Saturday, November 13, 2010

Terms of endearment.

*names, details, etc. changed. . . .yadda, yadda, yadda. . .

 "You need anything, sweetie?"

"Mrs. Jasper?  Mrs. Charlesetta Jasper?" I overheard a nurse calling from the door  dividing the clinic from the waiting room.  Shortly after, a very snappily dressed Grady ultra-elder shuffled her way to the door with all of her weight leaning on her four pronged cane.  The nurse stepped backward and leaned her back on to the door to create more space for the patient. "You're gonna come right on through here, sweetie," she said while pointing toward the triage room.                                               

Mrs. Jasper pushed and stepped along with her cane, but inadvertently bypassed the triage door.  "No, no, sweetie. . . .over here," the nurse gently instructed her.

"Oh. . .I thought we was gon' go strett to the room," replied Mrs. Jasper in a wobbly voice.

"No, love, we're going right in here." The nurse gestured to the entrance and helped her into a chair to get her vital signs measured.

"Thank you," spoke Mrs. Jasper.

"Yes, ma'am, no problem." Mrs. Jasper smiled warmly and stuck out her left arm for the blood pressure cuff.

A few hours later, I walked downstairs to the gift shop to grab a quick diet Coke.  I was immediately greeted by Shanika, one of the cashiers.  "Hey, Dr. Manning!  How you doing?"

"I am so sleepy!" I replied with an exaggerated shake of my head. "I need a diet Coke fix!"

"And your granola bar, too?"  We both paused for a moment and shared a laugh, acknowledging how completely predictable these pitstops have become for me. 

"You doing alright, Miss Shanika?" I smalltalked as I rummaged through the refrigerator. I have this dumb practice of placing my hand on several drinks in an effort to choose the coldest one (probably one of the most completely asinine things I do on a daily basis.)

"I'm fine, baby," she answered with a broad smile. I liked her confidence and decided that the gleaming gold in her front tooth was fitting. I smile in return. Next, I sift through the granola bars and predictably choose the same "Peanut Butter" one. Finally, I hand it, along with the winning cola to Shanika.

I studied the cursive tattoos across her forearms and her long, curved acrylic nails as she rang up my two items.  She caught my eye and flashed that glowing smile once more.

"You want a bag, baby?" she asked.

"Naaah, I'm fine."

"Alright then, baby," she said pushing my purchase over toward me. "It's  good seeing you as always." Shanika dropped my change into my hand and nodded.

"Thanks, Miss Shanika!"

"Okay, babe."

I twisted open the bottle, took a few swigs and scurried back to the clinic.

As I headed up the stairs I found myself reflecting on words like "sweetie", "love", and "baby."  I recognize in that moment that Miss Shanika, who was easily fifteen years my junior, and the nurse who spoke to Mrs. Jasper, who could have been her granddaughter, both freely used the terms.

I asked myself if hearing Shanika call me "baby" offended me, and quickly admitted to myself that, for some reason, it did not. It's not like she is my close friend, or even someone who is old enough to be anything other than my "baby" sister. Maybe I should have been put off. Yet the "baby" that she kept using to address me sort of rolled off her tongue in a way that felt . . .I don't know. . .endearing. 

I thought about Mrs. Jasper. I could still see her appreciative smile, and decided that maybe she didn't mind her "sweeties" and "loves" so much either.

Or did she?

I still remember that time when I had my first pelvic exam, and the doctor kept calling me "sweetie" and "honey."  I hated it.  It made me feel creepy and patronized, even though I was only sixteen and a half and not yet fully aware that what I was feeling was even called "patronized."  Since then, subconsciously more than likely, I've never been a huge fan or user of those terms of "endearment" for my own patients.

But I'm still guilty.

