Every attending physician I meet within the context of work I address by their title. For example, I would always call Dr. Charles “Dr. Charles” and never “Aidan”. I only deviate from this practice when the attending physician specifically requests that I address him only by his first name. I usually need a friendly reminder.
I attribute this rigid practice to a surgery resident. (My obsessive-compulsive traits may play a marginal factor, too.) I was a third-year medical student on my first clinical rotation—trauma surgery—when I met Dr. Montgomery Ward (not his real name).
Dr. Montgomery Ward was a third-year surgery resident who attended medical school at a prestigious academic institution on the East Coast. Dark circles drooped below his eyes, neatly trimmed chestnut hair crowned his head, and thick, unsmiling lips adorned his face. He wore a medium-sized scrub top, large-sized scrub pants, and brown clogs over his off-white socks. He carried a small, black notebook in the left pocket of his rumpled, tired white coat and a stethoscope in his right pocket.
(In fact, I never wear my stethoscope around my neck when I am not actively using it because Dr. Ward provided a mocking admonition to the medical students during our first week on the service: “If you wear it around your necks like those medicine docs, it looks like a dog collar. Don’t wear a dog collar—have some class and put it in your pocket.”)
He had nice hands with nimble fingers and cleanly trimmed nails.
“People don’t show enough respect out here,” Dr. Montgomery Ward opined one afternoon, referring to the lackadaisical practices of the West Coast. “Medical students and residents should never address their attendings by their first names. Where I came from, everyone addressed the residents as ‘doctor’. It’s too lax out here.”
Already feeling anxious from my bumbling presentations during rounds, inability to scrub correctly, let alone efficiently, for operations, and fears that someone would yell at me for breathing incorrectly while in the operating suite, I incorporated as many suggestions as I could to minimize the opportunities I would look like a complete idiot.
“On the East Coast, we always address the attendings as ’sir’,” Dr. Montgomery Ward said. He didn’t tell us how to address our female surgery attendings—maybe they didn’t have female attending surgeons on the East Coast?
He practiced what he preached—watching him interact with the attending surgeons was simultaneously awe-inspiring and nauseating.
“Where would you like to begin rounds, Dr. King?”
“Would you like to personally see the wound, Dr. King?”
“Yes, sir? No, sir. Absolutely not, sir. Thank you, sir.”
“I would be delighted to assist you during the procedure, Dr. King. Thank you for considering me, sir.”
“Dr. Ward is an excellent resident,” the attending surgeons shared with the medical students. “He may be a bit formal, but he is smart and is outstanding in the operating room.”
“Monty takes this too seriously,” the junior residents snorted. “All of the ‘doctor this’ and ‘doctor that’—stop calling me ‘Dr. Penny’ and just call me ‘JC’, okay? And, really, you don’t have to call him ‘Dr. Ward’, either.”
And yet, Dr. Montgomery Ward was stern—his dark eyes glowered at us from across the circle if our presentations hinted at informality. Or even if we neglected to greet the attending surgeon by his full title. The medical students lived in discomfort under the bright glare of Dr. Ward’s scrutiny.
Dr. Montgomery Ward, however, taught well. I still have my notes that I hastily scribbled during his impromptu talk on mechanical ventilation. I never said his name—first or last. I feared that he would chuck a central line kit at me if I ever called him “Monty” and it seemed odd to call him “Dr. Ward” when we called the other residents by their first names. So I just ensured that we made solid eye contact before I asked or answered questions.
When my time on the trauma surgery service came to an end, Dr. Montgomery Ward provided terse feedback (”You did fine, Maria—good, concise presentations.”) and, rubbing the sleep from his eyes, briskly walked towards the cafeteria. I don’t think he said “good-bye”. Then again, he never said “good morning” to anyone other than the attending surgeons.
These days, I correct all the nurses and medical students who address me as ‘doctor’ and insist that they address me by my first name. Like me, some balk and insist on using my title—and I know better than to argue.
(Part of the ongoing Relationship Series.)
