Enclothed Cognition

Here is a story of probably the nicest thing any patient has ever said to me. I wanted to write it down before I forgot, so I can look back at it on the days that I feel like my work doesn't matter, an attending berates me, the nurses undermine my work, or there is a sad outcome. I went into medicine because I wanted to help people. And I thought becoming a doctor was the best way for me to do this- to gain the technical and clinical skills to be helpful. Sometimes it is. Sometimes it feels like it isn't. But, I love what I do, and what I get the opportunity to provide. Sometimes it's easy to forget this, which is why I hold on to this memory, precious and vivid. I admitted a young woman, pregnant with her first baby, at 34 weeks. She was feeling sick, and her baby's heart tracing was concerning. Both of them looked sicker within the hour, but the attending and I were slow to want to do a c-section on a premature baby. We gave her fluids, and I watched them both closely. Then, the baby's heart rate when down. I called a crash section, and with the help of the OR team, had delivered that baby before the attending even got to the hospital. There are a few quiet minutes, in between initiating the crash and the quick ride to the operating room and swift delivery. They are precious, my one opportunity to sit calmly with a mother and her loved ones before the chaos begins. I take her hand, and tell her "Everything is okay. Your baby's heart rate went down, so we need to do a delivery now. But, we do this all the time, and can get your baby delivered quickly." Usually the panicked mother starts to cry about now. I let her know gently, "in just a few moments, it's going to get very busy in here, with a lot of people, but that's normal. We just need lots of hands to help. We are going to take a quick ride down the hall to the operating room, and I'll be waiting for you there." This time was no different. Lots of nurses, a quick ride down the hall, me smiling at her with everything but my eyes covered by a mask. A few minutes later she was delivered, and I was stitching her up, just as the attending arrived. The gem came later, two days after her delivery, during my morning postpartum rounds. I went to see how she was doing, and she grabbed my hand and squeezed it. She said "I just want you to know...that time you sat talking to me, when you told me how it was going to get busy, but not to worry, because that was normal? That was so calming, and I just wanted to tell you...when I think about my baby's birth, I think of you. My clearest memory of my delivery is you, sitting on my bed, in your flowered hat (scrub cap), holding my hand and telling me what to expect, and that it would all be okay. Thank you." Thank you, dear patient. Medelita Guest Blogger: Dr. Anne Kennard. Anne is an OB/GYN resident in Phoenix. She has kept a collection of writings about medicine/becoming a doctor since her second year of medical school, and we're honored to welcome her as a guest blogger for Medelita.

"Enclothed Cognition", a recent study published by the Kellogg School of Management at Northwestern University, supports the theory that what you wear affects your aptitude and performance. Research subjects wearing white doctors coats performed significantly better than their peers on a "Stroop test" - a test that challenges cognition by displaying the name of a word in a conflicting color. During a Stroop test, participants are asked to say the word, rather than name the color, and those wearing lab coats made about half as many errors as those wearing street clothes. But will any white coat fit the bill? Some participants were given a lab coat, yet informed that it was an artist's coat. Interestingly, those participants scored below average - supporting the idea that it's not just the clothes, but the symbolic meaning behind them that affects us on a cognitive level. “It’s the simultaneous combination of the posture or the clothes and the symbolic meaning of them that matters,” said researcher, Adam Galinsky. While we're a fashion forward company, it's our primary desire to ensure that our customers feel confident and polished in their medical garments - a task that seems impossible when you're forced to wear boxy, unprofessional lab coats and scrubs. Many of our female colleagues have commented that traditional lab coats leave them feeling as though they're wearing their father's coat . . . hardly the right image for a knowledgeable professional who has dedicated what seems like centuries to their career. With this is mind, our dedication to providing medical professionals with garments deserving of their stature becomes even more rewarding. For us, it's not about the bottom line, but about ensuring that your lab coat reflects your prestige and aptitude . . . something that's not just a matter of fashion anymore.

