One of the things you have to learn in order to sound smart while presenting a case (in other words, telling a patient’s story) is how to make generous use of signs. In general, signs are objective manifestations of illness, as opposed to symptoms, which are subjective: for example, in strep throat, severe pain is a symptom while white patches on the tonsils are a sign. Obviously, it is very important to make note of these.
Lots of them are eponyms: for example, Lhermitte’s sign is a sensation of electricity shooting down the spine while bending the neck forward; it’s considered classic for multiple sclerosis. (It’s also technically a symptom, not a sign, if we’re going to be pedantic about it, which of course we are.) Kernig’s sign and Brudzinski’s sign are pain when the leg is raised by an examiner, and pain causing involuntary hip flexion when the neck is flexed by an examiner, respectively; both are classic for meningitis, and I can never keep them straight. Grey Turner’s sign, bruising in the flank area, indicates internal bleeding and is frequently checked for in cases of pancreatitis. (Most of these signs have not been exhaustively investigated and it’s unclear how useful they actually are, but we love them anyway.)
When reporting these, we generally say something like “The patient has a positive Brudzinski sign.” This formulation is apparently so catchy that it has spawned a whole slew of other signs, most not particularly respectful.
Some are flippant terms for actual helpful diagnostic findings. For example, patients with pelvic inflammatory disease usually exhibit exquisite cervical motion tenderness. This is sometimes referred to as a “positive chandelier sign,” as in, the patient is jumping up to the chandelier during the pelvic exam. Of course, no one would write this in a medical record, but it’s not uncommonly heard in emergency rooms.
Then there are some terms that grow up in particular institutions. One that I’ve heard several times is the “10 allergies” sign. Patients who list more than a small handful of allergies are much more likely than others to have multiple vague complaints that are beyond the powers of modern medicine to solve, and I’ve heard more than one resident grumble “positive 10-allergy sign” before going in to see a patient.
I think the best (and also worst, in some sense) of the irreverent terms is the “fish sign.” You see, our hospital has a big fish tank stocked with many beautiful tropical fish. There’s a camera which broadcasts a view of the fish on the hospital’s closed-circuit TV system. Patients who are comatose, severely demented, or otherwise unable to express their viewing preferences often have their TVs set to the fish channel. That’s a positive fish sign. It’s considered a poor prognostic indicator.
After repeated remarks from Tim, I spent some time investigating the correctness of the construction “needs doing.” It looks like I might have conflated it with “needs done” as a regionalism. According to the Columbia Guide to Standard American English (at Bartleby.com), “needs”:
… can combine with the preposition to plus an infinitive or a passive infinitive, as in She needs to see [to be seen by] a dentist, or it can be followed by a gerund as direct object, as in The lamp needs fixing. The past participle in a somewhat similar construction is dialectal and Nonstandard: This lamp needs fixed.
I haven’t found any other sources that look respectable, though I’d be interested to hear more. It looks like, despite the strangeness of “needs doing” to my ear, it is probably standard.
One of the most amusing things about visiting my parents in Cleveland is reading the Plain Dealer. I used to particularly enjoy laughing at the people who write letters to the editor, but my new favorite thing is regionalism-spotting. I don’t know if the PD uses regionalisms as a conscious style decision or if their copy-editors just don’t notice them. Either way, it’s rather charming.
My list so far:
I wonder how many more I can spot the rest of the week.
Over at Language Log, Mark Liberman has been on a roll debunking claims about gender differences found in the popular press. (That link goes to a post that has a list of all his posts on the subject at the bottom.)
Shockingly, it turns out that when you read a claim about gender differences (like “women say 20,000 words a day and men only say 7,000″) and decide to go check the research, most of the time the research says nothing of the sort. That particular claim appears to have been made up out of whole cloth; the available research is not totally conclusive but tends to show that men actually speak slightly more.
There are also many instances of actual studies being reported in so misleading a fashion as to make the news stories essentially lies. (Any time you hear somebody claim that men really do have trouble hearing women, don’t believe it.)
In a few cases, there are fairly-well-supported findings of gender differences, with the typical caveats that while the means are different, there’s a ton of overlap, and other traits besides sex are also good predictors of differences. Liberman concludes that post by stating:
But the most important lesson, in my opinion, is that the facts matter. Where the facts turn out to support consequential cognitive differences between human females and males, let’s try to look clearly at what those differences are, where they come from, and what individual, social and political conclusions we should draw. But let’s not let popularizers of brain-sex differences bring overgeneralizations and outright fallacies into the discussion as if they were scientific results.
