Monday, September 17, 2007

Word!

[Credit to Judy for suggesting this picture.]


I think it might be about 8,000. Or is it 12,000? Anyway, somewhere I've seen the number of new words people learn in medical school, and whatever the correct amount, it's impressive. Here and there in this blog, I've mentioned some words I really enjoy just for the saying: bezoar, inspissated. How about radiculopathy? (Sounds like a word that could be applied to most politicians, whether you pronounce it "rih-diculo... or "raa-diculo...) Neovascularization. Tachyarrythmia. Pancreaticoduodenectomy. Intussusception. Bezoar.

Bee-zore. Say it like the taunting "air-ball" at a basketball game. (Digression: It's been shown that at every venue, whenever the chant is chunt, it's always in the same pitch, the same notes on the scale. F - D, matter of fact.)

OK. The point I want to make is that in addition to the neo-vocabulary we learn, there is also a more esoteric lexicon: words or terms that bubbled into the vernacular and have become universally understood, at least within certain sub-cultures: gomer; O-sign; Q-sign; flail. Let me tell you one of my favorites. It has it all: nice sound, excellent meaning, and, in my case, a connection to one of my favorite people. The word is

NOOGER.

In my book, I described learning how to dissect through distorted, inflamed, difficult anatomy. I called the method "delicate brutality." (Too late, it occurs to me that that would have been a great title for the book.) Central to the technique is the ability to nooger; namely, to ootz a finger into a sticky place and wiggle it, pinch it, insinuate it until you find a way through without poking a hole into something important. Noogering can be done with other blunt instruments: a sucker, a round-ended clamp, closed scissors, often along with the finger. Indeed it requires a combination of delicacy and brutality, plus some sort of either learned or innate (or both) sense of touch; of tissue turgor (there's another good word: turgor, turgid) and confidence of anatomy. If you can't tell where a thing is, you need to be fairly confident of where it isn't.

Not all surgeons need to nooger. Orthopods and neurosurgeons don't. Bone isn't noogerable, and brain, well, God help us... But a non-noogerescent general surgeon is bound for trouble. Important as it is, I can't think, exactly, how I learned it; or how properly to teach it. But I did, both. In a situation requiring one to nooger -- precarious as it usually is -- I'd rather do it myself than try to tell someone else how.

Among my favorite characters from training was the chief cardiac resident, a gangly, good-humored, soft-spoken, slow-walking but fast-thinking southern boy, Joe (full name: Joe) Utley. (The picture is from much later, in his evidently post-gangly years. Like mine.) In stark contrast to the other men populating that department -- who were volatile, egomaniacal, bad surgeons, crazy, nasty, or pretty much any combination of those characteristics -- Joe was laid-back, engaging, and highly talented. He told dumb jokes, quoted lines from movies, played the fluglehorn while wearing a sombrero, and treated me -- his over-worked intern -- with respect and caring (although, it could be argued, having an intern and his girlfriend [now wife] over and subjecting them to the horn and the hat was anything but respectful). I loved the guy. (Joe died a couple of years ago. I sent a copy of my book, in which he played a prominent role, to his wife; she wrote back that she knew he'd have loved it, and she could imagine him laughing out loud while reading it. That made me feel good.)

In hooking a person up to the heart-lung machine, it's necessary to control blood returning to the heart via the venae cavae. That requires (did then, anyway) slinging the veins with ties; to do so necessitates dissecting within the pericardium, behind those delicate structures, completely encircling them. Joe had a favorite instrument for the job, a very large clamp with a curved and bluntly-rounded tip. This he referred to as a "Giant Noogerer." Open heart surgery has a certain drama, and, in those relatively early days on the time-line, tension compounded by lengthiness. But as an intern on the service, because there was always lots to do, stretching into sleeplessness, time in the cardiac room was -- depending on who was in charge -- rarely pleasant. With no opportunity to do anything but stand there and answer questions, the hours dragged me down, while pushing the day's work further into the night. Except with Joe. I found myself looking forward each time, as the moment approached, to hearing him ask for the tool. "Giant noogerer," he'd say, hand out, and it always arrived with no need for clarification. With his gentle accent, it sounded like "jahnt nurgrer." I wanted to link here to a picture of one. But I have no idea what the real name is.

24 comments:

Bongi said...

great new word. i think i'll adopt it for myself. my prof was very anti noogering. i could never understand why. i always felt my finger was a pretty good instrument. a well trained finger in the abdomen during an appendisectomy for instance can be as good as a sonar.

a neurosurgeon could nooger the patient's maths and science away. probably not good. but i'm not a neurosurgeon so don't just take my word for it.

rlbates said...

I guess I've always used this (called it blunt digital dissection). Now have a new word for it. Thanks

Midwife with a Knife said...

I like the new word. Can I use it in a dictation? "The ileum was then noogered off of the right ovary and fallopian tube with care, revealing the tubo-ovarian abscess." :)

Seriously, medicine is full of cool words. I do like inspissated (although seldom get to use it). My favorite antibiotic to say is moxifloxacin.

Sid Schwab said...

Hmm, I'm getting the impression that the word is less universal than I'd thought. I do think someone should use it in a dictation, and I think MWAK ought to be the first. And moxifloxicin must be right at the top of the list. Sounds like the name of a bunny-rabbit.

prairie mary said...

I have to say that noogering is a great way to make one's way through a mass of abstract thoughts and relationships in one's noggin so as to find the internal structure of it. Noogering sounds much closer to the way it "feels" than blundering, which is a little blunt.

