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The Doctor's Note

Posted Oct 23 2008 11:16am

If you've completed your dissertation and any lingering requirements for graduation, the last day of your internship is quite a unique experience. It's the culmination of five years (minimum) of graduate work. You walk into work as "Mr." or "Ms." and come out as "Dr.". On my last day of internship I spent most of the afternoon finishing up paperwork, transferring patients to the soon-to-be arriving interns and saw a few patients myself for termination sessions. One client, I'll call him Seth, was very fortunate to be successfully completing therapy for Generalized Anxiety Disorder just as I was ready to graduate and move to New York City.

As we've learned, termination sessions are not always pleasurable experiences. But when treatment is successful it is ideally a time to celebrate the hard work done, the loss of symptoms and the newfound growth in a person.

Seth and I had worked together for eleven months. A few years younger than me, he saw me as an older and (theoretically) wiser brother. I saw him through two promotions, one demotion, a relocation to a different part of the state, three break-ups and a cancer scare. Seth had had an active year and I felt fortunate to see him work through his hardships and develop as a man. We spent most of the final session discussing what he had accomplished, ways to prevent a return of symptoms and what he might do should he need further treatment. We also talked about our sadness at the fact that we would no longer be working together. Seth got a bit glassy-eyed but didn't lose his composure. When the session was over we shook hands and said good-bye.

"Rob, I forgot to tell you that my boss now requires a doctor's note for my sessions so that I'm not docked pay. Can you write one for this session?"

"Sure," I said. "My pleasure."

I scribbled out a quick "Please excuse Seth from work from 1-2 P.M. as he had an appointment for psychological services rendered." I signed it "Rob Dobrenski, M.A."

Seth read the note. "No. I need a doctor's note. This says 'M.A.'. Isn't that 'Master of Arts?'"

Therapist Rule: Tell all clients your credentials prior to initiating treatment so that they may make the most informed choice about their provider. This is especially important if you are an unlicensed practitioner.

"Right," I said. "I had told you at our first meeting that I'm a graduate student with a Master's Degree and that I'm completing my doctorate."

"I don't think you told me that."

"It's actually a very strict requirement by the state and all doctorate programs in the United States. I'm pretty sure I told you."

"But my boss is such a pain in the ass. He'll freak if I bring him a non-doctor's note."

"I don't understand why that's important. You had an appointment for therapy. And I'm not about to become a doctor in the sense he's referring to anyway."

"No no, he's really into titles and credentials and stuff. He'll give me shit if it's not signed by a Ph.D."

"I'm sorry, Seth. I don't know what to tell you." I still didn't quite get where his boss was coming from but I truly felt bad for Seth.

Seth's eyes started darting back and forth and you could practically see the neurons in his brain firing, problem-solving. "Wait! Isn't today your last day?"


"So aren't you a doctor when you punch out?"

Up until that moment it hadn't really occurred to me that my title was going to legally change in...three hours.

"Yes, technically."

"Great, great! What time are you done?"

"Five o'clock."

"Okay, I'll come back then and you'll sign the note!"

I quickly calculated what, if any, ethical violations were at play here. "But even though I'll have signed the note as a doctor, you're appointment would have been with a graduate student."

"Believe me," Seth said, "the guy doesn't care. He just wants to bust my balls."

I must have looked pretty skeptical. "Rob. No, Doctor Rob. Please," he said.

"Don't call me that! My name is not "Doctor" for another two hours and fifty-seven minutes. I've been waiting five years to start using that name and I'm not introducing it prematurely."

"No, no. Of course not. At 5 P.M. though, you are, officially, the man."

The man? Me? Always the fool for the ego stroke, I relented.

"Fine. Come back at five and I'll sign the note."

At 4:57 my classmates were at the Director of Training's party. Drunk, counting down the seconds, as I should have been. Instead I was standing at the receptionist's desk looking for a pen. I looked up and saw Seth's face giddy with anticipation.

"This is the moment, Dr....I mean Rob."

"Thanks Seth. I have your note. Let me just sign it for you."

"Wait! Not yet. It's 4:59. Let's treasure the moment."

Seth and I stood facing each other. The clock ticked in the background. When it struck five o'clock, Seth handed me a pen. "Congratulations, Doctor Dobrenski."

I leaned down and signed my new name: Rob Dobrenski, Ph.D. It looked...great. I'm a doctor...I'M A FUCKING DOCTOR! Not the real kind, but I'm a doctor!

It's a stretch to say that the die was cast at that point but the fact remains that my name was changed forever.

"Thank you, Dr. Rob," Seth said, "this is like an autographed rookie card."

And then it hit me: he didn't really need the note for his boss. He wanted to be there when I graduated.

"Dr. Rob," he said. "Go to New York and help people like me. I wish you nothing but the best."

"I...thanks, Seth. Thank you."

"You take care of yourself," he said with a sad smile. And then he left.

I went out that night with my classmates and celebrated, drinking more alcohol than medical science would suggest possible. I told the secretary that I was secretly in love with her. She was 74 years old with three grandchildren who were older than me. I woke up the next morning with a headache that would drive weaker (and smarter) men to suicide, got in my car, and drove to New York City. The rest is history.

Thank you, Seth.

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