Long ago, an enterprising man with a penchant for dentistry plucked an apple from the orchard as he made his way to work. Alas, his breakfast was thwarted when a small worm poked its head from the hole it had made within its juicy home. The apple was abandoned . . . or perhaps the worm was just eaten around (because hygiene and healthy habits were not yet a cultural priority). Shortly afterwards, our dental ancestor examined a patient's decaying teeth, taking note of the rounded cavities that had developed within. "Aha," he exclaimed, "It must be a tooth worm!" While my story about the origins of the tooth worm is a fabrication, the existence of such a myth is quite real. The "evil tooth worm" is an urban legend that dates back as far as 5000 BC - where it was referenced in a Sumerian text. Without adequate understanding of why teeth decayed, many believed that the tooth worm bore a hole through your tooth and hid beneath the surface. A toothache was, therefore, the result of a restless worm wiggling around. This idea spread through centuries and several cultures, with evidence of the tooth worm myth found all over the world. The tooth worm even has its own creation myth, courtesy of 1800 BC Mesopotamia: “When Anu created the Sky, the Sky created the Rivers, The Rivers created the Valleys, the Valleys created the Swamps, the Swamps created the Worm, the Worm went to Samas and wept. His tears flowed before Ea. “What will you give me to eat, what will you give me to such?” “I’ll give you a ripe fig, apricots and apple juice.” “What use are a ripe fig, an apricot and apple juice to me? Lift me up! Let me dwell ‘twixt teeth and gum! I’ll suck the blood from the teeth and gnaw the roots in their gums.” “Because you have said this, O Worm, may Ea sink you with his mighty hand!” Some ancient doctors mistook tooth nerves for tooth worms and extracted both tooth and nerve in a misguided and extremely painful predecessor to the modern day root canal. An enduring belief, the tooth worm was an accepted cause of cavities and toothaches right up until the 18th century - when it was finally scientifically scrutinized by our very own Pierre Fauchard.

I was so excited to get my white coat. The White Coat Ceremony was the beginning of medical school, the confirmation that yes, I was going to be a doctor, and I couldn't wait. As the dean of the program called my name and placed the coat on my shoulders, I smiled...and then noticed that the sleeves almost covered my fingers. I walked off the stage, a little disconcerted, pulling the coat around me, finding that it could wrap around far past the buttons. The shoulder seams hung loosely down my upper arms. It was a boxy, straight fit, and of course looked great on the guys. It should- it was a man's coat, that didn't come in a small enough size to fit me. Eventually, I shortened the sleeves. But it still hung loosely, awkwardly on my frame, like I didn't belong in it. I felt unprofessional, like I had put on my dad's coat and went to work. I knew how important perceptions are- I dressed well, in tailored, professional clothes...and then covered them up with this ill-fitting coat. Eventually, I graduated and got a longer coat, but this was still a man's coat, still as frustrating as before. Maybe even more so, because now I was a real doctor, but I didn't feel like it or look like I belonged in the coat. Then, I got my Medelita white coat. I ripped open the shipping package, putting it on over my workout gear in my kitchen. The first thing I noticed was how the sleeves came down- exactly to my wrists. The shoulder seams rested on my shoulders. The weight of the coat felt right- not flimsy, but still breathable, and it draped well. I eagerly checked out all the pockets, filling them with the pens, papers, granola bars, stethescope, and little books that were in my old coat. It still hung well, and didn't look overfilled as my other one had. I looked in the mirror and admired the princess seams, and the buttons on the back waist. I admired the small collar, professional and tailored. I adored the dark pink script with my name. My old coat had boring black block letters. I mean, I'm in obstetrics/gynecology! It should be pretty and pink! I tried it on with my work outfit, and scrubs, and wore it to work every day for the next few weeks. I got so many compliments, saying that I looked pretty, professional, that the coat was so well-cut, and where did I get it? (Of course I referred them!) The pink lettering was admired by all, and many commented on the pretty seams and back buttons. I watched blood drip onto it as a placed a central line, and then in amazement watched the blood drip off again, without leaving a stain. I dropped oatmeal on it, and wiped it off without at trace. On my day off, I washed and dried it with the rest of my laundry, and it looked great without even having to iron it. Over time, I became aware that I loved the coat not only for how it looked, but how it made me feel. When I used to walk into a patient's room, I felt young, like I was playing dress-up, like I didn't really fit in. Now, I walk in confidently, knowing that I look professional and polished, and that this is a better representation of me. My coat matches my nice work clothes, and can cover up the ill-fitting hospital scrubs I sometimes I have to wear for surgery. And even though it is a work piece, I love it's design and fit so much that it really is one of my favorite articles of clothing. Every day it makes me happy and feel good about myself. I definitely recommend Medelita to anyone that wants a beautiful, functional coat for everyday wear. Medelita Guest Blogger: Dr. Anne Kennard. Anne is an OB/GYN resident in Phoenix. She has kept a collection of writings about medicine/becoming a doctor since her second year of medical school, and we're honored to welcome her as a guest blogger for Medelita.

