I can remember my first night on call as a newly minted resident at Toronto's Hospital for Sick Kids like it was yesterday. I admitted three infants in respiratory distress, took blood samples on two more and started intravenous drips on three more. I can remember the excitement of being the first line of defense for the little ones under my care.
Still, as I look back, it's another memory that makes that first night on call at the hospital stand out. The next morning, my senior resident arrived on the ward, saw my haggard appearance, and walked over to the wall that I was leaning against to try and stay awake.
"So, Brian," he said, putting a reassuring hand on my shoulder, "how many babies did you box last night?" Box, as in coffin. He wanted to know how many patients I'd killed! For a half-second, he kept a perfectly deadpan look on his face, then broke into a big grin.
He was kidding, of course. My resident had enough confidence in my ability to keep the little ones alive that he could get away with the joke.
That was my personal introduction to hospital slang. Right away, I could see one of the key purposes of slang -- which is known to experts in linguistics as argot or cant. My senior resident used the slang to break the tension I was feeling. I was quite nervous that first night on call, and Rutherford's slang told me that I wasn't alone in that feeling. Not only that, he was letting me in on the secret handshake. Sharing slang is a ritual that binds young doctors to their band of brothers and sisters.
I'm amazed that there are those who are surprised that doctors keep and pass along a secret stash of slang terms -- as if doing so is highly unusual.
For those who work in high stress professions, dishing slang is pretty normal. The military have invented hundreds of such terms to describe their work. 'SNAFU', 'FUBAR,' and 'BOHICA' are just three terms in common use that started off as military slang. Police, firefighters and paramedics have their own unique slang. So do teachers, lawyers, stockbrokers and car salesmen.
True, it may be that doctors have invented more slang than most other kinds of professionals. But that's because as doctors they encounter more situations that generate strong emotional reactions than most other professions.
Another important purpose of hospital slang is to help health professionals cope with patients who are in pain and suffering as well as those who die on their watch.
What do the phrases "circling the drain," "discharged up," and "hanging crepe" have in common? They are just three of many phrases used by doctors that refer to patients who died or are in the process of dying. There are many more where those came from. There are probably more words and phrases used to talk about patients at or near death than almost any other clinical condition or situation.
Dark humour has been part of the culture of modern medicine for at least 70 years. In the 1950s, Dr. Renee Fox, one of the pioneers of medical sociology, observed second-year medical students at Columbia University Medical College as they attended their first autopsies. In her research from the 1950s, Fox noted that gallows humour flourished in the anatomy laboratory.
That gallows humour existed back then and still exists today does not in any way suggest or imply that doctors are unfeeling about their patients. The humour and the slang are coping skills for a profession increasingly stressed not only by the suffering of their patients but also by the futility of their efforts to ease it.
As physicians, none of this is supposed to affect us. That's because physicians have long been taught to remain emotionally detached from patients. We have a venerable Canadian physician named Sir William Osler to thank for that. Osler, who taught at McGill University, was one of the founders of modern medical education. In a famous essay entitled Aequanimitas, Osler admonished MDs to maintain an attitude of unflappability that he referred to as "imperturbability," which to me means never letting patients and their families see physicians sweat.
Today, we call that emotional detachment. Today, patients and their families want doctors to show concern for the situations that cause patients and their families emotional distress. Finding the balance between emotional detachment and concern for the patient is the great challenge of modern medicine.
As a veteran ER physician, I don't see how it's possible to observe the horrific traumas that befall our patients from a position of complete emotional safety. Given the rising rates of compassion fatigue, moral distress and burnout among health professionals, I doubt that detachment is as desirable as it may have been in Osler's day.
Given that, I believe that slang terms like "circling the drain" and "discharged up" help doctors acknowledge and reflect upon the death or the impending death of their patients. In that sense, using slang to vent strong feelings is better than bottling them up behind a mask of imperturbability that is increasingly harder to maintain.
If I were a patient or a the family member of a patient, I'd worry more about the emotional state of the doctor who refuses steadfastly to utter a word of slang than one who does.
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We do get them on our cheeks, says Jessica Krant, MD, a board-certified dermatologist and assistant clinical professor at SUNY Downstate Medical Center. Goose bumps, or cutis anserine, occur where we have hair -- pretty much everywhere except for our palms and soles of feet, Krant says. She breaks down the process: Each hair follicle contains a microscopic muscle called arrectores pilorum that contracts in response to the sensation of cold, or the feelings of fear or excitement. The reason most of us, especially women, don't notice goose bumps on our face is because the peach fuzz there is usually fine and short, and our facial skin muscles are less robust than those in our arms and legs. Krant adds that if you find goose-pimply bumps on any part of your body that don't seem to be affected by fear or temperature, you might have keratosis pilaris, an eczema-like condition caused by inflamed follicles.
