Any other name

Let's say, for the sake of argument, that my first name is Trixie.

I spent most of my first year of residency introducing myself as "Trixie Signout, the junior resident on the team." I got called "nurse" a lot, then started introducing myself as "Dr. Trixie Signout." I wanted people to feel comfortable calling me by my first name, I said. I didn't want to seem classist, or superior.

Most of my patients ended up calling me "Doctor," anyway. During most of my intern year, it felt like a joke. But over the past half year or so, I've started to feel like that's really what I am. I finally feel that I fill out that white coat the way a real doctor does, so now I introduce myself as one. "I'm Dr. Signout," I now say when I walk into a room. It feels right. It feels good.

I admitted a new patient to our service last week--a frail, emaciated little man with end-stage liver disease. He was transferred to us from the intensive care unit. On the first day I met him, he cried during most of my visit. When I asked what hurt, he motioned toward the site of an indwelling drain for his chronic collection of abdominal fluid. It hurt so badly that he could not form complete sentences to describe it.

I ordered a very simple form of pain control called patient-controlled analgesia, or PCA. With a PCA, a patient receives a continuous dose of pain medication through an IV, and a "demand" dose when they push a button (within certain predetermined limits). PCA's are a great way to achieve good pain control without risking oversedation--if you're sedated, you can't hit the button--and they are relatively easy for providers to titrate. For this reason, they are quite common in hospitals.

Nobody explained that to this patient. He thought his PCA was a medical miracle I had invented especially for him. On his second day on my service, he thanked me several times for controlling his pain. I have seldom had any patient express such gratitude for something I have done. It was sweet, gratifying, and a little embarrassing.

On the fifth day, his family was in his room when I walked in to examine him. We talked for a while--about the drain, about his medications, about the Polaroids that showed him as a chunky teenager. The patient and the family again expressed gratitude. Then, as I was preparing to leave, the patient asked me, "Do you know Dr. Dave?"

I wasn't sure who he was talking about. After hearing some description and a few fumbling attempts at his last name, I eventually understood: Dr. Dave was the best supervising doctor in the intensive care unit, a terrifically warm, smart, humble, and funny man. (And, incidentally, the first attending doctor I worked under as an intern.) "I like him very much," I said.

"Me, too," he said. "Very much. He really listened to me. He really helped me."

I said I'd let Dr. Dave know where he was. Before I turned to leave, his mother winked at me and said, "Thanks, Dr. Trixie."

What is all this hooha, after all, about the title? Maybe I'm overreading it, but however off-handedly, this woman had plunked me into the same professional category as "Dr. Dave." It was a greater compliment than she could have given me with any other name.

It also made me wince a little at how much I've invested in what I call myself. This doctor I respect so much, I'll bet he feels like a real doctor, no matter what he gets called.

More like this

It is an interesting thing to think about - this naming business. I graduated from med school on Monday, and my parents were so excited. I think they expected a magic wand to wave over me, and a magical transformation to take place.
My parents at breakfast that morning: "This is your last meal as a normal person!"
Me: "Wait, when did I become a normal person??"

My point is, it's interesting how even people we know quite well attach such importance to a title.

The other day I had someone call me Mr. Nerd (on the internet) and I thought, Why don't we have any gender-neutral titles for "normal" people? I'm kind of tired of being labeled by a gender (especially by the wrong one). I guess there has to be some sort of motivation to become a Dr. or Prof., eh?

Ah, but I'm quite sure "Dr. Dave" never got called "nurse!"

A lovely post! You deserve the gratitude sure, but I like to see the affection, too. What a nice family to partner with. :)

By Anonymous (not verified) on 10 Jun 2008 #permalink

To me you're still my "litol" one... your Mommmmaaa

By signout square 2 (not verified) on 19 Jun 2008 #permalink

What a beautiful post, Dr. Trixie! An interesting insight into labeling, self-worth, humility, pride and the likes.
Thank you for keeping it honest and real. You are loved.

Ah, but there's lots in a name, especially for women in the professions. I'm glad you're feeling like you've earned that "Dr." And that others are acknowledging the authority, knowledge, and skill you have to offer.

I'm not surprised your patient was so grateful. So many times when I was in the ER for uncontrollable migraine pain, when I would receive that simplest of things, a shot of demerol or dilaudid, and the pain would go away, the relief was so immense that I wanted to cry. I wanted to thank the nurse, the doctor, I wanted to let them know how very fabulous it was to have that pain taken away. I went through this so many times that it was not a surprise anymore, I knew what was coming each time, but each that that relief of the pain was so immense that the sense of gratitude was overwhelming. Maybe (some) doctors don't realize just how significant pain management is??? It is no small thing.

When a Dr. calls me "Ms. Reader" I call her or him "Dr. Lastname." If a Dr. calls me "Texas" I call her or him by the first name.

By Texas Reader (not verified) on 03 Sep 2008 #permalink

Bizde en iyi yerlere gelmek için bir çaba içindeyiz tabiki bunun zorluÄunu yaÅamaktayız ama bir yola çıktık ve bunu baÅarmaya çalıÅmaktayız bakalım nasıl olucak istediÄimize ulaÅabilcekmiyiz inanın böyle çok zor oluyor ama mecburuz napalım evet hayırlısı .
Herkesin birbirine yardım etmesi gerek aslında kendilerini düÅünmemeli herkes dostlarınıda düÅünmelidirler bence tabi bu benim fikrim