23 May 2007 | 7 comments.
Burst.
Sometimes we are blessed with unexpected firecrackers of inspiration that seem to burst into our minds without warning—
—though, upon deeper reflection, they were trickling through our daydreams and distractions. We just never realized what we were thinking.
Draft #13 did materialize nicely—and though there are still more colors and shades to add to the prose, I can now primarily concentrate on editing.
Although I had enrolled in improv classes to help me cultivate my skills in teaching, they have been more helpful in thinking about and constructing meaningful narrative. The instructor has said the same thing week after week; it was only while I was ill that I finally recognized what she was saying: The relationships are what make the narrative matter.
I picked up an old copy of Gladwell’s The Tipping Point and am making my way through the curious book and, sometime over dinner tonight, I sprung upon the idea of doing something like writing forty posts about various relationships in forty days. There is a link between Gladwell’s book and this idea; I just can’t make the connections clear right now. That kind of ambition mildly frightens me because writing, relationships, and writing about relationships require some amount of disclosure… and disclosure can be scary.
It’s the burst of inspiration I have been waiting for.
22 May 2007 | 1 comment.
Five Seconds Inside a Psychiatrist’s Head.
I should stop talking.
But I can’t just stop talking. It would be weird if I abruptly stopped mid-sentence. I need an unobtrusive ending to this paragraph. Quick.
His eyes are glazing over. I really need to stop talking.
“Ask more questions,” my supervisor says. I’m not asking questions right now; I’m providing an overly verbose explanation.
Why am I providing this overly verbose explanation? What is it about this interaction such that I feel compelled to offer a justification?
I’m not talking for the patient’s benefit; I’m talking to mitigate my own anxiety.
I should stop.
I think I’m worried about offending him. That’s why I am engaging in this lengthy pontification. I want to make it absolutely clear that I do not mean to offend.
Why do I think he’d be offended? That’s interesting. Not now—save that for later.
I’m still talking! He hasn’t blinked in some time now. I need to re-engage him—pull the brakes on this soliloquy train and transfer to the Socratic car.
I’m saying “um” a lot right now.
And there’s the closing phrase—wait for it—close your mouth—and stop.
He looked at me blankly.
“Okay,” he eventually ventured.
21 May 2007 | 1 comment.
Draft #12.
I am on draft #12 of my personal statement for my fellowship applications and, honestly, I’m actually not in the process of editing. I’m still trying to create better prose. You know, hoping that The Muse will bop me on the head with her sparkling Sceptre of Novel Ideas and Captivating Narrative (she obviously hasn’t hit me with the Wand of Brevity) to enable me to write a thoughtful piece that shall successfully persuade the readers to offer me an interview.
Draft #12! And it still feels like I’m working on a difficult crossword puzzle—you know, the kind with clues like
- Antihelminthic.
- Has a Poisson ratio of 0.259.
- Large fish eat small fish on canvas?
My personal statement for medical school went through about 22 drafts. For the residency application, I went through 17 drafts. Perhaps I am romanticizing the past, but I believe that I was not raking my fingers through neuronal sludge for ideas and narrative for those two essays.
Draft #1 (dated April 12th!) for my current statement is a concise list. I know my reasons for pursuing this fellowship. The reasons are legitimate, honorable, and honest.
Lists, however, do not charm people; stories do.
There is no story. There is no narrative. There is a brief description of an individual. Then there are many vague and bland sentences that could neutralize stomach acid. It’s not a personal statement; it’s a treatment for heartburn.
It all seems so usual. It’s like reading a recipe. These are the ingredients, these are the cooking instructions. Blah blah blah.
But! If, instead, I could write about the delectable cookies, the way the coaster-sized confections are arranged symmetrically on the glossy black plate, the wisps of grey steam floating from their surfaces, the column of milk standing at attention nearby, the lone candle, with its slender purple stem bursting into a bright yellow-orange blossom of flame, the corner of a cream-colored envelope tucked underneath the plate, the name “Matthew” ornately written in dark blue ink, with the tail of the “w” arching gracefully towards the top right corner of the envelope, a hastily scribbled heart in red ink above the name—
—that’s a narrative. That has shape, color, and direction. That has purpose.