Confession: I totally change my intonation when speaking to my Grady elders, and especially the Grady ultra-elders like Mrs. Jasper.  I ramp up my Southern hospitality and especially my "ma'am's" and "sirs." I even fine tune my "beg pardons?" and my "Good mornings." Now that I think of it. . . I have also convinced myself that tacking a "Miss" in front of someone's name when I don't know them or I'm younger than them makes me more respectful. . . but is it really? Couldn't that be bothersome, too?  And somehow it's like it just happens without me even thinking of it, just as I'm sure that nurse gave little thought to her pet names for Mrs. Jasper.  Without the "sweeties", yes, but could the musical quality of my voice be equally as. . .what do you call it. . . patronizing?


My friend Lesley M's kids attend a school where they call their teachers by their first names. Some deep thought has clearly gone into that decision, and that award-winning school is just as much in the bible belt as Grady Hospital.  But for some reason, I cringe when my kids roll up on adults and call them by any name that isn't preceded by a "Ms", "Mr.", an "Auntie" or an "Uncle." (And it ain't like I'm an award-winning child educator like that school. . . hello?) I wonder how their school would feel about "sweetie."


Is it okay if you mean well and are deferential? How about if you're syrupy sweet and with a masterful southern twang?  Would mixing it in with "ma'am" or stirring it up with"sir" make it more okay? And is there some accepted age differential that must be present to make it cool? Like, if you can qualify for Medicare, do you have carte blanche to use these words, or if you're old enough to pay a mortgage and the recipient isn't--does that make it alright?

I mean, that gynecologist that left me with feelings of violation back in 1987 was quite senior to me--yet the thought of his words and actions still make me bristle to this day. (Just bristled.)

Hmmm.  (This time with a head scratch and a slow head nod.)

I'll throw this one out to y'all.  . . . . and this time, comment--okay sweetie?


  1. Having worked and volunteered in hospitals, prior to starting medical school, this is definitely a topic I have contemplated many times.

    I have noticed that some people do it mindlessly, not so much in an attempt to be nurturing or friendly towards the patient, but simply as a matter of habit. That seems to bother me more, because it feels fake. It is akin to having a conversation with someone while they are just nodding and saying "uh-huh" without paying any attention whatsoever. The words lose their meaning.

    I am also guilty of changing my "tone" when talking to different people. When my older son was 8, he took me to task over this: "Mom, why do you sound like "hiiiiiiii, how AAARE you" [exaggerated mocking of my voice going up in pitch], when Mrs. N calls?" (Nothing like a bright-eyed 8-year-old to put you in your place!)

    So this has been on my mind, especially since starting medical school, and now having to interview and examine model patients weekly (2nd year). What concerns me most is that after the "sweet old lady" gets called "sweetie" or "honey" and gets an extra smile, the introverted, quiet old lady, who was waiting in the next chair and is in pain and not as friendly, will not get the smile or the same warm treatment.

  2. In my paramedic days my rule was inflexible: An adult patient, no matter the age difference, was always Mr./Ms./Mrs. Lastname unless very clearly directed otherwise by the patient (or in a rare situation where an altered mental status patient seemed to respond better to a first name). Sir or Ma'am were acceptable substitutes as appropriate. I've never been much on the "Sweetie" or other similar endearment terms.

    As a patient, I feel the same way. Until/unless I've said otherwise, I expect providers to call me Mr. Geraghty. That said, I'm usually pretty quick to ask that they use my first name. But I think that assuming that's the case is disrespectful.

  3. At my hospital, we are drilled on calling the patient by Mr/Mrs/Ms last name unless given leave to call them by first name. I confess to the occasional sweetie or honey when I can't remember what their name is at all. If THEY can't remember their own name, I use whatever they respond to.

  4. Love, love, love these comments. I am so with you, Anush! Love your son's insight, too. PJ and Tea, I think y'all are right that Mr/Mrs/Ms is supposed to be the default. I am starting to wonder if this is a southern thing? I don't know. But the "sweetie" thing is viral down here. . . .(as is the greetings with fluctuating octaves, Anush. . .)

  5. The comments have really enhanced the blog. They are all great and on target. It's nothing you can really put you finger on or suggest as a general rule. In some cases "it's habitual", in some cases it depends on how the person presents themselves. I doubt that a real "grump butt" will get a lotta "sweeties" and "babes". lol


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