Fashionably Challenged

Since starting medical school, I have been harboring a not-so-secret resentment towards the simplicity of men’s professional clothing. Button-up shirt and a tie, slacks, dress shoes, white coat and you’re done. Sure, there are variations on a theme and I’m sure there are men out there who put a lot of thought and care into their outfits, but even if you’re just falling on the basics it’s hard to go too wrong.

I don’t know anything about this dude, but I already trust him to save my life or take all my money.

It’s not that I don’t like getting dressed up. We had med school prom last weekend (I know, right?) and picking out a dress and accessories was an enjoyable distraction from academics. But that’s the thing about women’s fashion: it’s fun because it’s complicated. There are choices to be made, and choices mean a certain level of success and failure. Great for a night out when you want to make an impression. A pain in the neck when you’re running on four hours of sleep with an exam hanging over your head.

Let’s start from the ground and work our way up. Flats or heels? And if you go for heels, how high is appropriate and comfortable to walk around in? When and where are open-toes, open heels or sandals acceptable? Socks? Stockings? Tights? Bare legs? Dress, skirt or pants? And how short a skirt is acceptable? How tight a skirt is acceptable? How loose and flowing a skirt is acceptable? How large a belt? Is your skirt see-through? Is your shirt see-through? If it is, as is the case with most women’s clothing, what sort of undershirt should you wear?  Is it too low cut? Should you wear any jewelry? How much make-up?

The answer to any of these questions varies drastically depending on the person you ask. If you get it wrong there can be serious consequences. I’ve already written about the trials of wearing the wrong shoes, but there can also be more subtle types of pitfalls. For example, studies show that wearing exactly the right amount of make-up will help a women be taken seriously in interviews, but too much or too little will leave a negative impression.

There is this fine line between being attractive, but not too attractive. There can be absolutely no sign that you are attempting to look sexy, but it can be equally damaging to be perceived as “mannish” or plain. There are few solid rules to follow; the fabric of a shirt or the shape of the woman wearing it can push either extreme. And because of the subjective nature of these judgements, you may never know when or how you transgressed.

Clothing stores and designers are not helping either. There is no clear delineation between the different tiers of professionalism and fun dress when you walk into a department store. Watch any television show and the going standard for professionals seems to be six-inch stilettos and a carefully calculated cleavage-to-neckline ratio that defies most Newtonian laws of physics.

At least the skirt covers her knees?

I don’t mean to imply that all of the women in our class are walking a razor’s edge every time we’re expected to look professional for a patient. Still, it does take time and energy and attention to detail that I don’t expect the guys in our class experience in the same way. It is also starting to get expensive, not only because women’s clothes tend to be pricy but also because each outfit is distinct enough that repeats are noticeable even to the less observant. I’m sure the boys all change up their clothes regularly, but I’m paying pretty close attention if I even spot a repeat tie pattern.

Of course much of this stems from larger, systemic issues regarding the treatment of women in the workplace and the double standards we set for professional behavior. I could go on for days. In the end, though, I wish we could dispense with the whole mess and just all wear scrubs to work every day. How can you go wrong?

Okay, fair enough.

The Anatomy of an Anatomy Exam

Light warning: While this post does not contain any of the explicit descriptions of dissection featured in the last two entries, it does, to borrow a phrase from This American Life, acknowledge the existence of cadavers and the events of anatomy lab. Also, my perception of acceptable dinnertime conversation remains off center, so please take that into account as you read this entry.

There is a special kind of fear struck into the hearts of medical students at the mention of the anatomical practical exam. Although this frustrating ritual of medical education has decreased in importance in recent years, it is still an important rite of passage for medical students. I call it a rite of passage because I question its direct vital importance to the learning of anatomy, despite feeling that the actual dissection of cadavers has been immensely helpful in my medical education. To be honest, I think the practical exam exists mostly as a means of motivating us to devote the proper time and attention to studying the cadavers, rather than being an accurate means of testing our mastery of anatomy.

At our school, the exams are held on a designated Friday afternoon. The class is divided up into groups, and each group (ranging from 30 to 50 students depending on the number of questions/stations available) is assigned a time. We are to

Seriously though, who even owns a clipboard these days?

bring a clipboard and a writing tool. Those who wish can change into scrubs, but no safety gear is required.

We arrive in the hallway in front of the lab, drop off our backpacks in the locker room, and stand around nervously. Eventually the anatomy professor emerges and hands us all pieces of paper with 60 blank lines. She instructs us to write nothing other than our names on the papers, but as soon as we enter the lab we can scribble whatever notes we wish. Once everyone is ready we file into the lab through the women’s locker room.