We don't see many images of fertility goddesses as skinny stick figures. And it's true that underweight women make a form of estrogen that can be too weak for successful conception, according to the American Society for Reproductive Medicine (ASRM). But while obese women often have an overabundance of estrogen, this can affect their cycle to the point that they stop ovulating. Excess weight can influence fertility in other ways, too: A 2007 Dutch study of more than 3,000 couples (without any known ovulation problems) found that women with a body mass index of 30 or higher had significantly lower probability of becoming pregnant, when compared with women with BMIs of between 21 and 29. This is why the ASRM stresses the importance of maintaining a healthy weight when trying to conceive. By the way, having full hips won't even provide an advantage during childbirth: "It's the front-to-back dimension that creates the tightest squeeze," discovered Nathanael Johnson while exploring the science and history of childbirth (among other biological processes) for his book All Natural. So an average-weight woman has the best chance of getting pregnant naturally and giving birth more easily.
This query usually exposes a childhood fascination with Road Runner cartoons, says Billy Goldberg, MD, a New York emergency room physician and the co-author (with Mark Leyner) of two books about health trivia ("the stuff everyone wants to know, but that doctors aren't taught in medical school," Goldberg says). For those who've forgotten: Wile E. Coyote would blow himself up with explosive nitroglycerin -- the same substance used in heart medication. In the commonly prescribed pill form, nitroglycerin helps increase blood flow to oxygen-deprived areas of the heart by dilating blood vessels. The medicinal dose of nitroglycerin in heart medication is infinitesimal compared with the amount in a stick of dynamite, explains Goldberg in Why Do Men Fall Asleep After Sex?. It's also highly diluted for safe handling.
Goldberg says this is one of his favorite questions -- mostly because he assumed it was too ridiculous to be true. While writing Why Do Men Have Nipples?, he and Leyner pored over medical textbooks and studies to find out that some people have a strange reaction to blazing sunlight that causes them to sneeze uncontrollably. This is due to something called the photic sneeze reflex -- also known as autosomal dominant compelling helio-ophthalmic outburst, or ACHOO. A 2005 study of six Spanish families showed that there are usually two to three "achoo"s per episode of ACHOO. This reflex is relatively under-studied and not completely understood, says Goldberg, but it is thought to have something to do with an accidental crossing of nerve signals.
This question comes up all the time, says Goldberg (most likely during the sweltering East Coast summers). The answer is found in the human body's way of regulating temperature. We're constantly producing heat as we burn calories and exert energy, says Goldberg, and the heat needs to escape. He explains that it's easier to release pent-up heat when the temperatures outside are moderate or cool. When the temps soar, the body increases blood flow to the skin to help the heat escape through sweat. The hotter it gets, the more sweat and energy the body needs to exert, and the harder it ends up working. As a result, you feel like you're burning up.
This is definitely one of the more far-fetched questions Goldberg has been asked in his 20-plus years as an emergency room doctor and assistant professor of emergency medicine at New York University. But the answer underscores the importance of staying hydrated at all times. Our drink of choice would have been seawater. But Goldberg informs us that we have it wrong: Seawater is three times as concentrated as human blood, and to process it, the body would need to excrete the excess salt through the kidneys as urine. As your body worked to flush out the salt, you'd lose precious fluids and become even more dehydrated. Before long, your muscles would atrophy, your heart would pound out of rhythm, and you'd eventually die of dehydration. He says it's probably safer to drink urine than seawater, but you'll probably be too dehydrated to make enough to quench your thirst.
Goldberg says he's seen many people end up in the ER because they've failed to respond to that weird prickly feeling, perhaps because they've been knocked out by alcohol, sleeping pills or a punch in the face. He explains that when you've been kneeling for too long (or doing something else that puts pressure on your leg), the arteries in that area can become compressed, preventing them from providing tissues and nerves with oxygen and glucose. This also blocks nerve pathways, causing some nerves to stop firing and others to go off like a 4th of July fireworks finale. When the brain receives these signals, it interprets them as that uncomfortable sensation of pins and needles. Prolonged pressure on the arteries can indeed lead to temporary or even permanent nerve damage, so it's important to respond to the feeling as soon as you notice it.
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