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UBI in the Knife and Gun Club

Posted by Richard Conniff on September 24, 2009

medical-slang-388I have a back page in the October Smithsonian on the colorful language of doctors and nurses:

Young doctors these days get trained to talk nice, think pretty thoughts and steer clear of malpractice lawyers. So the colorful subculture of medical slang is probably CTD (“circling the drain”), if not DOA (“dead on arrival”), and that may be a good thing. It was probably a little insensitive when doctors sticking a pulmonary artery catheter into a plus-sized person referred to it as “harpooning.” And it was never great bedside manner to remark that a newly arrived motorcycle crash victim was GPO (“good for parts only”).

But in the bad old days, when medical life was more freewheeling, “MASH”-style humor was commonplace. Patient reports were safely stashed away in the back office, so doctors felt free to scribble cryptic little notes to themselves, like FLK (“funny-looking kid”) or even FLK with GLM (“good-looking mom”). The LOL in NAD (“little old lady in no acute distress”) was the bread-and-butter of many medical practices, at least until she got transferred to the ECU (“eternal care unit”). Or sometimes her family dumped her at the Knife and Gun Club (“emergency room”) without cause, generally as they were racing off on vacation. When that happened, the language used by harried ER staffers tended to become unprintable.

If patients had trouble understanding instructions, doctors sometimes label­ed them CNS-QNS (“central nervous system—quotient not sufficient”) or just plain NTB (“not too bright”). In England, where getting “pissed,” or drunk, at the local pub was a popular route to CNS-QNS, doctors often categorized patients as PFO, PGT or PDE (“pissed, fell over,” “pissed, got thumped,” “pissed, denies everything”). Less diagnostically precise, though still useful, was the bruised and battered catchall category UBI (“unexplained beer injury”).

To be fair, doctors often directed their callous argot not just at patients but also at one another. Depending on specialty, a doctor could be a “gas passer,” “nose picker,” “crotch doc” or “rear admiral.” Surgeons were “knife happy” or “slashers,” while “fossil docs” learned everything they knew back when mustard plaster was cutting edge.

Especially for interns and residents, “developing our own private lingo made us part of a club (or a gang) who looked out for each other,” one middle-aged doctor recalls. They shared the experience of getting PIMPED (“put in my place”) by a hostile elder firing questions drill-sergeant style. For the real horrors of their work, referring to blood as “the house red” or to burn victims as “crispy critters” put the pain at a bearable distance.

The slang was no doubt also a way to vent unwholesome attitudes. Categorizing a patient as FOS (which does not mean “full of sense”) or suffering from TMB (“too many birthdays”) probably would not meet the standards of modern compassionate care. So good riddance, to be sure.

And yet a part of me also regrets the idea that doctors now get discouraged from even thinking, much less expressing, what any human being in their position might naturally feel. The other day, for instance, I showed up at my eye doctor to get new glasses. The nurse led me through the usual tests, and I wound up sheepishly admitting what had happened to my old glasses. We need not get into all the messy details here. Let’s just say that it involved storing my glasses in my shoes and, later, walking around for a while before I noticed that something underfoot felt oddly crunchy.

The nurse looked at me for a moment, possibly searching for a UBI, or trying to decide if I was a pumpkin (“you shine a light in the ear and the whole skull lights up”).

Then she murmured to herself, “NTB,” and I could hardly disagree with her diagnosis.

Richard Conniff‘s newest book is Swimming With Piranhas at Feeding Time: My Life Doing Dumb Stuff With Animals.

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