Dressed to kill

The clock radio jolted Dr. Jim Bahn into consciousness. It had been a late night of martinis and romance. He wiped the crust from his REM-deprived, bloodshot eyes. He'd steeled himself for this, with years of training and a well balanced diet. The svelte young man jumped out of bed and landed on the floor, senses alert, ready for anything.

His morning ablutions completed, he combed his thick black hair, looked in the mirror, and gave himself a sly wink. Perfect. Dr. Bahn looked through his closet at rows of neatly pressed dress shirts, color-coordinated ties, and high-end suits and sport coats. He would be the best-dressed intern without a doubt. He selected a conservative striped silk tie and a long white lab coat (cloth buttons, heavy starch) and carried it on a hanger to avoid wrinkles. He slipped quietly out of the room, leaving the sleeping woman behind. It was easier that way as he could not remember her name. Medical school was nothing more than a memory. Now he not only looked like a doctor, he really was one.

An unusual wave of mild panic flowed over Dr. Bahn at the thought that he might be late for the first day of internship. He ran down the stairs and jumped into his convertible, not bothering to open the door. He looked at himself in the rearview mirror and brushed a piece of dirt off his shoulder. He blasted from his garage doing 60 miles per hour and fishtailed down the road. He stopped at the corner to give a luscious young nurse a ride to the hospital. Some things are worth being late for, he thought to himself as he snagged the last parking spot in the nearest patients' lot, cutting off a less aggressive geriatric driver.

He ran up a flight of stairs not cracking a sweat. He checked his pockets for his “secret weapons”—pens, penlight, nametag, stethoscope, reflex hammer, pharmacology flash cards, pocket study book, guaiac cards and developer, tongue depressor. He patted the reflex hammer he carried in a holster on his leg, as it left too much of a bulge in the line of his suit. He draped the stethoscope around his neck, smoothed down a wrinkle in his lab coat and entered the conference room.

The other residents were decidedly less elegant than he, with their rumpled lab coats, polo shirts and ratty old sneakers—most not even wearing ties! He was shocked. At his school the students wore jackets and ties. This looked so shabby. He knew in the depths of his soul that he had to look good to be good.

Later that day he rushed to see his first new patient, getting to the room before the nurse. He examined the man and took his history in 15 minutes flat. Efficiency above all else was his plan for internship, to be the first one done each day so he would have time for his other “hobbies.” His lab coat was unbuttoned. It was hot in the room. His tie flopped forward into the patient's face as he did his exam. As he walked from the room, tucking his tie back into place, he noticed the cart full of yellow gowns. He asked the nurse about it. “That's Mr. Henry, a frequent flier. He's MRSA- and VRE-positive.” Good thing he'd gotten in before all that isolation business.

The next patient had C. difficile, the one thereafter multi-drug-resistant Pseudomonas. During each visit, his tie had fallen forward onto the patient. His senior resident pulled him aside and told Dr. Bahn to get rid of the tie; it was a hazard. Hadn't he seen the articles about ties as a vector for Staphylococcus?

Dr. Bahn did not believe these studies. There was no way his fine silk ties would become agar plates. The study ties were probably cheap polyester. Maybe he would have to get a tie clip, though, to keep his ties neat. Maybe a diamond tie pin! A gold clip? A silver one for the days he wore his black suits! This was a whole new fashion concept. One thing for sure, no way he'd go for a bow tie.

The next patient was admitted for neutropenic fever post-chemotherapy. Dr. Bahn was as thorough as he was ever going to be, spending a whole 20 minutes on his history and physical. His tie draped across the immunologically impaired patient as he performed his exam. The resident came up to him with a furious look on his face. He yelled that the tie was a danger to their patients. Would he see patients without washing his hands? Dr. Bahn looked down at all the tools he had tucked in his pockets and tried to visualize the microbes swarming all over. Was he some kind of Typhoid Mary, covered from head to toe with bacteria just waiting to be passed on to unsuspecting patients? Should he go tieless or—horrors—use scrubs?

He smiled at his senior resident and walked away, but as soon as he turned the corner of the hallway, he tightened his double Windsor knot. As long as there was no written policy against ties, he was not giving his up! His tie was not killing any patient. How could a tie be responsible for anyone's death? It was ridiculous.

He ran for the elevator, his tie flapping in the breeze. The doors closed just as he arrived, and the end of the tie caught in the closing doors. The elevator went up, pulling the tie with it. His resident, a few minutes too late, found him hanging there. Dr. Bahn thought as he lost consciousness, “At least I'll make a handsome cadaver.”