Unlike this current entry. Gah. I just want a story.
In unrelated musings, I am contemplating another literary project for the medbloggers, though my current idea isn’t actually all that literary and would be relatively labor-intensive (for me). Plus, another medblogger has informed me that he intends to launch a curious project (you read it here first!) and I am uncertain of medblogging project etiquette: Is it poor form to launch a project when someone else has suggested a pending project launch? Will less fewer medbloggers participate in my project if conducted concomitantly with his project? Would it be better if I refrained from creating and just consumed online content? Will I be contributing to interblogger conflict with the introduction of my project? Is it clear that I am joking?
Thirteen may be a lucky number. I don’t want to dredge this out to 42 drafts. I just want a story.
20 May 2007 | 10 comments.
Time and Place.
The last time I saw her was nearly three years ago. We were newly minted physicians and warmly said good-bye, stay in touch, let me know how residency goes, I hope to see you soon. Our black graduation gowns swirled around our ankles from the afternoon breeze.
There were regular phone calls and Christmas cards. The Northwest and Southwest proved to be too far for a visit, though, until now—she has only one month before she makes the leap from resident to attending physician.
She looked older—maybe it was the wrinkles from the desert sun, maybe it was the furrow in her eyebrows when she discussed difficult situations in the hospital, maybe it was maturity and distance etched into her features after witnessing the morbidity and mortality of children.
She still said “like” a lot, though. Some things don’t change.
She brought the sun with her; I think she attached the glowing celestial orb to the tail of the plane and, today, attached it to her wrist as if it was a balloon.
Having visitors reminds me of the charm and beauty of Seattle. Not only am I reminded of the why I am fond my friends, but I also remember why I enjoy this city. Today, we
>> ate breakfast at Lowell’s, which is located inside Pike Place Market. The waters of Elliott Bay were restless and choppy and the distant mountains, crowned with grey storm clouds, stood serious and unmoved at the horizon. The morning sun sprayed silver glitter over the bay and a large ship sat patiently at a pier, awaiting its freedom. The food there is good; the views are even better.
>> attended The Cheese Festival. Had we known that this was occurring, we may have skipped breakfast. (Insert “you are what you eat” jokes in here.) Cheese mongers are enthusiastic, warm, and charming (much like the fish mongers). The most memorable blob of cheese I sampled consisted of goat cheese, apricot chutney, and almonds.
>> noshed through Pike Place Market. Today’s nibblings included flavored honeys, sweetened nuts, pieces of fruit, and ridiculously sweet cookies. “Divinity” cookies are not divine; they are dangerous vices. I also find their structural integrity disappointing. Cookies ought not melt in one’s hand.
>> meandered through the Olympic Sculpture Park. I do appreciate Seattle’s dedication to preserving and maintaining park space. I was particularly impressed with “Love & Loss” (with the rotating orange ampersand), “Split” (the metal tree), and “Wake” (the waves composed of nuclear submarines). Neither she nor I are artsy types, but we found ourselves providing thoughtful commentary about our reactions to these pieces of art. Who knew.
>> attended The Underground Tour. It’s been nearly two years since I last took the tour; I still enjoy it immensely. Seattle’s history is quirky and that visitors can actually walk through it is remarkable. I believe the tour is a requisite part of any visit to Seattle.
>> ate a fantastic dinner at Coastal Kitchen. The current menu features Jamaican dishes (the rockfish is delicious). I am never disappointed with my dining experiences there.
Amongst other things, she and I speculated upon attending a medical school reunion. Many of my colleagues are completing their trainings this year; they’ll be attendings while I continue my existence as a resident.
This reminds me that I am growing older—aging! Is it really happening right now?
The wind felt cool against my face and the sun was bright in my eyes. The minute hand continued to sweep across the face of the glowing orange clock.
19 May 2007 | 4 comments.