In the previous issue of Mimosa, one of our letters of comment remarked that fandom has its educational side-effects. We point to this next vocabulary-building installment in Sharon Farber's "medical school" series as a case in point. We received this article only about a month ago, and had been afraid that after three previous articles, she had run out of things to write about. "Not to worry," she tells us, "there's more on the way yet."

'Tales of Adventure and Medical Life, Part IV' by Sharon 
  Farber; title illo by Joe Mayhew
Our first day of medical school, we were confronted by various administrators and professors, who made various promises, such as you have been carefully preselected so, no matter who hopeless it may sometimes seem, you will get through. This was true -- so far as I know, no one flunked out of my class (though many took a very long time to graduate), and we had more suicides than dropouts.

A second promise -- or threat -- was that in our four years we would learn 20,000 new words. Now, as the average person seldom needs more that 800 words, unless involved in a technical profession (in which case 800 will often suffice anyway, as in "Hey, pass the whatchamacallit, you know, over there next to the thingie."), this was a bit daunting. Of course, many of the words were things like obex, learned once for an anatomy midterm and then dumped from the files, or chemical names like galactocerebrosidase, again learned for a test and ever after referred to as "some enzyme or other". Many words had multiple meanings depending on context, such as cortex and medulla, which are equally at home in the brain or the kidney, or frenulum, which might be found under the tongue or under a penis.

We also learned new ways to mangle our mother tongue. We began to speak in formalized patterns, generally involving the passive tense. "This is the first Barnes Hospital admission for this forty-two year old single white male which a chief complaint of dyspnea on exertion." We learned to use adjectives in new ways -- angry red lesions, frank psychosis. (Frank seemed to mean "hey, it ain't subtle, Jack," as in frank burns. And you thought that was just a doctor in M*A*S*H.) We learned, for no particular reason to pronounce centimeter, sahn-ti-me-ter, and umbilicus, um-bi-lai-cus.

And so, after two years of having words shoved into our brains, like Japanese commuters into a rush-hour subway, we left the classroom and hit the clinics -- only to learn that, like someone moving to French after studying at Berlitz, we didn't really know the language at all.


# # #

To start with, there were abbreviations. That opening sentence to a workup, a few paragraphs back ("This is the first..") would be written "1st BHA for 42 yo SWM c CC DOE." An astute resident could write an entire page without a noun. Of course, no one else might know what he was talking about ('BS', for instance, was breath sounds, bowel sounds, blood sugar, or the medical student's opinion, depending on the context), but at least abbreviations were more legible that the average sleepy, rushed doctor's handwriting.

More baffling but also more fun than abbreviations was slang. Any oppressed minority -- such as medical students and house officers -- tends to develop its own language, to baffle or annoy the oppressors; once they become the oppressor, or go into private practice, doctors tend to abandon slang.

Medical slang was generally angry and bitter. Take the concept of pimping. Where I came from, pimping is generally against the law, and has to do with the promotion of solicitation. (Growing up in a major seaport, I knew about such things. When I was ten, a John Bircher's spawn called me a "radical whore". I ran home to ask Mommy what a radical was. And I was most puzzled upon first reading Dracula, where Jonathan Harker admits to being a solicitor.).

Pimping is the relentless, merciless questioning of students or interns (or anyone of academic inferiority), cruelty masquerading as education. The Journal of the American Medical Association recently printed a hilarious article on the origins of pimping, tracing it back to the founding fathers of medicine. The only thing funnier than the article was the subsequent spate of letters from doctors who, unable to recognize satire if it bit them on the nose, wrote in to disagree with the historical references.

Luckily most of us had had some preparation for medical slang by reading The House of God {{ed. note: by Samuel Shem, M.D. }}. This is probably the best book about modern medical training, though it is hideously sexist. But then, medical education and most doctors are hideously sexist, so what the hey.

The House of God introduced us to the concepts of buff and turf (i.e., make the chart look complete and yourself look intelligent, and then send the patient to another service). Turfing a difficult or obnoxious patient was something that not only gave you pleasure and relief, but also gained you the admiration of your peers (excepting only those who accepted the patient, whose admiration would be tainted with annoyance).

