"a little sting"

[Arnold M. Zwicky]

On Jun 24, 2005, at 2:53 PM, Mark A. Mandel wrote:

> Arnold wrote:
>
> and now i can add, from direct observation at the Palo Alto Medical
> Foundation this afternoon:  "a little sting", meaning 'there will be
> a little sting'.  the m.d. was a bit taken aback when i commented on
> his usage as he was wielding the hypodermic needle.
>
Mark followed up:
>
> Yeah, doctors can be funny that way. You were turning the tables by
> applying
> your professional expertise to him.


well, this was a new guy -- a podiatrist who did minor surgery on my
foot.  all the rest of the (very) many physicians (family physicians,
neurologists, surgeons, and many more) i've dealt with over the years
have expected me to be knowledgeable.  and they used symmetric
address, calling me "doctor" or "professor" zwicky, or "arnold", and
expecting parallel terms in response. of course, they were almost all
colleagues at either ohio state or stanford.

my family doctor, jay, tells me that he's always pleased to see me,
because we have such interesting conversations.  our current joint
triumphs are

- the time i phoned to say that i'd woken up with bell's palsy and
explained how i knew it was b.p. and not a stroke.  jay agreed and
said that that meant there was no high crisis, but he still wanted to
see me that morning because he'd come across some japanese research
indicating that a particular antiviral might clear the condition up.
he noted that i was unlikely to have come across this work in a
literature search.  the antiviral worked like a charm; the palsy
passed away in days rather than weeks or months.  we were both
pleased with ourselves.

- the time i came in right after developing an apparent boil that
looked like it was turning into cellulitis.  despite having a high
fever and feeling deranged by it, i did my homework first.  at the
office visit, jay said, well, it's probably just cellulitis, which is
troublesome but not life-threatening, but that there were three very
unlikely (and life-threatening) things it could be.  oh, i said:
bubonic plague, bubonic syphilis, and necrotizing fasciitis.  right,
he crowed.  we were quickly able to rule out the first two but had to
consider the third as a remote possibility, so aggressive care and
watchfulness were called for.  the fact that i came in immediately
and that he entertained the possibility of n.f. saved my life.

> When I told mine about my tendinitis,
> she was at first totally unable to deal with my description of the
> site of
> the first symptom as "my left extensor indicis". Patients just aren't
> expected to know and use accurate medical terminology.

accurate medical terminology isn't always particularly useful.  my
experience is that doctors are grateful if you use it when it's
relevant, but are seriously annoyed if you just show off.  this makes
sense to me.

sometimes there's just no choice.  over many years i had to explain
to a series of doctors that among the many disastrous neurological
conditions my partner was suffering from was something called peri-
ictal schizophreniform-like psychosis.  many doctors have at least
heard of anosognosia (another one of his conditions with no common
name), but peri-ictal etc. is so rare that even many neurologists are
unfamiliar with it.  on several occasions, i had to spell out the
name for doctors who were filling out insurance forms.

at one point in columbus, the neurologist had me bring jacques in to
see him and a young man who was just starting his residency in
neurology.  the resident had just had his first real-life experience
with florid schizophrenia and was obviously rattled by it.  the
neurologist and i then passed the ball back and forth, explaining to
the resident the many ways in which peri-ictal etc. could be
distinguished from textbook schizophrenia of the sort he'd just
seen.  this was sort of fun, *and* i got to feel that some small
useful thing was coming out of the horror of jacques's decline.

arnold (zwicky at csli.stanford.edu)