Table of Contents
CHART ABBREVIATIONS CLARIFIED
"HEENT WNL" --> Head, eyes, ears, nose and throat were not examined.
"MS" -->mitral stenosis
(Choose appropriate term in context, e.g., "this 24-year-old ms" would be "meshuga student"; "this 24-year-old with ms" would be mitral stenosis unless you see knives sticking out; and "this 24-year-old with abnormal ms" would be "mental status," unless of course you think the term "abnormal mitral stenosis" is good English.)
"DOE" --> [Patient] does observe Easter
"SOB" --> [Patient is/is not] short of bread
"IDDM" --> idiopathic, dumbfounding, diabetes mellitus
"Pt. left AMA" --> Patient left the American Medical Association without paying his dues
"No acute 's" --> No pretty triangles
"pt. () MI" --> Patient negative about Michigan (note: some patients are positive about Michigan, i.e. pt. (+) MI)
"CRF" --> chronic/continuous/constant/crippling/costly
"TPA" --> Tissue plasminogen activator
Treponema pallidum antibody
Total parenteral alimentation
Typical pathetic argument
"DRT's 2+ and =" --> Patient's twin daughters are a little over two years old.
MEDICAL JARGON CLARIFIED - AS HEARD ON WARD ROUNDS
"Let's send him to the floor." --> A bed is too good for this patient.
"We have no beds." --> But we have plenty of floor space.
"The house is full." --> We are boarding with relatives.
"He was Lasix'd." --> And zapped at the same time.
"We Swan'd the patient." --> The patient should have been Ganz'd.
"He is a poor historian." --> This history professor is down on his luck.
MEDICAL JARGON CLARIFIED - AS FOUND IN THE CHART
"Rectal deferred" --> No way, José.
"Hx of chronic ETOH" --> Doctor doesn't know how to spell alcoholism.
"Pt status-quo" --> Everything looks OK from the doorway
"Agree with above" --> I'm not really involved in the care of this patient but just writing a note to cover myself.
"Pt. seen and examined, full note to follow" --> I peeked in from the doorway.
"Rectal-refused" --> No way, José.
MEDICAL CLICHES CLARIFIED - WHAT THE DOCTOR REALLY MEANS
"The prognosis is guarded."
'Guarded means nothing, but it sure sounds better than dismal.'
"The patient is gravely ill."
'This patient might as well be six feet under.'
"Patient well known to this hospital..."
'Wow, there sure are a lot of medical records for this patient. Too bad I don't know a thing about him.'
"The pleural effusion was straw-colored."
'Sounds good and no one ever questions it. Wonder what straw looks like.'
"Aspirated coffee-ground material..."
'Wonder what you write if the patient did swallow some coffee grounds.'
small hospital bill
good night call
TWO RIDICULOUSLY-LONG MEDICAL WORDS
(there are many others)
19th-century medical terms that have become obsolete (and what they meant)
apoplexy (stroke) grippe (influenza)
catarrh (mucus; mucus melancholia (depression)
membr. inflamm.) lumbago (lumbar pain)
consumption (tuberculosis) neurasthenia (fatigue, lethargy)
dropsy (edema) vapors (depression and hysteria)
20th-century terms that may become obsolete in the next century (because they are imprecise and tend to characterize different conditions, or are used loosely by both lay public and physicians)
asthmatic bronchitis herpes
bronchitis panic attack
heart attack anorexia
nervous breakdown hyperventilation
"Touch him, hit him, but don't hurt him."
"A heart is coming in today."
"The overdose needs a bed."
"She bought a tube."
"We've got to ship out bed six."
"Send him to the floor."
"I touched him with some Lasix."
"He needs to be zapped."
"I'll hit him with Nitro."
What is this, conversation between a warehouse distributor and prize fighter? No, just typical housestaff conversation on morning rounds in our intensive care unit. Housestaff lingo has always been idiomatic and rather irreverent. Read (or re-read) Dr. Samuel Shem's classic 1974 comic novel House of God, to get an idea how an earlier generation of trainees talked about their patients. At least terms like "gomer" (elderly, demented patient), "turkey" (patient whose symptoms don't warrant hospitalization), and GORK (a patient about whom "God only really knows") have thankfully gone out of style.
Instead of these objectionable terms I have encountered an
often weird phraseology in which everyday nouns like "floor"
and "fish bowl" take on new meaning, other nouns become
verbs, and patients are "touched" or "hit" with formulary-approved drugs. On rounds our interns and residents often
speak like graduates of Idiom U. Their language is not "valley
speak" or "pig Latin," to be sure, but it can sound just as
strange to the uninitiated. To make my point, I sometimes
feign the role of an ignorant, straight-talking doc.
INTENSIVE CARE UNIT ROUNDS WITH HOUSE OFFICERS JOHN, MARK, SUSAN AND BILL. (House officer comments are italicized).
"John, why do you want to ship out bed six? It's the new electric model. Isn't it working?"
"Heh, Heh, Dr. Martin. You know I mean Mrs. Jones, the lady with the CVA, who is in the bed."
"You know: cerebrovascular accident."
"Mrs. Jones had an accident?"
"No, just a thrombotic stroke. She's stable and ready to go the floor."
"Then why call it an...oh, never mind. But why do you want to put her on the floor? Can't she stay in a bed? Or at least something more comfortable than the floor. How about a couch?"
"The floor, the floor...you know, the regular wards of the hospital, not the ICU. In fact, we have a bed for her in the fish bowl."
"Come again? Fish bowl? First you're going to put her on the floor and now in a fish bowl? I didn't know we had any fish in the hospital?"
