"What's a Bed Plug? An L.O.L. in N.A.D."

Few things turn life on its head like a medical residency. Sleep cycles are inverted, social life becomes vanishingly scarce and comfortable attitudes toward nakedness, blood, illness and death are challenged as freshly minted medical school graduates spend three to five years training day and night in their chosen fields.

Accompanying this strange lifestyle is a new language to be learned and not all of it is derived from Latin and Greek. Like any specialized jargon, the shoptalk used by residents not only conveys facts but provides a running commentary on the absurdities of hospital life. It is by turns terse, bawdy, vague, precise, self-deprecating and profanely irreverent, offering a darkly comic defense against the daily onslaught of work, and the inevitable day when doctor becomes patient.

While such argot may seem callous, often skewering the very patients who give it life, its venom almost always stems from and is aimed at the impossible, carnivorous health care system, not the ill who innocently fall into its maw. It is an organic, inexact language that exposes the inexactness of the science of medicine. A sampling of current resident-speak follows, drawn from the wards of a busy teaching hospital.

Anaerobe: a term borrowed from bacteriology used to refer to a patient with chronically poor lung function whose blood oxygen levels seem too low to be compatible with life, yet who seems to function normally nonetheless.

Banana bag: an intravenous solution containing a liquid multivitamin that colors the fluid a bright yellow, used in undernourished or alcoholic patients.

Beans: kidneys. "Better watch that Gentamycin level you don't want to fry her beans."

Bed plug: a low-maintenance patient occupying a bed that might otherwise be filled with a more difficult case.

Bright lights: surgery (also, "bright lights and cold steel"). "The meds aren't doing squat sounds like this guy needs some bright lights."

C.T.D: circling the drain. Description of a patient who is slowly deteriorating and likely to die.

Code brown: bowel incontinence that can be smelled throughout the ward. "Code brown on 3 East better take the back stairs."

Ditzel: a small, unidentified mass seen on an X-ray, usually benign by implication. "The CAT scan was fine except for a vague ditzel in the parietal lobe, probably a calcium deposit." (See also goombah.)

D.N.R.: do not resuscitate. Instructions allowing a patient to die undisturbed in the event of a sudden catastrophic event; no C.P.R., no respirator, no electric shocks.

Doc-in-the-box: an urgent-care walk-in clinic. "He's moonlighting at a doc-in-the-box downtown."

Fascinoma: a very unusual or fascinating case. "They're presenting the fascinoma from 4 East at grand rounds this morning."

F/C/S/N/V/HA/C.P.: fever, chills, sweats, nausea, vomiting, headache, chest pain. A list of symptoms so commonly checked off in questioning that the savvy resident can "name that tune" with only one or two letters.

Fleas: Internists, because of their constant attention to the minutiae of daily patient care. In a less complimentary light, as a patient's death becomes imminent, the consulting specialists will often sign off the case, which internists, as primary care doctors, are unable to do. So internists resemble fleas, which are as the saying has it "the last ones to jump off a dying dog."

Gomer: shorthand for "Get out of my emergency room." Any undesirable patient, usually one that is unkempt, demented, combative or any combination of the above. (The phrase is now sharply discouraged due to a new sensitivity to the image of doctors, in reaction to the uncaring image presented by H.M.O.'s.)

Goombah: a large unidentified mass seen on an X-ray, usually implied to be malignant. "He's got some kind of goombah in the left upper lobe on his chest film." (See also ditzel.)

Heme: blood, often used as a euphemism in the presence of conscious patients to avoid upsetting them. "A little suction, nurse. I'm getting a little heme at the biopsy site."

Hit: a new patient. "Better grab some dinner quick we've got three hits coming up from the E.R."

Incidentaloma: an incidental finding noted on a radiograph performed for an unrelated purpose. "The M.R.I. Of the C-spine was normal except for an incidentaloma in the thyroid."

I's and O's: intake and output a daily count of the patient's total fluid intake and measurable output (urine, blood, wound drainage, etc.). An accurate tally allows assessment of the patient's hydration status.

K: the chemical symbol for potassium. "Mrs. Zilka's K was pretty low this morning better give her a dose of K-phos."

L.O.L.: little old lady. (Oddly, there is no male equivalent.)

N.A.D.: no apparent distress. The classic description of a patient in a state of well-being: "L.O.L. in N.A.D."

Neuron: neurologist. "Better get an M.R.I. before you get that neuro consult the neurons don't go to the bathroom without seeing an M.R.I. first."

O sign: a persistently open mouth, as seen on a mouth-breathing sleeping patient, or on a demented conscious patient. "He's resting comfortably; positive O sign." (See also Q sign.)

O.C.: obsessive-compulsive. "Dr. Heller gets pretty O.C. about checking I's and O's on his patients."

Pimp: to test the medical knowledge of an underling, usually in a public and unexpected manner. "The chief made rounds with us this morning, and I got pimped wicked about hepatitis."

Pleasantly demented: a standard description of a patient who, though deep in the throes of senility, can carry on an appropriate conversation and occasionally give the impression of having perfect mental capacity.

Q sign: an open mouth with a tongue dangling from it. "Looks like Mr. O'Reilly's not going to need his sleeping pills tonight he's already got a positive Q sign showing." (See also O sign.)

Rock: a very stable patient, often used at sign-out, when one physician is turning over care to another. "Mr. Green on 3 South just had a hernia repair nothing to do there, he's a rock."

Scut puppy: an underling, usually a third-year medical student, assigned to perform menial tasks like drawing blood and retrieving lab results.

Snake: to perform a procedure involving insertion of a fiber-optic scope into a body orifice; also, the instrument itself. "Mrs. Goldstein's ulcer seems to be acting up we better snake her and take a look."

S.O.B: shortness of breath. "Mr. Hanson complains of three weeks of intermittent C.P. accompanied by S.O.B."

Tail-light sign: when a patient (usually elderly) is dropped off at an emergency room by relatives who drive away before an evaluation is complete, forcing the patient to be admitted to the hospital whether or not his medical condition requires it. 

Train wreck: a patient with multiple medical problems. "Dr. Jacobs can't come down right now he's tied up with a train wreck in the E.R." 

Veteran (variant: veteranoid): a grizzled, elderly patient, usually male, who has great forbearance with testing and readily agrees to any procedures that are advised; reminiscent of the type of patient normally found in a V.A. hospital.

Wallet biopsy: checking a patient's insurance or financial status before embarking on expensive procedures. "They were going to keep her a couple more days, but the wallet biopsy showed she could be treated at home instead."

W.N.L.: within normal limits, as in a lab or X- ray result; or, alternatively, "We Never Looked."

W.N./W.D.: well-nourished and well-developed. Standard opening shorthand in any physical examination: `W.N./W.D. female in N.A.D."

Zebra: an outlandish or unlikely diagnosis. A medical school aphorism holds, "If you're walking down Fifth Avenue and you hear hoofbeats, you think of horses, not zebras," meaning that a common diagnosis is more likely to be correct than a rare one.

-- Sheilendr Khipple, New York Times, May 13, 2001