Of Mice and Men: The Language of Medicine | Erin Stevens, MD
My third year of fellowship is my research year. Whereas I long to go back to the clinical service and talk to patients, my current patients are mice. My mice are housed on the ninth floor of the basic science building in the Department of Laboratory Animal Research, or DLAR. Over two months ago, I gave a small cohort of them ovarian cancer. I go every day to weigh them and see if they’re growing tumors. So far, it has worked in about half of them – suffice it to say I’m definitely better cut out for the clinical side of gynecologic oncology. Due to construction, the direct elevators to the DLAR have been out of service for months. You either have to take the stairs up nine flights or cut through the construction site. I usually choose the latter.
Every time I get off the elevator, I see the piles of sawdust, sheetrock, and ductwork stacked in the hall, breathe the distinct smell of work dust and catch a glimpse of the leftover bag from yesterday’s lunch at McDonald’s in the corner, and I can’t help but smile. My father is a master carpenter and has worked in construction my entire life. The sights, sounds and smells of my walk to the DLAR remind me of my childhood trips going to visit my dad at the construction site as he was building a new building.
My dad may only have a high school education, but he’s got a very inquisitive mind. When I first started doing surgery, he asked how I can make a big long cut in someone and not have the person bleed all over the place? He reasoned that when he cuts himself shaving, he bleeds a lot and figured all that blood would make it difficult to see what we were doing. So I explained to him the layers of the abdominal wall and the electrosurgical bovie device we used to make blood vessels stop bleeding. He didn’t understand what it meant when I said I did a laparoscopic hysterectomy, so I showed him a video of me operating and went over anatomy.
The idea of the robot for surgery fascinates my father. And when I picked cancer as a field to specialize in, the questions didn’t stop. Explaining to him on the phone that cancer is a cell that has forgotten how to die and so it keeps growing and dividing. How cancer can start in one place and travel via the blood or lymphatics to other places. And how the pathologists tell where the cancer might have come from based on what it looks like under a microscope, even if the biopsy is taken from a place it traveled to. My dad comes up with great questions when we get talking—questions that I’m sure many lay people wonder but never get the opportunity to ask.
As physicians, we learn a new language in medical school. We learn to speak a language that ends in -itises, -ectomies, -agias and turns simple words into fancy ones—peeing becomes micturition and passing gas becomes flatus. Patients hear the word “tumor” and become terrified, because they aren’t sure if “benign tumor” is good or bad. (Benign is the non-cancerous one, by the way.) All this training leads us to talk in a language patients can’t understand. And we do this, all too often, when we’re standing right in front of them at the bedside.
Talking to my dad and answering his questions has helped me to be better at explaining the complicated things we do to our patients. Sometimes I struggle to use non-medical terms with him, but he’s always quick to ask more questions when he doesn’t understand. Patients are sometimes embarrassed to ask what a word means or to say they don’t understand what we’re saying. It’s easier to nod your head “yes” and feign understanding than to admit you’re completely lost. As physicians, we need to remember that. When a patient or family member compliments me on my explanation, I’m thankful my dad’s questions have helped me formulate clear answers. And I look forward to that next question coming from my dad—it keeps me on my toes!