Before medical schools, technology, and advanced surgical techniques existed, medicine was a field of mystery and experimentation. The art of surgery, therefore, was a process of trial and error - often utilizing barbaric and dangerous methods. Let’s take a look at how some of our forefathers operated during ancient times. For most of you – perhaps it's a recap. But hopefully a very interesting one! STONE AGE The first signs of historical surgical operations are trepanned skulls and sharpened flints dating as far back as the Stone Age. Although no one is certain of the nature or cause for these operations, it is assumed that they were performed on people who suffered from head injuries, and were intended to release pressure building up inside the brain. ANCIENT EGYPT It is an undeniable fact that the Egyptians really know their way around embalming and mummifying people. The process of mummification and the removal of internal organs was actually a rather refined art, consisting of the smallest possible incisions - they even removed the brain through the nose to avoid damaging the outer appearance of the body! However, Egyptian surgery also included treating broken bones, suturing wounds, and dealing with abscesses and boils. They had plenty of surgical instruments on hand - using sutures, clamps, scissors and cauterization to close open wounds as well as saws, forceps, scalpels, and probes to explore injuries. ANCIENT ROME During the Roman Empire’s golden years, the surgical arena was dominated by the works and ideas of Galen. He was significantly fascinated and curious about the human anatomy. However, since it was forbidden to open up human bodies at that time, Galen spent most of his days dissecting animals, including apes. Needless to say, some of his ideas were wrong as he assumed a great similarity between animal and human bodies. However, Galen was a very powerful and influential writer, and his inaccurate works travelled far and wide - dominating the medical field for centuries. ANCIENT INDIA In Ancient India, surgeons were incredibly skilled. Because people were constantly punished by having their noses chopped off, undergoing operations for the “repair” or reconstruction of their noses was widespread. As an inevitable result, India became the birthplace of plastic surgery. As long as humanity has existed, it has required medicine. From skull-smashing and the preservation of the dead to ape dissection and criminal plastic surgery, these primitive operations, even in their flawed design, helped to form the foundation for the advanced surgical field of our modern era. I, for one, am grateful for this extensive evolution of surgical techniques.

Every day, doctors and PAs (including you!) come across a number of puzzling illnesses. But only a few are as strange and perplexing as these. We’ll call these the top five for now, until we hear yours . . . The Teenager Who Can Only Eat Tic Tacs Adherance to the food pyramid is definitely not an option here. Natalie Cooper, a 17-year old teenager, happens to have an illness that prevents her from eating almost all foods. What is even more interesting is that Natalie always gets sick whenever she eats anything except for . . . Tic Tac Mints! For reasons no health care professional can explain, Tic Tacs seem to be the only edible thing she can stomach, which means that she gets the rest of her nourishment through a PEG tube. Hopefully they sell Tic Tacs at Costco . . . The Woman That Collapses Every Time She Feels Emotion (of any kind!) I’d be curious to hear if you’ve heard of this before - a disorder that causes a person to experience syncope right on the spot whenever she feels any type of strong emotion such as anger, awe, fear, surprise and even embarrassment. This disorder is called cataplexy, and Kay Underwood is a sufferer. The 20-year old woman from England was diagnosed with this perplexing disorder 5 years ago and has been known to collapse over 40 times in just one day. In addition to collapsing every time she feels an intense emotion, Kay also tends to drift off to sleep without warning – even while she’s walking down the street. Hmmm . . . The Little Boy Who Couldn’t Sleep Rhett Lamb is just like many toddlers – cranky and extremely active. But there’s one thing that sets him apart from the rest: Rhett is unable to sleep (!). Obviously extremely rare, this little boy is awake for almost 24 hours a day, forcing his parents to split shifts of watching over him while he is in sleep-deprive mode. This condition has puzzled (and I imagine frustrated) his parents and doctors for years. After a good number of conflicting opinions, they finally found out what was ailing the child. Specialists diagnosed Rhett with a disorder called chiari malformation (this rang a bell to our Founder), wherein the brain stem – the portion of the brain which controls speech, sleep, cranial nerves, circulatory and breathing system – is squeezed, compressed and strangulated into the