We at Wash U. didn't seem to buff much, but maybe that was a Harvard preoccupation, The House of God being set there. Doctors in training move around a lot, so much of medical slang is standardized, but some terms are strictly regional. The Dude Brothers, for instance, those guys who seem to be responsible for so much mayhem, are to my knowledge found only in Missouri and Kansas City. (I called a friend once to see if he'd join me for dinner. "Sorry," her replied. "I'm in the emergency room. The whole Dude family is having a shootout.")

I recently learned that patients at Grady, the big charity hospital in Atlanta, are called rooters. This evidently comes from a group of drunks who sit outside the emergency room and cheer those entering, and boo those leaving. And then there is brady-lordy, when someone -- usually an elderly black lady -- incessantly moans "lordy, lordy," for hours on end. Slow heart beat is bradycardia; I occasionally refer to the mentally deficient as The Brady Bunch. Rapid heart beat is tachycardia, and an often fatal arrhythmia is ventricular tachycardia, or v-tach. At The Jewish Hospital of St. Louis, old ladies often lay there calling "oy, oy, oy," which was, of course, oy-tach.

Terms for dying appear to have regional variations. Box, to be placed in a coffin, was the favorite at my school, as in "Where's Mr. Jones?"

"He boxed."

There was also "Turfed in Sky Clinic," or "Transferred to the Eternal Care Unit." Here in Chattanooga, the ICU nurses tend to say "He caught the bus." The first time I heard that, my jaw dropped. I couldn't figure out how my comatose patient on the ventilator had recovered and been discharged so rapidly.

People walking down the main corridor at Barnes Hospital always smiled when they passed the sign reading CURE Unit. You could almost hear their thought. "Cure unit. How wonderful, how inspiring." They were unaware that 'CURE' stood for 'Clinical Unit for the Recently Expired'. It was the morgue.

# # #

Scut seems to be a universal concept. Scutwork is that boring, time-consuming and educationally useless part of patient care that non-doctors do in non-teaching hospitals -- carry labs, transport patients, draw blood, start intravenous lines. At Barnes, those proficient in the technical skills were called scut-dogs (or, if still students, scut-puppies.) However, in other places they were called scut-monkeys, or even just beasts.

(One of my house-mates was taking a short cut down an unfamiliar hall in Children's Hospital, her first month of third-year, when a resident she'd never seem before ran out of a room, grabbed her, and dragged her inside to hold down a screaming child from whom he was attempting to draw blood. He apologized, explaining that he'd asked a nurse to hold the child, and she's refused, saying, "That's scut. You have medical students to do scut.")

# # #

illo by Joe Mayhew There were nicknames for the various specialties (surgeons liked to call themselves blades and internists fleas), but many more words were devoted to the unfortunate patients. After all, when you're working thirty-six hours in a row, always tired, always baffled, not to mention getting pimped, it's hard to be affectionate to the source of confusion. Besides, many patients during training are charity cases from socioeconomic or ethic groups most med students are unfamiliar with. Or they are just downright gross -- drug-addicts, criminals, street-people. It is no wonder, then, that we tended to have insulting names for patients.

One night when I was resident on call, the team was discussing our new admits, all jobless, drunk, sociopathic men. Somehow, the intern's train of thought strayed from the general worthlessness of the evening's specific patients, and he began to generalize their shortcomings to the entire black race. It was one of those times where I wasn't sure if I wanted to murder an intern or just curl up my toes and box -- because the intern, leaning fervently across the table, attempting to instill his wisdom into our third-year-student, was somehow overlooking the fact that the student was black!

I'm not sure what was going on there.

# # #

Most doctors in training scrupulously avoid using slang before superiors, and pretend to deplore the entire concept. "How can anyone insult that dear, sweet, aged gentleman holding a knife and drooling all over?"

"Yeah, yeah," your attending replies. "Disarm him and bathe him twice before I go near him."

My friend Dave and I wrote a skit about this for our senior show, which took place the week before graduation, and seemed the sensible place to vent four year's accumulated spleen. Sometimes class shows did effect some changes -- I remember a game show called "What's My Molecular Weight?" in which profes¬sors were pulled out of the audience and given questions from their own tests, which they could not get (Leading, one assumes, to slightly less trivia on exams.) Several years before I started, a show entitled SCREW (Saturday Classes Ruin Every Weekend) helped end weekend lectures.

To our surprise, we had difficulty casting the slang skit. Typical with the response of our classmates was the divine Miss M, who said it contained offensive words. Now, not only was this shockingly hypocritical -- I had heard her use at least half of them -- but she did not seem to comprehend the concept of satire. (Didn't I say that about someone else a few paragraphs back?)

