RICK RADER, MD ■ EDITOR-IN-CHIEF

WHAT'S IN A NAME?: Buildings, airplanes and vehicles are also codenamed; hence the White House is known as Castle, Air Force One is known as Angel, and the Presidential State Car is known as Stagecoach.

"Rawhide" is Heading to the "Stagecoach"

It's quite gratifying to hear nurses, therapists, physicians and dentists refer to our patients as All In, Striving, Always Up, Top Gun, Gang of One, Upbeat, The Best – and my favorite, Perfect.

As a physician working in the field of intellectual and developmental disabilities, I have a great appreciation for transitions and the challenges they bring forth.

In medicine we struggle with transitioning patients from pediatrics to adult medicine to geriatrics and, eventually, to palliative care and hospice care.

In social supports we are challenged with the transition from living at home to living in a community-supported living arrangement. We are often perplexed when transitioning someone from school to the workplace. We try hard to seamlessly move individuals from one social role to another. In fact, we struggle with the transitions inherent in daily routines.

For someone with a compromised ability to completely understand their surroundings, one can appreciate the disharmony from waking up, leaving the home, riding in a car, going to work, eating meals, toileting, communicating your needs, returning home, trying to relax, bathing, getting ready for bed and preparing to do it all over again the next day. For many people with developmental disorders it's the transitioning that provides the most stressors, missteps, and emotional hurricanes.

In my mind, the only group that could possibly encounter a more complex and strenuous transitioning period would be the first week of a newly- elected American president. Just imagine. One week you're trying to find parking, and the next week you're given launch codes to an arsenal of atomic missiles. One week you're ordering take-out and the next week they hand you the keys to Air Force One.

One week you're known as Bill, George, Harry, Donald, Ronald, Jimmy or Barack, and the next week you're known as Rawhide, Searchlight, Deacon, Timberwolf, Eagle or Renegade.

During the first week of being the new President, you are assigned a secret codename compliments of the United States Secret Service. In actuality, the responsibility of coming up with a code name falls to The White House Communications Agency. According to established protocols, "good code words are unambiguous words that can be easily pronounced and readily understood by those who transmit and receive voice messages by radio or telephone, regardless of their native language." These guidelines were obviously created prior to current communication technology advances, including encrypted electronics. The first President to have a codename was Harry S. Truman; he was known as "General," probably based on his military experience.

On occasion, the new President is given a choice of names and can chose, or he can provide his own preference, but in the end, the codename is typically assigned. Often, the name is based on personality traits, interests or themes. In addition to providing the President with a codename, buildings are also named; hence the White House is known as Castle, while the White House Situation Room is known as Cement Mixer, and the Capitol is known as Punch Bowl. Air Force One is codenamed Angel, while the Presidential State Car is known as Stagecoach. See if you can appreciate the codenames that have been assigned to these past presidents:

John F. Kennedy's code name was Lancer; his administration was often compared to Camelot, the magical court of King Arthur where Lancelot was a legendary knight. Ronald Reagan who, as an actor, appeared in numerous western movies was codenamed Rawhide. Jimmy Carter's codename, Deacon, reflected his deep religious faith. He continued to teach Sunday school after becoming a president.

Timberwolf, named for the largest member of the dog family was the code for George H.W. Bush; no one can figure out the rationale. Bill Clinton's name, Eagle, is based on the myth that he was an Eagle Scout. In reality, he was a Cub Scout and never moved up to the Boy Scouts. Barack Obama reportedly picked Renegade from a list of code names that started with R. There is no word on what the other choices were.

While President Donald Trump jokes about suggesting that his codename should have been Humble, the Secret Service provided him with the moniker Mogul.

First Ladies (as well as immediate family members) are provided with code names; their names all start with the first letter of the President's code names. Examples are Renaissance for Michelle Obama, Muse for Melania Trump, Evergreen for Hillary Clinton, Rainbow for Nancy Reagan and Dancer for Rosalynn Carter.

While the Presidential codenames are used during the administration after the Presidents leave office, the names are dropped. Of course, the Secret Service agents probably have their own "codenames" for the Presidents and those continue to remain "top secret."

It's not unusual for physicians and dentists to have their own codenames for their patients. Unfortunately, they are often derived from negative characteristics. For instance, I have heard disrespectful references to The Complainer, Never-shows, Airhead, The Talker, and Unpleasable.

I feel sorry for the legions of healthcare "For the most part, clinicians who treat patients with intellectual and developmental disabilities use code names that reflect patients who are positive, appreciative, appealing, cooperative and rewarding." providers who are constantly confronted by patients they wish would go elsewhere. They should take a lesson from the clini cians who treat patients with intellectual and developmental disabilities. For the most part, their code names reflect patients who are appreciative, positive, appealing, cooperative and rewarding.

It's quite gratifying to hear nurses, therapists, physicians and dentists refer to our patients as All In, Striving, Always Up, Top Gun, Gang of One, Upbeat, The Best – and my favorite, Perfect. All of these patients have their own novel and unique experiences with transitions, and their code names often reflect how they navigated these difficult life changes. One thing our patients have taught us about transitions is best summed up by Tom Stoppard, "Look on every exit as being an entrance somewhere else."

And for me, I heard my codename is Gray Beard.•

In his 87th year, the artist Michelangelo (1475 -1564) is believed to have said "Ancora imparo" (I am still learning). Hence, the name for my monthly observations and comments. – Rick Rader, MD, Editor-in-Chief, EP Magazine Director, Morton J. Kent Habilitation Center Orange Grove Center, Chattanooga, TN