spinal column, impeding its ability to function normally. Now that sounds stressful. The Man Who Never Feels Cold He may seem like a street magician doing some extreme tricks, but Dutchman Wim Hof, otherwise known as the Iceman, can withstand incredibly cold temperatures. He can swim under ice and stand in bins filled with ice cubes. He even climbed the icy-cold Mont Blanc in France without putting anything on but shorts! He has set world records and is always on the lookout for new challenges. Experts cannot really explain how the Iceman does this, but he can certainly withstand cold temperatures that are typically fatal to the average person. No Patagonia gear for him . . . So we’re anxious to hear yours. What cases have you had that top this list?

Without a doubt, the history of medicine is a dignified one, with a fundamental goal to alleviate human suffering and prolong human life. But it is not without a share of con artists, charlatans and incompetents, whose greatest malevolence was to cast doubts on the real advantages of proven medicine in the minds of unknowing people. Quackery is a derogative term used to express the promotion of fraudulent or unproven medical practices, and a “quack” is a fraud who publicly or professionally pretends that he has the medical skills, knowledge or qualifications that he does not actually possess. Here are three unabashed quacks in the history of pretend medicine who used the most erroneous methods and achieved the nastiest of results. William J.A Bailey (1884 - 1949) This man might have tried to turn a nuclear power plant into a resort hospital. William John Aloysius Bailey was a Harvard drop out who fallaciously proclaimed himself to be a doctor of medicine. He was the president of Radium Company and was known to prescribe radioactive radium to his patients as a cure for fatigue, flu, cough and other common illnesses. He produced many products including Radithor, a solution of radium in water which Bailey claimed would help revitalize tired people, Arium, an “aphrodisiac” for married people whose desire for each other had waned, a radioactive belt-clip for “portable energy” and a radioactive paperweight that would presumably “awaken” tired and weary businessmen. His most noteworthy patient was Eben Byers, an affluent industrialist who took in 1400 bottles of Radithor, before having his entire jaw fall off, and subsequently dying from poisoning. Upon Eben Byer’s death, it was revealed that the radium had devoured gigantic holes in his skull and brain. Walter Freeman (1895 - 1972) There are a lot of things that come in vans, like ice cream, tacos, and even mobile dog groomers . . . but lobotomies is going a bit too far. Walter Freeman was a well-known psychiatrist and neurologist who popularized the lobotomy by making it simple and “handy”. He “perfected” the transorbital lobotomy by inserting a sharp instrument (such as an icepick from his very own kitchen), into the inside corner of the eyes and hammering it until it broke through the skull and penetrated the frontal lobe of the brain. Once it is inside, the instrument was then wiggled to cut neuronal connections. These so-called surgeries were done outside the operating room, without an anesthetic, and only after the patient was put out of action by electroshock therapy. Freeman ultimately created his own lobotomy instrument and called it a “leucotome”. He had to refine it though after one went kaput inside a client’s orbital socket. Even after his license was taken away for killing a patient with his methods, he still travelled around the country in his “Lobotomobile” to render service to the needy - only $25 per lobotomy. He performed 3,439 lobotomies in his entire career, but the physical and psychological damaged he caused was no doubt immeasurable. Albert Abrams (1863 - 1924) Introducing the delightfully devious, devilishly deceptive, diagnosing Dynamizer! I really can't picture Albert Abrams without imagining him on a soapbox trying to swindle the good folks of a small town. Abrams claimed that his invention, the Dynamizer, could diagnose any ailment simply by reading a sample of a patient's blood . . . or handwriting. The absurdity of handwriting proving the same information as blood aside, if given the choice between bleeding or writing, I would always choose writing - wouldn't everyone? Albert Abrams operated the Dynamizer by attaching an electrode to the forehead of a bare-chested assistant. The assistant faced West under dim light, and his abdomen was then struck repeatedly with a mallet. Abrams was, by his own account, able to decipher the vibrations from his assistant's abdomen to determine the disease. If your response was ". . . what?", then you're not alone. The skeptical medical community sent a drop of rooster blood to be analyzed with the Dynamizer - the "patient" was diagnosed with malaria, syphilis, diabetes, and cancer. That's one sick chicken. What's the most ridiculous "cure" you've ever heard of?