Bravo.
For whatever reason, “scientific” findings about gender differences are more popular than just about anything else (except maybe diet claims). People find this stuff fascinating, and can’t seem to help projecting their prior commitments about gender onto the research, no matter what (if anything) it actually says. The chaff so greatly outweighs the wheat in this field that anyone committed to scientific accuracy really shouldn’t believe any claims without taking a look at the research.
Strangely enough, there are three words frequently encountered in medical school that feature the pronunciation n[?]-’mä-nik (where [?] signifies a sometimes-varying vowel sound) and contain a silent consonant. Though they are frequently confused, each word is different, as is each silent consonant. A quick guide, including a mnemonic to keep them straight:
mnemonic: a memory aid. M is for Memory.
pneumonic: relating to the lungs; e.g. pneumonic plague. P is for Pulmonary (or Plague).
pathognomonic: definitively characteristic of a particular disease. G is for Guess (what you don’t have to do if you see a pathognomonic sign).
(gnomonic: a kind of map projection; not likely to be found in medical school.)
Friday evening Tim and I went to see The Pillowman at the St. Louis Rep. From the description on the site:
In a totalitarian state, a young man—butcher by day, aspiring writer by night—is detained and faces an interrogation by a cruel, corrupt detective about the gruesome content of his lurid fairy tales, the plots of which bear striking similarities to a number of horrific child murders happening in his town.
Based on that description, I was a little worried that the play would be too disturbing for me, but I decided to go because it was supposed to be really good. It turned out to be excellent.
The play is really about storytelling - it turns out that the main character filters his life through his stories, and gains courage from telling them. As the play unfolds, we discover that all the characters are storytellers in some way or another.
The set design reflects the themes of the play. The “real life” scenes are set in an interrogation room, which is completely utilitarian, featuring only a table, chairs, and filing cabinet on an essentially bare stage. But these scenes are interspersed with scenes of the main character telling his stories. The rear of the stage becomes another stage, framed with what looks like a decoration on a storybook. The sets for the stories are colorful and stylized, with bold lines and exaggerated angles. The actors are also dressed colorfully, and act out the stories with exaggerated motions as the writer tells them. The contrast works very well.
Quite a bit of meta is to be expected with a story about storytelling. One bit in particular made me laugh. The main character is telling a story to his mentally-handicapped brother, who interrupts to ask what aggravated means. The storyteller says it means annoyed or irritated and goes on. While I can’t be totally sure, I think this is a dig at overly-prescriptive editors, who insist (based on questionable etymology) that aggravate should only be used to mean worsen, with irritate reserved to mean annoy. (Note that the first page of Google results for “aggravate irritate” consists almost entirely of style guides making this prescription, with only one link referring to the actual etymology and supporting the use of aggravate for annoy. Linguists agree.)
The only criticism I had also involves the use of language; while I generally have no issue with the appropriate usage of Anglo-Saxon profanity, I don’t understand why fuck had to be used in what often seemed like every sentence, frequently many times per sentence. I can only assume that this was also some sort of statement, as no other words were overused to that extent, but I don’t get it.
Overall, it was a great production, and if anybody in St. Louis has a chance to check it out I’d recommend it.
It’s Not the Sights, It’s the Sounds
Fueled by frequent stops at diners (this was my third pie and coffee, and it wasn’t lunchtime yet), I was in the midst of a road trip through the American linguistic landscape. My guide was not Rand McNally but rather The Atlas of North American English, by William Labov, Sharon Ash and Charles Boberg, the first complete survey of American phonetics, published late last year by Mouton de Gruyter.
[…]
When I called Professor Labov at his linguistics lab at the University of Pennsylvania and proposed I take a phonetic road trip — a journey about listening, much as a blind person or linguist experiences travel — he was enthusiastic. “When I travel,” he said, “I always ask myself, what do I expect to hear that tells me that I’m not just anyplace?”
I have a very low-key teaching style. Today I was teaching a chemistry class and I made some comment about gas molecules zooming around, which made one student laugh and ask me if that was a technical term. I probably could come up with fancy-sounding words (though maybe not while thinking on my feet), but I think it’s more effective to use simple words if the fancy ones don’t add anything different - the easier it is for people to understand the vast majority of what I’m saying, the more likely they’ll be able to focus on the parts that are actually new material, rather than spending time deciphering blather.
People say doctors are really bad with the jargon, and it’s totally true. Half my classmates have already started up with MI for heart attack, hyperlipidemia for high cholesterol, diapheresis for sweating, and “Please move medially” instead of “Move to the middle of the row” to accommodate latecomers.
