As a child, I would show off my homework to my dad each afternoon, proudly displaying my tidy schoolwork and beautiful handwriting. In response, he would smile and pull scraps of paper covered in his scrawl out of the pockets of his white coat, saying, “Doctors have terrible handwriting.”

Ever the curious child, I would ask him if you had to have bad handwriting to enter medical school, or if it became poor while you became a doctor. My dad would give me a shrug and smile, stating he didn’t know, but to keep working hard and being a good student.

Looking back at my old notebooks from middle and high school, my handwriting is large, bubbly, and entirely legible. I went through phases, as most girls do. There was a period in which I topped my lowercase i’s with hearts, then little circles. I swapped black pens for blue pens for purple pens, eventually getting detention for turning in my Latin homework in purple. I used gel pens, ballpoint pens, and felt-tipped pens that stained my hands.

My handwriting got smaller, larger, and smaller again as I switched from college ruled to wide ruled notebooks and then back. Each September when the school year started, my handwriting was always a little sloppy, but it would gradually get neater as the school year progressed and I got used to writing all day long. Even in college, when I became much more reliant on computers, I felt a sense of satisfaction before final exams when classmates asked for photocopies of my handwritten, color-coded notes. I started medical school in Philadelphia in 2016. So much in my life changed: different city, car, friends, responsibilities, and most surprising of all, handwriting.

The word metaplasia comes from the Greek, meaning “a change in form.” Medical students learn extensively about the metaplastic process during pathology classes. Metaplasia is an adaptive response where one cell type under chronic stress from the environment will change into another cell type that is better able to tolerate the stress.

There are several examples in the human body, Barrett’s esophagus being the classic one. Found in cigarette smokers and those with long-standing acid reflux, the lining of the esophagus will start to look like the lining of the stomach. This happens because the stomach lining is better able to withstand stressors such as chronic acid exposure. The change in lining is a double-edged sword. The new lining confers a protective benefit, but it is also much more likely to become abnormal, even cancerous.

My handwriting has undergone its own form of metaplasia during the process of becoming a doctor. Writing an order for an antipsychotic medication while a patient is having a psychotic break, or scrambling to keep pace with a professor flying over important material in lecture have transformed my handwriting into a sloppy mess. These days, I can barely tell what I’ve written on the bits of paper I find in my own white coat pockets. My t’s and h’s have started to run together when I write words such as thyroid, thoracic, and asthma.

Colleagues have even “consulted” me for a “handwriting translation” when I hand them scribbled notes about each patient during evening sign-out.

It isn’t just being in a hurry that has become the enemy of my penmanship.

I always try to give patients my full attention in the exam room. I look them in the eye while they speak, rather than typing into a tablet or writing notes by hand. Then, on my way to present the patient to my attending, I’ll press a piece of scrap paper against the wall and scribble key facts down. Hypertension becomes HTN and family members who are living or dead become up or down arrows, respectively.

Occasionally, I worry that my terrible handwriting could harm a patient if an overworked pharmacist interprets Celebrex (a nonsteroidal anti-inflammatory medication) for Celexa (a depression medicine) in the middle of the night. Fortunately, electronic medical records save us from such disasters these days.

One day, I may have a curious child with perfect penmanship who asks me, “Mom, do you have to have bad handwriting to be a doctor, or does it get bad while you become a doctor?” I will smile, as my father did, but I will have a more definitive answer. I will then turn my pockets inside out to display my own bits of scrawl and say that mine was once perfect, too.

Kathleen Ackert is a third-year medical student at the Philadelphia College of Osteopathic Medicine. She grew up in Manhasset, N.Y., is a graduate of Siena College in Albany, N.Y., and loves to call Philadelphia home these days.