These Pretzels Are Making Me Thirsty

Ben Bryner -- I'm sorry, everybody, for blogging about death for a while there. Today I’m going to talk about the show Seinfeld. I apologize to those of you not familiar with the U.S. television series, as well as casual fans of the show who aren't obsessive enough to be familiar with the episode in question. I realize that includes something like 95% of people reading this entry, but stay with me. In one of my favorite episodes, the aspiring actor Kramer is given a single line in a Woody Allen movie: "These pretzels are making me thirsty!" The four main characters of the show debate the best way for Kramer to deliver the line. As usual, Kramer overdoes it (and makes Woody Allen cry). But through the rest of the episode, each of the characters utters the line "These pretzels are making me thirsty!" When each of them says it, the phrase takes on a meaning like "I am extremely frustrated, and I am to blame, yet I am powerless to do anything to change the situation." It becomes a kind of shorthand between the characters and the audience, a simplified (and funny) way of conveying a complex reaction to a particular event.

In medicine we sometimes use similar kinds of phrases. For example, a procedure that should be relatively simple but gets more complicated and frustrating is called a "flog." (Atul Gawande uses the example of placing a central line; it should go smoothly but can suddenly turn awful.) We twist words from their true meaning toward a different one: when I describe a lecture or meeting as "painful," another med student understands this as not literally causing a sensation of pain, but being slow/boring/incomprehensible, etc. Not that this ever actually happens.

It seems like a lot of these terms are derogatory, which is partially true. My theory is that these phrases evolved to allow med students to vent quickly to fellow med students in the short amount of non-supervised time they have together. (Since you never, ever complain to a resident, or when residents are around, you have to be efficient at airing your grievances to your fellow students over a quick lunch or other chance encounter.) I'm sure a lot of other groups have this kind of term too. Certainly the military does -- one of my VA patients, a Vietnam vet, was less than satisfied with the way his care was going -- with life in general, really. I’d say things like:

"Good morning, Mr. Smith. Did you sleep well last night?"

"No, it was a total cluster."

or

"Hey Mr. Smith, did you get all your questions answered about your CT?"

"No, it was a total cluster. I don't know anything."

or

"Hey Mr. Smith, how was lunch?"

"A cluster."

So I picked up on that term. I liked the guy, and he wasn't really mad at us personally, just frustrated at the system (common even in the best of VA hospitals). But even though he favored us with the less profane version of the term, we all got kind of sick of hearing everything described as a "cluster," and finally on rounds one day my intern (a psych resident) got annoyed and sort of told him to shut up. I liked him, though, and he was my patient, so I kept going to talk to him and in the process heard him describe everything from his bed linens to scheduling surgery to the weather as a "cluster."

Anyway, not all our informal descriptions are negative; there are more positive shorthand terms too. I heard one of my favorites today -- describing a pediatric patient who has recovered well and is doing much better than expected as a "rock star." It doesn't mean the kid is really ready to play the Hollywood Bowl. It doesn't even mean that they're really good at Guitar Hero. But we all know what that term means: the patient's doing well, recovering, on the road to discharge.

This is part of the reason med students aren't always terrific conversationalists; for example, it's just easy for us to describe our day in clinic as "a huge flog" (a flog-a-thon?) to each other. That's so much easier than talking to a non-medical person where you have to explain a) what should happen in clinic and then b) how things went wrong and c) why each of those is particularly frustrating. I try to resist using these terms in polite society (by which I mean people who are not med students or doctors). And one of the reasons I like talking to non-medical people is to get a regular perspective on daily life. But as hard as I try, words slip in here and there, and before I can stop myself I'm describing a trip to the grocery store as a "flog." Then I have to explain what I mean, and apologize for sounding like an idiot; and the worst part is that I haven't saved any time at all. These pretzels are making me thirsty.