The skit featured some second-year students, forced to accompany houseofficers on work rounds before physical examination class. This was a stupid, stupid idea, as they knew nothing yet about the diseases or tests being discussed, and of course didn't know the slang, and the second-year in the audience cheered us for it.

After several sentences of pure slang, the doctors depart, leaving the WUMS IIs to question the third-year student.

"Whale?" they ask, "Gome? Troll?"

"You must learn the language of medicine," the third-year replies, in a manner that out-saccharines Julie Andrews at her worst, and then begins to sing:

"Gome, a crock who's never washed;
Troll, a dirtball tried and true
Gork, a person without squash
Crump, what gorks will always do.
Shpos, subhuman piece of shit.
Veg, add water they won't grow
Whale, your tourniquet won't fit--
And that brings us back to gome, gome, gome."

The students, now comprehending fully, sing joyously, and we fade out.

Shocking, eh?

# # #

illo by Joe Mayhew Now for the translation.

Gome. Short for gomer. This is a well known bit of medical slang. Some say it derives from an Old English word for oldster. Others say it stands for "get out of my emergency room". Everyone agrees that it denotes a disgusting old person with too many medical problems. A sweet, clean polite old lady is not a gomer. I may (who can remember?) be the originator of the phrase Juvenile Onset Gomerism (akin to juvenile onset diabetes), for a person in the presenium who has already burned out brain and body.

Crock. Okay, I admit it, the first line of the song made no sense -- but it does rhyme. A crock fakes symptoms, either because he's crazy or malingering. The technical term for fake systems and signs is functional. When your doc says your problem is functional, he's politely calling you a crock. Probable derivation: crock of shit. A related term is serum porcelain titers, an imaginary blood test to see if a person is crazy.

Troll and dirtball are self-explanatory. There are subtle ramifications of what makes one sleazoid a troll and another a dirtball -- trolls tend to be grungier, or more hardened criminals. Dirtball is the major insult for patients involved in anything evil; violence, child abuse, trying to scam their doctor into giving them narcotics. I assume it comes from scumbag, the time honored New York City insult, as doctors in some locals say dirtbags instead.

A gork is a comatose individual. Squash is brain. Someone once explained to me that it derived from the brain's resemblance to cauliflower; he was not pleased when I protested that 1) brain doesn't look at all like a cauliflower, and 2) cauliflower is not a member of the squash family. A stroke due to a cardiac embolus (a blood clot from a malfunctioning heart that goes straight to the brain) is called a boulder to the squash -- a bizarre but picturesque mixed metaphor.

To crump, is to go sour, to become rapidly moribund, as in "He was GI bleeding, the crit dropped to 20 and he was crumping, but we started fluids and topped off the tank and now he's stable." Yay! Good work!

Shpos means just that, subhuman piece of shit. It is New York City slang. As a fourth-year on cardiology, I made the mistake of calling a prominent government figure a shpos, and the attending gave me hell. Not for my politics or my crudity, mind you, but because I'd pronounced it wrong! It seemed that I had said it shpaz, which implied that I'd come from certain medical centers in Manhattan, whereas at my attending's home institution it was shpohss. Evidently you can hang out at Bellevue and tell which schools the various medical students hail from just by how they pronounce this crucial insult.

Veg. Vegetable. Some medical slang that's become part of the common tongue. It refers to a permanently comatose individual requiring life support, from the more technical phrase "permanent vegetative state". A man once said, "Keep my wife alive, even if she's a vegetable." Before you get all sentimental here, you should know that he was living off her Social Security.

Whale. A patient beyond extreme obesity. To weigh much over 300 pounds carries hazards beyond those of diabetes, heart disease, etc. You just can't properly examine a patient that fat ("The liver didn't feel enlarged but hey, I couldn't feel the liver."), and most x-ray tables have a 300 lb weight limit. Plus, some procedures are next to impossible, because you can't see or feel where you're going, and the needle probably won't be long enough. I no longer even try to do a spinal tap on patients that big, but one of my residents (when I was chief) was an expert at harpooning Moby Dick, always carrying an extra long anaesthesia needle in her pocket, just in case.

Okay, that's today's Berlitz lesson in medical slang. Don't use these words around your own docs, boys and girls. For all you know, I may have published my own version of the Monty Python phrasebook...

All illustrations by Joe Mayhew

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