From the beautiful to the obscure

As someone who probably should have majored in English instead of geology, I often feel my mind oscillate between two modes of thought: the scientific and the lettered. I hear myself say “Romberg negative, no dysdiadochokinesis or pronator drift,” and the lexicophile in me stands back, marveling. They may be English, but those words are as opaque to the layman as the treasured two-inch clipping on my fridge is to me. It announces a physics lecture at Yale—“Time-Reversal Breaking and the Theory of the Gap in Underdoped Cuprates.” But when it comes to delightful obscurity, cleverness or just beauty, medical language holds its own, even against the physicists.

We have the scimitar sign, the cloverleaf skull and my personal favorite, the jumping Frenchmen of Maine syndrome. Granted, you don’t see that disease every day, but its appearance in the dictionary proves that some august authority has accepted the term. We find incidentalomas on CT scans that were done to check for something else entirely. Look at a pathology textbook. It’s full of phrases that make you wonder whether the microscopists were hallucinating: cells can have a starry-sky appearance, owl’s eyes or Orphan Annie nuclei. Sometimes we anthropomorphize, ascribing grumpy emotions to the body. There’s irritable bowel syndrome, of course, but our circulation may become embarrassed. When phagocytosis goes wrong—when a cell can’t slimily surround and eat something—it is frustrated. On the other hand, we make some body parts sound coy: to elicit the anal wink during a physical exam is to know that all is well with the nerves to the nether regions. I can’t be the only one who appreciates that.

Some of us medical students used to wonder worriedly if we should have studied classical languages, the rumor being that it would help us learn medical terminology. A groundless fear, of course—Spanish is a hundred times more useful—but medicine does have some splendid Greco-Latinate mouthfuls. Consider the mellifluous confluence of consonants in sphygmomanometer (a blood pressure cuff), syzygy (when organs fuse to each other during development) or borborygmi (the sounds of overly vigorous digestion). Less lyrical but just as vivid is the cauda equina—horse’s tail—the bundle of nerve roots at the end of the spinal cord.

When it comes to naming new phenomena, I’m in favor of eponyms over descriptive terms. Not only are they a portable history of medicine, but people’s names can be wonderful, alone or in combination. Carr-Barr-Plunkett syndrome is admittedly less descriptive than 48 xxxx syndrome, but which is more fun to say? The number-one silliest medical word must be pseudopseudohypoparathyroidism. It may be descriptive, but it’s also a missed opportunity to name a disease after oneself, if there ever was one. (No single word that is not German should consist of 12 syllables; there are shorter poems.) I’m glad that the discoverers of Dandy-Walker syndrome and Howell-Jolly bodies weren’t as self-effacing.

A fondness for abbreviation can reduce doctors’ notes to a very exclusive code. I can write “NPH 8 U BID C FS Q 12 and SS as backup,” and nobody bats an eyelash. (It’s a set of instructions for keeping a diabetic patient’s blood sugar under control.) There are disease syndromes abbreviated LEOPARD, HELLP and POEMS, and medical trials have made an art form of the clever acronym for unwieldy descriptors like “Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events.” ESSENCE is easier.

We need most of our jargon, as does any specialized field, but for some words there seems to be no justification other than to befuddle the layman. We don’t say that the patient sweated if we can say that he diaphoresed. We never say he has a black eye when what he really has is a periorbital ecchymosis. There’s only one main use for a stethoscope, and we call it auscultation. I remember watching one operation and asking “Is that all bleeding from the broken bone?” “Yes,” the resident replied, “that’s hematoma from the fracture.” Still, some doctors know when to put obtuse jargon aside in favor of more colloquial terms. To my next question—“Is that part of the fracture as well?”—the senior surgeon replied, “Yup, it’s busticated.”