Do you know how long this thin, fragile rod has been around? And why there are so many different temperature scales? Whether used to determine a fever or to help decide whether to wear a coat or a tank top, nearly everyone is familiar with thermometers . . . but are you familiar with its origins? Early History The word thermometer comes from the Greek words thermos ("warm") and meter ("to measure"). The Greeks, brilliant and curious as they were, invented the earliest temperature-measuring gizmos around the first century B.C. The first thermometer was a simple device consisting of a tube filled with air and water. As the air grew heated, it would expand and cause the water to rise. There was no system of measurement applied to these crude devices, and they were used primarily to observe changes in temperature. Thermoscopes In 1592, Galileo Galilei improved upon the Greek creation and invented the 'Thermoscope' - a bulb with a long thin neck, upturned over a container of water. When the bottle was heated, the air expanded to push the water level in the neck down. When the bottle was cool, the water rose. Galileo also later invented the 'Galileo Thermometer' - a large glass cylinder containing several bulbs of varying density. As the temperature of the water inside the cylinder increased, the density decreased, changing the buoyancy of the inner bulbs. The lowest bulb would then indicate the temperature. In the early 17th century, an Italian physician, Santorio Santorio was the first to add a scale to a thermoscope, in order to quantify changes in temperature. Designed to be placed in a patient's mouth, Santorio's invention is considered the first clinical thermometer. The Fahrenheit Scale Though many people created versions of the thermometer, each with unique scales, only a few were able to survive the test of time. German physicist, Daniel Gabriel Fahrenheit, was the first to use mercury in a thermometer. Daniel Fahrenheit became well-known during the early 18th century for the accuracy and quality of his scale, which used 96 F, "blood heat" (In 1835, it was discovered that blood heat was actually 98.6°F) and 32 F, the melting point of ice, as its two fixed calibration points. The Celsius Scale Scientists and inventors, aware that the Celsius thermometer was influenced by atmospheric pressure, looked for ways to trounce its effects. In 1742, Andres Celsius, a Swedish astronomer, created the centigrade scale which used the temperatures measured when the thermometer bulb was dipped in melting snow (100 C) and when it was immersed in boiling water (0 C) as its fixed calibration points. By the end of the 20th century, the Celsius scale had replaced the Fahrenheit scale throughout most of the world.

