have doctors. This is a way of bringing professional credibility as a form of solidarity. But I've never done this, and though I thought about it earlier this evening, I don't think I will this time either.

This particular issue is fairly clear: when people don't get medicines to treat HIV, they often die of AIDS. Incredibly enough, and despite everything bad you can say about an organization like the World Trade Organization, nations around the world have agreed on ways that countries can make sure people get medicines. If you want to reap the benefits of global capitalism you should at least play by its very limited rules.

This message does not require a white coat for its credibility.

To say that you should listen to my views about intellectual property policy because I'm going to be a doctor would be absurd. After all, so many other doctors have been so egregiously wrong about this kind of issue that I would hate to encourage people to listen to doctors about patent policy. As far as the embroidery on my white coat, it says "Harvard Medical School" and it doesn't say my name. And I don't believe there's anything about my Harvard Medical School education that makes me any more equipped than any other reasonably well-informed person to express my opinion about Abbott's approach to intellectual property. All I know now that I didn't know before is the details of how people die from lack of medicines, and what happens to their various organ systems as they get more ill.

You could argue that wearing the white coat is a kind of threat to Abbott, along the lines of the anti-Abbott coalition's suggestions for doctors that they prescribe equivalent generics instead of Abbott products, refuse to talk to Abbott drug reps, and refuse to accept gifts from Abbott reps. But for me, this would not be sending the right message: whether or not Abbott cares about Thai people living with HIV and AIDS, I will prescribe generics when I can, I won't talk to drug reps, and I won't accept gifts. If I was the kind of doctor who was actually thoughtlessly prescribing unneeded overpriced brand name drugs and getting chummy with drug reps, I probably wouldn't be going to a protest at Abbott headquarters anyway.

Another entirely opposite direction would be the Treatment Action Campaign's "HIV Positive" t-shirt. But I've always felt that this shirt has a different meaning in the United States than it does in South Africa, and it definitely means something different when worn by groups of people which do not include many people living with HIV. In the US, the meaning of this shirt can be helpful but it can also be presumptuous; tomorrow, at least, I'm not taking this approach.

The only visual signal I might feel comfortable displaying is letting people know that I am a health worker--someone who makes it their life's work to care about the well-being of people who are sick. I'm uncertain about the political value of that gesture, but I think that at least it is a visual reminder that the protest is an issue of health, and survival, and not just an issue of market rules.

In other words, I've reduced my protest wardrobe to two alternatives: I can either dress as just me, a concerned citizen--or I can dress as a health worker. Considering the health worker option, I realized once again that if I take this route, I would not wear the clothes of the profession (the white coat), but of the hospital and all who work on its clinical floors: I would wear scrubs.

Fleeced.

After many loud denials and proclamations against it, I have reversed my position: I have purchased a class fleece.

But before we come to why I finally committed this dastardly act, it's worth explaining the broader phenomenon of medical fleece. I'm not sure exactly how it happened. But I'm pretty sure it started happening about two years ago: every health-related group started getting fleece jackets and vests with their logos and team names embroidered on the left chest.

This is not unique to healthcare. In fact, I think the first local fleece explosion came from the Harvard Business School students. They've been walking around town for the last several years with HBS fleeces, each with their section name on them, full of mysterious significance. The HBS logo, initials and class year are accompanied by a big proclamation of "Section A" or "Section C", and so on, generic and externally meaningless, only serving to alert fellow HBS students to the room of people to whom the fleece-wearer was randomly assigned. In fact, it is their sheer meaninglessness which is their meaning. The fleece above all is an expression of group membership, and what is more in-group than a piece of arbitrary jargon? I'm sure that computer companies and consulting firms have been handing out team fleeces for even longer, and for the same reason. (I feel like I've seen fleeces that say stuff like "HDC Implementation Task Team" or similarly obscure nonsense, but who can remember that kind of thing?)

Last year or the year before, I'm not sure which, doctors-in-training in the Boston area joined the fleece craze. They started getting fleeces with their hospital logos and the name of their department: "Internal Medicine" or "Surgery." Soon after, nurses and attending physicians started getting more specific kinds of team fleeces: "Obstetrics L &D"; "MICU"; "Emergency". (This has the effect of one-upping the housestaff fleece. Because it says you work on a particular floor, doing a particular job, it also says that you are not a trainee.) These fleeces began replacing the white coat as a way to walk around the hospital and look like you belong there. For medical residents, they also were a proclamation of your team. If you were a meddie, you walked about in your team fleece that said "medicine" loud and proud.

