The Doctor is in and Yes, that means Me!

By Denise Kavuma, Uganda:

Picture this if you will

A cold wind is howling outside and a chill has settled deep in your bones even as you try to stay awake at 3 a.m. on a Tuesday. You’re on call in a hospital and the emergencies have finally slowed to a halt. Optimism suddenly rises and you hope that you may get at least an hour of sleep that night. Not so fast though, a seemingly healthy person strolls into your emergency room at that moment and with your voice hoarse, you ask him what the problem is. He says that he’s there to get some treatment for a cough he’s been having. You take a moment to internalize this. After all, you’ve been awake for close to 30 hours and your brain is a little slow. Finally, with the patience of the gods at your command, you ask him if he’s in pain, distressed, or if the symptoms have suddenly worsened. He looks at you, shrugs and says that he just wanted the drugs and in fact, the cough had eased up in the past 2 days but well, the hospital works 24/7 anyway, right?

You try to convince yourself that you simply cannot afford to expend any energy in the effort to punch him in the dick so you decide to treat him as you would any normal person (though he’s clearly the spawn of Satan). Hey, the gods never were abundantly patient, you tell yourself. Finally, you get done with him and just before he walks out, to go back to hell, no doubt,” he mumbles a quiet: “Thanks, nurse.”

These moments have happened numerous times before and I’ll spare you the boring details of how I usually handle them and say that I wish I would just get up and say, (with my skin glowing and my hair dancing in the wind): “I am not a nurse. I am Denise Kavuma. First of my name (no, seriously, look it up). Denise Jessie of House Kavuma. Holder of an MBCh.B. Queen of the slit lamp and of counseling patients with unsettling diseases. Painter of anime. Published writer. Breaker of Thin, Plastic Chairs With My Thick, Thick Thighs. Winner of high school poetry medals. Mother of nothing (now and always). You will show me the proper respect!? Then I’d like seek my dragons on them or something of the sort. This doesn’t happen largely because I can’t even remember when my skin last glowed and I just can’t stand my hair not held up and strapped to my head with chains even, if necessary.

Titles are important but I think names are better. I’ve always felt a little animosity for people who insisted on calling me doctor and I’m sure there’s a special circle of hell reserved for those who go ahead to shorten it to doc. I have a name, you know, but because humanity is the embodiment of belligerence, the more I insist on people using my name, the less they use it. It doesn’t help that I seem to have moved from one end of the spectrum to the other end and I’m now being called a nurse everywhere I turn though. I had been used to people referring to me as and imagine me gritting my teeth as you read this?doc but now every time I hear the title, I force myself to not turn around because they’re almost never referring to me.

I am currently back at school, doing my Masters of Medicine in Ophthalmology and subsequently stuck in a small town in Southwestern Uganda which seems held in time. Not the cool and quirky stuck-in-time ones we see on TV but rather the misogynistic, clueless, will-walk-up-to-a-stranger-and-command-her-to-eat-less-because-she’s-fat kind. No, I’m serious. I’ve actually lost count on the number of times dudes have crossed the street to ask me why I don?t exercise more, but I digress.

Most of the doctors I’ve met don’t seem to mind being called nurses and simply just decide to shrug it off but I have had some nasty experiences with patients complaining publicly that they went to such and such a hospital and were only seen by a nurse. I used to go out of my way to ask patients if they just spent all the money they did to see a nurse and if not, why would they assume that I was one, but now I simply state that I am not a nurse, but a doctor. It doesn’t matter that the tag I wear clearly has the title doctor before my name, I am always referred to as a nurse first. I find it the strangest thing really; some of these people don’t want to be corrected and one man yelled loudly in the waiting area that for [the tribe which dwells most in Southwestern Uganda] it had stuck that every female medic is a nurse so I shouldn’t bother.

There have been some pretty bizarre experiences along this line, like the time some guy was tired of waiting in line and yelled at one of my friends and started being a nuisance in the waiting area so my friend had to step out of her office and try to calm him down. He ended up yelling something along the lines of a nurse can’t tell me what to do; go and get the doctor, now!? I could only imagine the emotions she felt but she walked back in her office and the dude had to go see her after they’d explained to him that she was indeed the doctor, in spite of her being female.

Or how about the time when this young lady walked in with her really sick neonate (child below one month). The baby was so dehydrated and hypoglycemic that he could barely cry and was instead making a wheezing sound with a lot of effort. It was a disturbing sight. The nurses and I immediately attempted to resuscitate this child and as we were trying to gain IV access, the mother walks over to the waiting area, sits down, and starts texting/surfing/playing games/*insert here whatever the young people do these days* on her phone. I glanced over at her in confusion but for sure, she stayed there a while and even made a phone call, stating somewhere along the way that the nurses were attending to the baby and she was waiting for the doctor.

It’s at this point that I should state for those who are not yet so offended that they stopped reading a while ago that I have no issue with nurses. They come in all shapes and sizes and I find being called one as offensive as someone referring to me as Denis (and this happens way more than it ever should, mind you). Which is to say, I don’t find it offensive at all but rather, more bemusing. I’d really much rather set the record straight either way that my name clearly has an “e” at the end of it. It’s pedantry at its most basic.

I remember my irritation when a patient wanted to get the attention of one of my colleagues and something in his head thought he could call her girl! This is an accomplished lady with years of experience under her belt, is raising four children in a stable home, and is so brave that she left her Francophone world to come and get her masters in a primarily English-speaking country. I’ll state that again. She actually came to learn medicine in English when she hadn’t been speaking a word of it 3 months prior to her arrival and is going to go back and practice in French after she is done. She’s brave and brilliant and there this person was yelling “girl!” and thinking that that should be enough to get her attention, after she’d examined him, done his investigations, and admitted him all so nicely, wearing a white coat all the while.

Why does it bother me so? Well, this isn’t exactly the space for me to air out my views on women making strides in this generation so I’ll go with the 4th most important reason. Nurses tend to be treated rather roughly in our medical system and I hate that with a passion; I get especially aggressive when those nurses happen to be under my jurisdiction. I love to protect the people on my team and in order to do so, I must command some respect in the aggressor’s eyes or I will need to get especially vicious in order to get them to back down. That is a situation I’m sure most people would rather avoid.

There is a difference in the way even information is retained when I’m counseling a patient and she instead thinks she’s talking to a nurse. They just outright don’t believe me and this is much harder now that I’m dealing with sight and have to emphasize certain changes in behavior lest they go blind. Some of these patients end up swearing that I never explained anything to them and it really is quite bizarre that they can lie so boldly; they don’t call me the Counseling Queen for nothing, after all.

I would be lying if I said that my ego wasn’t involved here as well. Yes indeed, there are all these medical-legal issues involved when a patient thinks it’s a nurse who attended to him instead of a doctor but respect is something we’d all rather have. While the patience of the gods isn’t much, it can last for a while if used wisely and so I’ll just have to keep explaining that no, not all female medics are nurses, some are doctors, and that yes, science indeed has come that far.

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