Learning Medicine Requires Learning a New Language
Repurposed medicalese
Whenever you enter a field, part of the training and the acculturation is learning the vocabulary. Medicine is no different. It is a tired, but true, statement that the hardest thing about the first year of medical school is learning the language. I took this whole idea very literally. I’d always been a terrible speller. I told myself, if you’re learning a new language, this is your chance to be a good speller in your new language. I was unsuccessful. Skeletal, incontinence, and patellofemoral remain beyond my abilities.
After learning medical-speak, you find the new words are very useful in everyday use. What works well in the hospital works just as well at home. Some terms – lateral, medial, ventral, dorsal – just allow you to be more precise. Others make you sound odd and perhaps a little self-important.
Here, for a little Sunday extra, bear with me for a little short story.
Allen’s day at work had been pretty benign, with little in the way of office drama. When he entered the house, it was dark and quiet. Both kids, Bryan, 17, and Audrey, 14, were holed up in their rooms. Allen missed the chaos that had ruled the house years earlier. He missed the time when the kids ran to greet him as soon as he got home. He did not miss the searing pain caused by stepping on a Lego brick, an event practically guaranteed by the kids’ metastasizing toys.
After a few minutes, Audrey sauntered down the stairs to ask what was for dinner. She was still wearing her soccer shorts and held a clarinet. While Bryan had terminally differentiated into a STEM nerd, Audey remained pluripotent; whether her future would be in sports, music, arts, humanities, or physics was anybody’s guess.
Allen planned to make one of his favorite dinners, penne with pancetta and Brussels sprouts. Looking at the sprouts, however, he realized it would be more work than he expected, as many of the sprouts were anemic-looking. He thought about doing pesto instead, but the basil plant he had brought in from the back porch a few weeks earlier was at the end stage of basil sudden death syndrome.
Just as he was beginning to trim the sprouts, Stacy came home. She was usually exhausted on Thursday evening because it was the day she worked at a poorly functioning off-site clinic, but tonight she was buoyed by the promised diastole of their upcoming vacation. She walked into the kitchen, poured herself a glass of wine, and said:
“You can’ believe the day I had. It got off to a terrible start because the first thing I had to do was kick carcinomas off the car’s bumpers.[i]1 But then, listen to this. When I got to work, that totally malignant urologist I usually have to work with was decompensating over some nothing issue. And you know what? He quit. Just walked right out. The whole day got better and better from then on.”
Allen responded, “What you mean he quit? What was behind it all? What is going to happen?
“I really have no idea. Nobody did. Everyone thinks he much have been planning it as some sort of grand statement. I am sure it will declare itself with time, but I really don’t care. What are you doing to that Brussels sprout?
“They’re in pretty rough shape. I have to excise lesions from a few of them before they look healthy enough to cook.”
With that, Stacy headed upstairs to change, glass of wine in hand.
Allen sauteed about 12 ounces of diced pancetta in a little olive oil. Once crispy, he removed the pancetta with a slotted spoon and placed it on a paper towel. Next, he threw the sprouts, which he had quartered lengthwise, and two dried chiles into the oil. He sautéed these until they were soft and slightly browned. As the pasta water began to boil, he added a generous pour of kosher salt. At this point in the process, he could practically hear his mother’s voice saying, “More salt!”
Just then, he heard a crash upstairs. There was a beat of silence and then voices, footsteps, and Stacy’s voice, “Allen, we could use a little help here.” He turned off the heat and headed upstairs.
Walking into Bryan’s room, he saw that his desk had collapsed, dumping a few dozen books and a laptop on the floor, as well as scraping skin off one of his son’s shins. For what was a superficial wound, there was quite a bit of blood. Stacy was already in triage mode, leading Bryan to a chair and sending Audey to get a first aid kit. (The first aid kit had been purchased when she had come home one afternoon to find Bryan with a scraped knee. He had MacGyvered a dressing out of Kleenex and Scotch Tape.)
“What happened here?”
“It should be obvious, Dad, the desk you put together collapsed.”
“I see that, what made it collapse?”
“I think it was idiopathic, a cryptogenic desk failure.”
“I’m not buying that! I’ve been telling you that that collection of books needed debulking for weeks.”
Stacy was already done with the dressing. “OK, enough, we don’t need to discuss the differential diagnosis of a desk collapse. But, for the record, I’m going with iatrogenesis. The ‘professional’ who put the thing together must have done something wrong. Let’s just go downstairs to eat.”
Dinner conversation was dedicated to a post-mortem of the desk collapse incident.
A sincere thanks to my colleagues for brainstorming with me for the vocabulary for this piece!
Photo Credit: Abolfazl Ranjbar
In medicine, a carcinoma is a cancer arising from epithelial cells. In this context, it is a growth, made of ice, that hangs off a car. Get it?
One of my favorites was the common introductory description of a patient in a case presentation as "well developed and well nourished". This was quickly introduced into our everyday speech such as "I met a well developed well nourished female at the party last night".
When I was a third-year resident in general surgery, Erenie, my senior resident wrote a hysterical, laugh out loud, play on words story of a playboy, Rolando, who drove a Giardia Lamblia and was trying desparately to get into his girlfriend, Sylvia's, fissure. He was eventually successful, with Sylvia encouraging him by crying out, "putamen!" What I wouldn't give to have a copy of that today. I remember in our week of orientation for med school being told that we were going to learn 10,000 new words in the next four years. 47 years later, I still find myself talking in "medicalese." My wife likes it so you know I won't stop!