As a veterinarian, I like to share my crazy animal stories. This one does not involve me directly, but my husband Max, and our friends, Drs. J and V, fellow veterinarians. J. owns a single engine 6 seater Cessna, and we enjoyed many fun flights together a few years ago, when we lived in Nevada. J and his wife V are not your average veterinarians. They spend their free time running a non-profit educational zoo, where they emphasize hands-on experience for the visitors. They started by getting a few kangaroos years ago, and now take care of about 160 animals! One may wonder how they managed to get all these exotic animals to Nevada. Well, this story is an example of how far one has to go to get a new pet... J offers us to join him on his next flight to go get new "residents" for the zoo. Two porcupines are waiting in South Dakota, about 1000 miles away. How exciting! After a week of bad weather, take off is finally scheduled for Saturday morning. Unfortunately, I cannot go since I have to work that day. On the big day, my husband wakes me up at 1am to kiss me good-bye. Thanks. I have to be at work very early and I cannot fall back asleep, I am too excited for them! All morning I keep checking the weather for their route, between a dog vaccination and a cat spay. Finally, I get a voicemail “We just landed. We have the Joey, we are waiting for the porcupines”. In a different context this could be a code for a secret trade, but in the veterinarian world it just means that they are ready to exchange animals. J's friends who have the porcupines also raise “Roos”. During the flight there, J had warned Max that they might have to go and catch the porcupines themselves. I can only imagine my husband’s face, thinking, “I didn’t sign up for that”. But a good cross-country flight is worth a porcupine hunt. Thankfully, when J's friends arrive with the precious cargo, the pets are in cages, and there is no need to chase them! Everything is going to be fine after all. They will be back in the air soon, and back in Nevada in about 5 hours. Perfect. Until they look at the metal cages a little closer. The porcupines are in two large carriers. More importantly, there are several layers of zip-ties and wires securing the carriers… “Oh, yeah, they are kind of aggressive right now, and I don’t want you guys to crash because of these little fellows", says J's friend. “Great, I didn’t sign up for that either", thinks Max. Pilots and pets all made it back safely to Nevada, but it was a trip worth remembering! Medelita Guest Blogger: Julie Pearson, DVM. Julie is currently working on the East Coast as a small animal veterinarian. She was born and raised in France, where she got her degree before getting licensed in the USA. She enjoys being a general practitioner, and feels privileged to be there for her patients, whether it is for a wellness visit or a serious medical issue. Julie has been wearing Medelita since August 2010, and is seen here wearing her scrubs.

Theodor Billroth, the Father of Modern Abdominal Surgery, never planned to be a doctor. As a matter of fact, his passion was music, and he was deemed to be a poor student who lacked the ability to focus on anything else. However, at the wishes of his mother and the prodding of his friends, Theodor Billroth entered medical school . . . and went on to prove that one need not abandon their dreams to be successful. Life in the Medical Field Theodor Billroth was born on April 26, 1829 in Prussia. His father died when he was five, leaving his family no other choice but to move to his grandparents’ house in Greifswald, Germany. He began his medical education here and later enrolled in the University of Gottingen and University of Berlin. After receiving his doctorate degree in medicine in 1852, Theodor Billroth went to work briefly in the clinic of the famous ophthalmologist, Albrecht von Graefe. Then, following a failed attempt to start his own practice in Vienna, Theodor returned to the University of Berlin, where he studied pathological anatomy, lectured, and demonstrated surgical techniques for several years. It was here in Berlin that he met and fell in love with his wife, Christine. Their marriage brought them five children, four daughters and a son. In 1860, Billroth transferred to Zurich, where he introduced the concept of audits - reporting both good and bad results in order to foster frank discussion of surgical techniques. Seven years later, he was appointed professor of surgery at the University of Vienna. During his tenure in Vienna, Theodore Billroth performed several landmark surgeries, including the first esophagectomy in 1871 and the first laryngectomy in 1873. He is most famous, however, for performing the first successful gastrectomy for gastric cancer in 1881. His success came after many failed attempts, and in what I consider a rather serious job hazard, Billroth was allegedly nearly stoned to death in the streets of Vienna when his first gastrectomy patient died. Life with Music Though Billroth became a renowned surgeon, his love for music never waned. During his prime, Theodor Billroth became the good friend and confidante of the famous composer Johannes Brahms. The well-known composer even asked Billroth to review a few of his works and dedicated two of his string quartets to him. Though he had played the piano as a child, Billroth had a passion for string instruments and took up the viola in his adult years. He played in a popular string quartet for a long while, spent late nights in the city while enjoying the company of Brahms and other musicians, became a guest conductor at the Zurich symphony orchestra twice , and wrote a book entitled, “Wer ist musikalisch?” (What does it mean to be musical?), which was an organized approach on how music can relate to man’s physiological and psychological nature. Indeed, Billroth was a man with many talents. In our sleep-deprived world filled with rushed coffee breaks and overdue paperwork, balancing work and play can often seem like an impossible task. Yet Theodor Billroth found the time to become a legendary surgeon AND a respected musician - an inspiring example of living life to the fullest.