For now, you can call me Plain Mr. Harrington (S.)

Bad_Sir_BrianIt has been three weeks since I stepped into the void. Taking that step means I gave up one of the most responsible jobs in the workforce, making decisions for patients that had life or death consequences. Did I expect that change to make me feel small, reduced, insignificant? I think I did, and for a few days I felt that way.

I have traveled to and from DC several times since leaving my medical practice. The further away I am from the office and hospital the less I remember of my former self. I feel partially stripped of my former identity – in a good way.

However, the closer I get to the hospital or office the more acutely aware I am of what I have given up. Indeed, during my recent cardiology check up I felt particularly dysphoric.

On my current return to DC, I attended a retirement party for one of the most underappreciated (by the administration) but warmly loved (by the staff) nurse managers in our department. All my former colleagues were there. One doctor was receiving calls from the ER regarding consults for that evening. I looked around at the assembled MDs, all aging like me, and I felt fine.

In fact, I am quite surprised at how comfortable I feel without the constant responsibility I bore. I did it for decades and I did it well. I am done with it.

Dr. Harrington vs. Mr. Harrington

I also have a new consciousness of the distinction between Dr. Harrington and Mr. Harrington. At my former hospital an old-fashioned relationship between doctors and nurses was generally maintained. Most nurses addressed physicians as “Doctor” when asking questions or reporting on patients. This practice extended to less formal circumstances including retirement party etiquette.

In my many phone calls of the last three weeks I am conscious of people referring to me as Mr. Harrington even when the information in front of them indicates my professional title.  I do not mind.

My wife thinks I should correct them. “Once a doctor, always a doctor.” I do not agree. I feel that only doctors actually treating patients for true health care issues deserve that honorific and the attendant respect. In that regard my daughters are the “doctors” in the family.

A subtle variation on that theme comes to mind when I think of the flattening of the hierarchy of care that has evolved over the last few decades.  My elder daughter works in a neonatal intensive care unit in a team of neonatologists, physician assistants and nurse practitioners.

I think she generally is more comfortable working with her team on a first name basis.  I understand.  She thinks of the title as a solecism. I do not. [Note: I am trying to convince Sam not to use $5 words. I am not positive he has used “solecism” correctly here. In the interest of marital harmony, I am leaving it be. – Debbie] At the end of the day she is the doctor and makes the final call about therapy. She bears the responsibility.  She is the “Doctor.”

My younger daughter is a new surgical resident.  She is probably struggling to embrace the title as she is surrounded by nurses, PAs (physician assistants), and techs with more experience and skills than she has for the moment.  After a year in the crucible of internship I know she will have earned the mantle.

I respect the title so much, when applied to good and active practitioners, that I am comfortable without it as I define my new self as “Plain Mr. Botany (B.)” – at least for the duration of my Gap Year.

Sam is a big A. A. Milne fan. The illustration above is from the A.A. Milne poem, Bad Sir Brian Botany. The punch line is that Bad Sir Brian loses his battleaxe and his spurs and becomes Plain Mr. Botany (B.) – Debbie

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Puncturing a lampshade and crossing the Rubicon

iStock_lampshade_000004703320XSmallAfter leaving Milwaukee I returned to DC. I needed to clear my desk and I had a medical check up scheduled. Getting close to the action created temporary feelings of inadequacy and purposelessness. But being a patient at the overly technological office visit reminded me of the outrage I feel at the complexity medical care has assumed.

For the last few days Debbie and I have been packing up about ten percent of our house and ninety percent of our stored memorabilia for delivery to our new cottage and storage space in Maine. Packing and sorting is always unsettling.

For Debbie the distress was compounded by the move of her office materials from Washington to Maine. For me it was a distraction from the feelings of loss I was experiencing. It is hard to describe the sense of loss.

I think there are two ubiquitous fragile stretches of cloth that people commonly encounter and occasionally puncture. These are the black cloth underneath upholstered furniture and the white lining inside fabric lampshades. The function of these membranes is subtle but significant.

For some reason I have always been unsettled on the rare occasion when I puncture one of these pieces of fabric. Perhaps as a child I did it intentionally or perhaps unthinkingly as a foolish adolescent. Was I, perhaps, sharply criticized by my parents after such an occurrence? I do not remember. Whatever the reason I remain very distressed when such a tear happens, caused either by myself or someone else.

Yesterday, while disassembling a lamp to take to my daughter I punctured the diaphanous inner lining of the lampshade. I have been unable to get this out of my head as we drive away from DC to meet our belongings in Maine. It is not our final departure but it has a sense of inevitability.

I feel that I have perforated some larger membrane. Is it the thin band of trust that I have violated by “abandoning” my patients? Is it that driving away from our house on O street is a sign that we can’t turn back? Have we gone from one reality to another lesser reality?

I don’t think so because I know that my point of no return – my Rubicon – was when I mailed the letter to my patients announcing my plans to leave my practice. I had not slept well for months before that. It was a secret plan that could not be leaked but was best disseminated quickly and broadly. I slept well the night the letter went out.

It is easier to look forward when driving away from the past. Certain torn fabrics can never be repaired; they can only be replaced.

Now, we have started the drive.