I realize that some of these offer more precision than the lay terms, and so they’re certainly useful in technical situations, but I’m amazed at how quickly people forget what is actually going to make sense to a normal person who doesn’t spend six hours a day listening to medical lectures.
And some of the terms appear to be replacing other technical terms: evidently, saying “urination” for what the less couth might call peeing isn’t technical enough! We have to call it micturition.
Last night Tim and I went to see I Am My Own Wife at the St. Louis Rep. (I got free tickets through a class I’m taking.) I enjoyed it quite a bit. It’s a one-actor play about the semi-true story of Charlotte von Mahlsdorf, a transvestite who lived in East Berlin through both Nazi and Communist rule. I’d never seen a one-man play before; in high school and college drama departments the rule seems to be to choose shows with as many characters as possible to let everyone participate. I was worried that it would be excessively arty and difficult to follow, but it worked very well. I never had trouble figuring out which character was speaking; it helped that the actor did different accents for most of the characters, but the body language was very important too. And the minimalism of the set worked in the play’s favor - there wasn’t anything around to distract.
Since the play is set in Germany, there was a fair amount of German worked into the dialogue, and I enjoyed that, especially when I could catch the jokes sooner. I was especially impressed that the actor did multiple accents in German, not just in English. There were quite a few things that were amusing to a speaker of both languages, mostly the sad attempts of the Americans to speak German. Also, the title character had a habit of saying “became” when she meant “received” (e.g., “He died and I became his furniture”), which I thought was funny because I used to make the opposite mistake: in German, bekommen means to receive, while werden means to become. So learners of German often (incorrectly) use bekommen in sentences about things like what they’d like to be when they grow up, where werden would be correct. I’d never noticed a German-speaker doing that, but I assume the real-life Charlotte von Mahlsdorf must have and that’s why it was in the play.
I so love reading Language Log. Lately Geoff Pullum has been on a tear about the use of they with singular antecedents - the sort of situation in which your high school English teacher most likely instructed you to use the clunky he or she if not the somewhat sexist he. Pullum, a linguist who in fact wrote the book on grammar knows better.
He starts out by deploring “the following piece of ill-considered stupidness” in the The Times online style guide:
they should always agree with the subject. Avoid sentences such as “If someone loves animals, they should protect them”. Say instead “If people love animals, they should protect them”
Pullum’s response:
Agree with the subject? Subjects have nothing to do with this, as you can see from an example like We told everyone they were free to leave, where they has a direct object as its antecedent. Here no sense can be made of the idea that they should “agree with the subject”. The editors … don’t know a subject from an antecedent, or doubtless from an artichoke, and they should be ashamed of themselves.
The rest of the post is just as funny.
The next day, Pullum discusses an example of the use of they with an antecedent of known sex: Sean Lennon’s statement that “Any girl who is interested must simply be born female and between the ages of 18 and 45. They must have an IQ above 130 and they must be honest.” Creepiness aside, this isn’t ungrammatical, Pullum argues, in a post that includes the following delightfully nerdy passage:
The traditional simplistic line is just the pronoun they is plural and that’s all there is to it; but that won’t do. The uses of they in the quote above do not really refer to any particular person or persons. Nor does the noun phrase any girl. But any girl expresses a quantifier, and the quantifier binds variables semantically, and the pronoun they realizes the bound variables syntactically. The number agreement facts show that they is morphosyntactically plural. But the anaphora facts show that it can take an antecedent that is morphosyntactically singular
And today, for those who don’t think Sean Lennon serves as a particularly good example of anything, not least grammatical English, Pullum has a third post with examples from Shakespeare. (This post is already long, so I won’t quote, though I took the title from one of them.) He closes,
By all means, avoid using they with singular antecedents in your own writing and speaking if you feel you cannot bear it. Language Log is not here to tell you how to write or speak. But don’t try to tell us that it’s grammatically incorrect. Because when a construction is clearly present several times in Shakespeare’s rightly admired plays and poems, and occurs in the carefully prepared published work of just about all major writers down the centuries, and is systematically present in the unreflecting conversational usage of just about everyone including Sean Lennon, then the claim that it is ungrammatical begins to look utterly unsustainable to us here at Language Log Plaza. This use of they isn’t ungrammatical, it isn’t a mistake, it’s a feature of ordinary English syntax that for some reason attracts the ire of particularly puristic pusillanimous pontificators, and we don’t buy what they’re selling.
I love it.