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.