Other hospital fashion changes started earlier, and I think they're related. Housestaff long ago started wearing scrubs around the hospital, even in situations where they clearly don't really need them, as did many other kind of healthcare workers. Scrubs have become a hospital worker uniform. Doctors and radiology techs can all wear the same pajamas.

It's not like hospitals have ditched hierarchy. So we should probably wonder why scrubs appeal to so many different healthcare workers regardless of status.

The first reason is utilitarian. The hospital gives them to you and then takes them back and washes them; you don't have to iron anything; and they're comfy.

But scrubs also signify more than sheer laziness. For those who wear them when they don't have to, scrubs signify a kind of industrial worker of healthcare, too busy saving lives to put on pressed shirts and ties. There's a kind of reverse glamour to scrubs. Scrubs originally come from the operating room, and they're designed for people who are ready at any moment to get themselves splattered with blood. Now people in the hospital who have nothing to do with surgery or fluid-splattering of any kind wear scrubs, as if to signify that they are part of the larger project of fluids splattering about, even if they personally are not going to get splattered.

I think scrubs and fleeces are part of the same set of social changes. Obviously no one intends to get their $100 Patagonia logo-embroidered fleece jacket splattered with body fluids. And yet it's common for fleece-wearers to be wearing scrubs underneath the fleece, walking down the empty lonely corridors in what is an outfit of pajamas, a jacket made out of material that feels like an infant's blanket, and round shoes without laces. In other words, medical fashion and toddler fashion have nearly met up. This is about comfy coziness, and definitely not about fighting through spurting arteries.

Housestaff and other healthcare workers sometimes wear their fleeces over other outfits, too. It's common to see medical housestaff wearing clogs, khakis, a shirt and tie, and their fleece, with their ID flapping around on a lanyard over the fleece. This is where the social functions of the scrubs and the fleece are headed in the same non-toddler direction. These are elements of a postindustrial factory-floor look. The fleece takes the role of the corporate identity (the hospital and department, without specifying the profession), rather than the white coat taking the role of the professional identity (the doctor, from a particular hospital).

As long as they avoid those nutty teddy-bear print scrubs that so many nurses have unfortunately become afflicted with (talk about toddler fashion!), the outfits of nurses and doctors start looking more and more alike: scrubs, fleeces, clogs. (Folks like radiology techs, respiratory therapists, and physical therapists can all potentially get in on the act too, although they've been slower to get the whole outfit together.) The scrubs and the fleece become about team membership, just like a white coat is about team membership. But it's in the hospital team sense rather than the professional team sense. I'm not sure that this provides any less distance from patients, but it's a different kind of distance. It says, "We're part of the hospital" rather than "I am a doctor."

So, why am I getting a medical school class fleece? Partly because my partner J says, "I got some of that college stuff when I graduated and later I was grateful"; partly because I want another warm zip-up sweatery thing for spring and fall. And then there's the problem that I'm just dying for a team fleece, even as I know it's a little ridiculous. I'm secretly as eager to be part of the world of medical fleeces as I once was to be a paramedic and wear a special paramedic uniform and drive around in a red truck with sirens.

At first, I had proclaimed against the fleece because it had our school's coat of arms. Also, it was crazy expensive. But proceeds beyond the retail price of an unadorned fleece jacket go to some kind of class party, which is fine. And at the end of the day, I have to admit that I'm actually proud to be graduating from medical school. I went from not remembering how to multiply fractions when I decided I was going to try to take chemistry, to getting a medical degree from a coat-of-arms kind of place. If the medical school fleece is some kind of aggressive status symbol, I at least feel as if I more or less earned it.

And what I earned is under the coat of arms: "MD 2007". The business school students can have their "Section A" and wear their fleeces like they're headed out to the team-building ropes course, I say smugly to myself; my fleece says "MD 2007" and I'm ready for the MICU. Their fleeces are practice for the consulting firms and investment banks which will give them their next fleeces; our fleeces are pre-hospital fleeces.

I'll get the actual hospital fleece soon enough. But for now, the medical school class fleece is a kind of hospital fashion/professional fashion hybrid. It's a white coat statement with a hospital floor sentiment. And right now, that's exactly who I am. That's the right fleece for me.