I recently received my New York State medical license. It arrived in a large, white, stiff envelope that bears the command “DO NOT BEND OR FOLD”. A few ladies were sorting through the oversized mail tray in the lobby of the building and, upon seeing me come through the door, handed me the envelope.

“Here’s something for you,” they said. “It looks official.”

Inside the envelope were (and are) the following items:

• Registration Certificate (which features a green background and the seal of the education department in New York; it resembles the document you may have in your car for vehicle registration or the document that hairdressers have in their salons)
• Registration Parchment (which resembles a diploma; everything is in capitalized letters in large font sizes)
• a document listing the provisions for unprofessional conduct (apparently revised February 2007)
• a letter (addressed to “Licensee”) informing me of the length of my licensure (”Physicians and medical physicist [sic] have a two-year registration period”)
• an Important Notice explaining the differences between the Registration Certificate and Parchment, along with several capitalized and bolded exhortations to KEEP MY NAME AND ADDRESS CURRENT
• an address and name change form
• a sheet with “Important Information Concerning Reporting Abuses of Persons Receiving Care or Services in Residential Health Care Facilities and Important Information Concerning Federal Narcotic Stamps”

I was particularly surprised to receive the Registration Parchment. Washington State does not distribute parchments; they only hand out Certificates. On blue background. (Perhaps had I applied for a full license, instead of a training license, I would have obtained a Parchment….)

Contrast this shiny, uncreased Parchment to my medical school diploma. I had stored my diploma in the basement and, sometime last year, the basement flooded. The sheet is now obviously warped and sports several smudges (aye, I avidly appreciate alliteration). The lower corner looks like someone held a flame to it. A splash of turquoise blue ink decorates the left edge.

Not that I’m particularly attached to diplomas—I’m not even sure if I’ll ever display them. Though I understand that these documents are meant to reflect years of schooling, academic achievement, blah blah blah, they are, ultimately, just pieces of paper. (… though I do have Arnold Schwarzenegger’s autograph on my medical school diploma.)

Furthermore, I can’t even imagine having my own office or space where I could display them. Medical training involves so much transience—our rotations are divided into month-long blocks, where we work closely with a group of individuals for thirty days… and we may never interact with them ever again. We may rotate through a number of hospitals or clinics, where we leave right when we begin to feel comfortable with the system. Even if we spend a day a week in a particular clinic, that is only a total of 52 days (if that, given vacations, holidays, sick leave, etc.).

Of course, the transience extends to our patients, too—”continuity of care” is continuous for only a few years. Maybe four. At most. If the resident is involved in outpatient care. (Though, of course, there are the patients that are admitted to the hospital numerous times over the course of a year….)

It’s remarkable how appropriate acquisition and application (…) of knowledge can be distilled into a single sheet of parchment paper adorned with a seal and black ink.

And perhaps one reason why we receive this sheet of paper is to remind us of our efforts because of the transience of our training.