"Very funny, Dr. Martin," says John, clearly meaning the opposite. "You know, the large front room by the nurses station on the regular ward, the room with the sliding glass doors so the nurses can always see what's going on. Like in a fish bowl. She'll get good attention there. Say, Dr. Martin, you never heard it called the fish bowl? Where have you been?"
His question is rhetorical because the answer is apparent: 'out to lunch'. I turn to address Mark.
"Mark, what do you mean you 'touched' Mr. Smith with Lasix? Lasix is not a topical drug, is it? Aren't you supposed to give it orally or intravenously?"
"I did, Dr. Martin. I IV'd him with twenty migs. You know, touched him."
"Migs? Oh, I see. You mean you gave him a low dose, only twenty milligrams, intravenously."
"Yea, that's right. Just a touch. Say, are you having a bad day, Dr. Martin?"
I begin to wonder. Desperate for some good old-fashioned plain language, I turn to Susan.
"Susan, who's this patient you just admitted?"
"Mr. Green is an elderly gentleman [so far so good], who came in last night with some vague complaints. He's really a poor historian and we don't have any old records..."
"I'm sorry, Susan, he flunked history? In high school or college?"
She doesn't get my joke.
"You said Mr. Green's a poor historian. At first I thought you meant he didn't do well in history. But perhaps you meant that his research into historical subjects is lacking in scholarship?"
"Neither. I just mean he couldn't give me a good history."
"Oh." I pause for effect. "If Arnold Toynbee or Edward Gibbon or Herodotus was admitted to the hospital and couldn't provide a good medical history, would you say they are poor historians?"
"Who are Arnold what's-his-name and the other two? I don't know those patients."
I look at the other three house officers and elicit only blank stares. No students of history here. My question an inspired one, if I say so myself is for naught.
"Never mind," I reply. "Go on." She continues with her presentation and I listen intently, silently, until:
"...anyway, Cardiology's coming by and we're going to zap him."
"Mr. Green needs to be zapped?"
"Yes, to convert his arrhythmia. A hundred watt seconds should do it. But first I'm going to hit him with nitroglycerine to bring down his pressure."
"Huh? You're going to hit him, then zap him?"
"Yes. I'll start low, about 5 mikes. I already Lasix'd him and that didn't work. Now I'll hit him with Nitro."
"Migs" for "milligrams"? "Mikes" for "micrograms"? "Lasix'd" for "gave him Lasix"? "Hit him with Nitro"? I feel like I'm rounding in a classified ad: '68-y-o pt. from doc-box, Lasix'd, hit 5 mikes nitro, rdy 4 review'. We seem to be losing sight of our primary mission, which is...what? Turf the patients and buff the chart? No, no, that's not it...it's...oh, I forget. Which is just as well, since Bill is rejoining rounds. He has just hung up the phone after talking with a physician in the emergency room.
"What's going on in the ER, Bill?"
"They have a present for us. An overdose."
"What? We don't need an overdose. What else do they have? How about a new cardiac monitor? Or a pulse oximeter for the ICU? Can we have a choice?"
My questions are ignored as Bill continues blithely onward.
"She's a polyfarm-o-d. Collapsed at a doc-in-the-box. On arrival she bought a tube."
"You mean this new patient has respiratory failure and she required endotracheal intubation?"
"Yes. They just tubed her."
"And before coming to the ER she was seen at one of the suburban urgent care centers that is not equipped to handle major emergencies?"
"And her basic problem is an overdose of several different pharmacologic preparations?"
"Yes, that's what I said. Polyfarm-o-d collapsed at a doc-in-the-box now tubed. You just took a lot longer to say the same thing."
I can't argue with that logic.
"OK, now I understand, Bill. But tell me, are you trafficking in organs? What's with this heart you're importing today?"
"Earlier I heard you say 'a heart is coming in today.'"
"Oh, you mean Mr. Pollack, the heart patient. He's being admitted from the clinic for CHF and cardiomyopathy. When he gets here we're going to swan him."
"Swan him? swan him? Wait just a minute."
I know what he means but I can't let this opportunity pass. I decide to check what the authorities have to say, and excuse myself from rounds to consult two medical dictionaries (Dorland's 27th ed. and Stedman's 25th ed.). Sure enough, Swan is listed in both under Swan-Ganz catheter, the balloon-tipped right heart catheter now in common use and named after two American cardiologists, Drs. Harold Swan and William Ganz (also with separate entries). Neither dictionary mentions that 'Swan-Ganz' is actually the brand name for the catheter marketed by one specific company and, like the Band-Aide brand for plastic adhesive strips, has become a generic term for all such catheters. I am sure the house officers don't know this singular bit of trivia. And I won't tell them, since it's beside the point.
I search further for the verb form by consulting an unabridged dictionary*. There I find:
swan, n. 1. any of several large, stately aquatic birds of the
subfamily Anserinae...2. a person or thing of unusual beauty,
excellence...3. Literary. a person who sings sweetly or a poet.
No help in this entry. But in the very next entry I find my verb.
swan, v.i. Midland and Southern U.S. Older Use. to swear or
declare (used with I): Well, I swan, I never expected to see you
here! [1775-85, Amer.; prob. continuing dial. (N England) I s'wan,
shortening of I shall warrant].
Armed with the latest linguistic information I eagerly rejoin rounds. "Bill, this patient who is coming in to the ICU today. Are you going to swear at him?"
"Huh? What kind of crazy question is that, Dr. Martin? Why would I swear at this patient? I haven't even met him yet!"
"Well, I swan, Bill, I don't rightly know!"
As soon as these words leave my mouth the house staff start
shaking their heads slowly, side to side. And I know what they
are thinking. 'Dr. Martin must be a little touched. Quick, hit
him with something!'
*Random House Dictionary of the English Language, 2nd Edition Unabridged. Random House, New York, 1987.