Prairie Mary

Anne said...

I love words! My husband bought me a medical dictionary for my birthday, and it's been horrible for me. I'm a hopeless addict. Here's one for you - omphaloskepsis - the act of staring at one's navel and meditating. I have another one, it's medical, but it's just too naughty for print. . .

Rob said...

The only place I can Nogger is when I am cutting Chicken.

I wish I could Nogger.

What can an internist do that sounds as fun as Noggering?

Midwife with a Knife said...

rob: I don't know that there's anything an internist does (with the possible exception of moxifloxacin!) that's as cool as noogering.

Seriously, you internists have all the cool drugs. There's that nasal insulin, the amusingly named antibiotics, 8 million oral hypoglycemics... you name it.

As an obstetrician, I have 3 bp meds (a few more if I can justify them), amp/gent/clinda, oxytocin, and glyburide, 2 kinds of insulin (although I think we should be using glargine). I need "nooger". ;)

Anonymous said...

Dear Dr. Schwab:

"Delicate Brutality" would indeed be an excellent title for a book -- may we hope to find it in bookstores soon? Remember, you are not limited to just one book ....

Dear MWAK:

I am not sure I understand. If you are not using insulin glargine, which two kinds of insulin _are_ you using? Regular and, God protect us from evil, NPH (or isophane)? Heaven preserve us (and particularly those poor gestational diabetics). You can have my insulin glulisine and the pump infusing it when you pry them from my cold, dead, and by then surely hyperglycaemic fingers. :-)

Cheers,
Felix.

ER's Mom said...

In training, we called it finger fracturing...it's the best thing in an awful case of endometriosis.

What's really awesome is in one of those cases, all of a sudden the finger finds just the right plane and you have a MAJOR BLOW FOR FREEDOM! Woo-Hoo! None of this millimeter by millimeter with the Metz BS.

I dictate it as blunt dissection, however. :)

Red Giraffe said...

OK! Now I have a word for what I do when I break down a tenderlion PSMO. Thanks!

Scott said...

Ha ha ha! That was an awesome post. ANY post that has a picture of Ralph Wiggum nose fishing to start has to be a great post!

Julia said...

Having never used the word inspissiated, how exactly is it pronounced? ins-PIS-si-ate-ed? in-SPY-si-ate-d? Something else entirely?

Prudence said...

Nooger...wow, new word for me today. Thanks!

Sid Schwab said...

Julia: it's IN-spiss-ated

enrico said...

"Inspissated" is one I'll proudly say I learned here. But even without trying, medicine is full of strange terms that even to the fluent Latin speakers of yore must've raised an eyebrow or two.

Case in point, banal as though this is (especially on a general surgeon's blog, heh): jejunum. It's like you're stuttering the first syllable, trying to simply say 'junum.' And jejunojejunostomy? Time to look for the Broca lesion... ;)

Erica said...

Awesome post - as always - but this one hits home for me primarily because words are my thang - and occupationally speaking, I get the chance to sling some 50-centers around once in a while. One of my all time faves is 'thenar eminence' - and I'm known to pepper my charts with stuff like that. Maybe I'll have to throw in the occasional bit of vernacular too. "IV access attempted x 2 with intradermal lidocaine and much noogering." "16 Fr Foley cath placed via nooger." Eeeew.

Sid Schwab said...

thenar eminence: indeed, a great one. Sounds like an esteemed representative from elsewhere in the galaxy. The other side of the coin is using terminology that lacks any similar panache, and just clutters a chart: left lower extremity, for example.

SnowLite said...

Great post Dr Schwab! I like the words too and nooger makes perfect sence. :)

I think Dr Utley probably read your book. We are limited on this side of life but just imagine all the possibilities on the other side. :)

SnowLite said...

sense!

Greg P said...

There are many traits of physicians that, were they to occur in the general populace would be pathological. One thing I've noticed is sociopathic behavior -- parking wherever you want, even tearing down barricades and driving across lawns, because, well because we're doctors!
We also feel free to coin whatever words come to mind, either some mash-up of older words or just something that sounds or feels good. In psychiatry, they would be described a neologisms. So the list of "new" words, for us anyway, doesn't really have any numerical boundary.
BTW, when I was in a medical fraternity, one of the guys had strangely unruly hair, so his nickname (most people got nicknames) was Bezoar. His younger brother started dental school a couple of years later and used to drop by, so the elder became trichobezoar and the younger phytobezoar.

Sid Schwab said...

Greg: It seems a lawn way from driving behavior to neologifuscation; I'm certainly guilty, being the social climber that I am, of the ladder. Meanwhile, you might have noted what I wrote about my mis-hearing of the word "phytobezoar" in med school.

Moof said...

Dr. Schwab ... I've just got to say that I love reading you! *LOL* :o)

Dr. John Baldwin said...

As a UCSF general and cardiac surgeon a few years before Dr. Schwab, the word Nuggerer was in traditional use during my seven long years of nuggering...and Sid's description of it is perfect. Most of my nuggering was done deep in the dark recesses of the pelvis...pinching things apart by the uterus, rectum and ovaries that most people would clamp. Nuggering rarely causes big time bleeding, but when it does, believe me, the hole is as big as your pointer finger and you can often hear it coming. There is no other place a person can nugger; you don't do it fixing a flat tire, putting on a bike chain or vacuuming a rug. You can nugger your own nose in search of a bugger, but with H1N1 around, I don't advise it anymore.