One of the lab instructors likes to spice things up. As we enter the lab there are jock jams blaring from an old boom box, and he’s wearing a bright orange baseball cap backwards as he jumps up and down. The man is in his late 50s at least, with a bushy white beard and an awkward, soft-spoken manner, so the first time I saw this I burst into nervous laughter. The other lab instructors and fourth-year TAs are also standing around in their scrubs and white coats, smiling encouragingly at our obvious anxiety.

We each head to a station. There are a number of cadavers, several models, and a number of computer screens with X-rays or CT images. Each cadaver has two stations, one on each side. Each station has a pin, an arrow or a string tied around a structure, and there is an index card nearby with a question or an instruction. There are several orange chairs positioned around the room as rest stations.

One of the professors gives us our instructions. They are the same every time: “Look at the number for your station and circle it. Be sure to write your first answer on that line. Don’t write your first answer on line one unless you are at station one. Check which number you are on frequently. You will have one minute at each station and there are a certain number of rest stations. Stay in order. Do not skip stations. If you get lost ask for help. If you do not know what structure is indicated, ask an instructor. If you ask anything else the answer will be, ‘use your best judgement.’” He says this last part with a sympathetic smile because he knows this is the most frustrating answer in the universe and the only way for the teachers to get through this exam in one piece.

Then he offers the usual advice: “First get oriented: are you on the front or the back? Which way is the head? Then identify the indicated structure. Next, read the card at your station and write the appropriate answer on the blank that corresponds to that station. Answer only the question on the card. Not all of the cards say ‘identify.’”

There are about eight televisions, the big boxy ones on metal shelves hanging from the ceiling like in public school classrooms. The screens are blue with a number in the center. When the instructor says go, the number starts at 59 and counts down silently to zero like you’re on a game show. Whenever the number hits zero, the lab instructor yells some variety of “rotate!” or “move!”

The instruction to “get oriented” seems obvious, but the cadavers are well draped. Mostly this is to protect them from drying out, a major problem, it turns out, once you remove a person’s skin. There is also a fair amount of obscuring done for the sake of difficulty. You cannot see faces, genitalia, hands or feet unless that structure is specifically being pointed out. The cadavers are also largely sans skin, so all the usual orientation clues are missing.

We are not allowed to touch anything either, which is frustrating given than all of our studying has required us to find the structures by digging them out for ourselves. If I’m used to locating the musculocutanous nerve by finding its origin at the brachial plexus, I had better hope they have positioned the cadaver so you can see the brachial plexus when they pin that nerve. It’s also harder to distinguish structures like arteries and nerves when you can’t feel to see if they are hollow or move the drape back just a bit to see if you can see what branches it gives off. I end up twisting and contorting myself trying to peer into body cavities without blocking the light, my nose and hair getting dangerously close to formaldehyde-soaked fabric.

One minute, as it turns out, is precisely enough time to settle on an immediate answer and then second guess yourself. In some ways it reminds me of physics tests from postbac, where it was better not to even try to check your work if you managed to stumble upon an answer. Just keep moving and don’t look back.

Spelling doesn’t count on these exams, which is good because the words ophthalmic and infundibulum will never cease to send my brain and fingers into spams without a spell check. We are strictly forbidden from abbreviations, however, which I find intriguing given how pervasive abbreviated language is in medicine and our school curriculum. (In two labs

Look at that judgmental expression. As if he could spell pterygopalatine fossa off the top if his head.

of brain anatomy alone we’ve already learned about PICA, and AICA, SCA, PCA, MCA and ACA.) They will also, apparently, take off for lack of specificity; it is the styloid process of the ulna, not the styloid of the ulna. There are also no points for being technically correct either; the identity of one x-ray structure was the adductor tubercle, and the fact that the arrow was also pointing to the medial condyle of the femur did not mean that was an acceptable answer.

Once the exam is over, we turn in our tests, file out, and, usually, head off to study for the written exam. By the time our tests are graded and accessible, we are usually well past the point of real concern. As good or as bad as it feels to see where you ultimately fall on the curve, the skills being tested in anatomy practicals don’t seem to correlate to anything particularly useful in medicine. “When am I ever going to have to diagnose someone without asking any questions or touching them?” one of my friends pointed out.

I will say, in defense of the anatomy practical, that studying for something “hands on” is completely different from studying for a written test. I could have pored over dozens of textbooks and memorized every division of every artery and nerve and never have really understood how it all fits together as well as I did studying it within a body. Some of my esteemed colleagues may disagree with me on this point, but I would argue that, although the exam may not have realistically assessed my understanding of anatomy, it was a powerful motivating force. I doubt that I would have ever learned so much or so thoroughly had that impending exam not driven me back to lab so many afternoons.