I, Noogerer

 

Sometimes, pointing out Trump’s mental decline and undeniable unfitness for office begins to feel like piling on. With his outrageous lies, insults to those who serve, and transparently impossible promises, he confirms it without need for comment. So, for a strategic break, during which he’ll undoubtedly keep doing it, here’s an off-topic column, from eight years ago:

I think it might be about 12,000. Somewhere I've seen the number of new words people learn in medical school, and whatever the correct amount, it's impressive. Here and there on my surgery blog (surgeonsblog.blogspot.com), I've mentioned some words I enjoy just for the saying: inspissated. Neovascularization. Tachyarrhythmia. Intussusception. Radiculopathy. (Switch one letter, it applies to Trump. Oops. I did it again.) Bezoar.

It's pronounced BEE-zore. I say it like the taunting "air-ball" at a basketball game. (Digression: It's been shown that at every venue, whenever that chant is chunt, it's always in the same notes on the musical scale. F - D, matter of fact.)

In addition to the daunting medical vocabulary we learn, there’s a more esoteric lexicon: unofficial terminology that bubbled into the vernacular and have become universal within certain sub-cultures: gomer; O-sign; Q-sign; lipstick sign; flail. One such has it all: nice sound, excellent meaning, and, in my case, a connection to one of my favorite people. The word is NOOGER.

In the memoir I wrote about surgical training, I described learning to dissect through distorted, inflamed, difficult anatomy. I called the method "delicate brutality." (Too late, it occurred to me that that would have been a better title.) Central to the technique is the ability to nooger; namely, to ootz a finger into a sticky place and wiggle it, pinch it, until you find a way through without poking a hole where you don’t want it. Improper noogering can lead to death, or something similar. In certain circumstances, though, it’s safer than sharp dissection.

Noogering can be done with instruments, too: a sucker, a blunt clamp, closed scissors, often along with the finger. Indeed it requires a combination of delicacy and brutality, plus a sense of touch; of tissue turgor (another good word: turgor) and confidence of anatomy. If you can't tell exactly where a thing is, anatomically, you need to be fairly sure where it isn't.

Not all surgeons need to nooger. Orthopods and neurosurgeons don't. Bone isn't noogerable, and brain, well, God help us... But a general surgeon unfamiliar with noogering is bound for trouble. Important as it is, I can't say how I learned it, or how properly to teach it. But I did, both.

Among my favorite characters from training was the chief cardiac resident, a gangly, soft-spoken but fast-thinking Southern boy, Joe (full name: Joe) Utley. In contrast to the others populating that department, who were various combinations of volatile, egomaniacal, nasty, or, in one case, all at once, Joe was laid-back, engaging, and highly talented. He told dumb jokes, quoted lines from movies (Patton, mostly), played the flugelhorn while wearing a sombrero, and treated me -- his over-worked intern and, later, junior resident -- with respect (although, it could be argued, having an intern and his girlfriend [now wife] over and subjecting them to the horn and the hat was anything but respectful).

I loved the guy. He died recently. I sent a copy of my book, in which he played a prominent role, to his wife; she wrote back that she knew he'd have loved it, and she could imagine him laughing out loud while reading it. That felt good.

When connecting a person to the heart-lung machine, it's necessary to control blood returning to the heart via the vena cava. That requires (did then, anyway) slinging the veins with ties; to do so necessitates dissecting behind those thin-walled, delicate structures, completely encircling them, within the tight confines of the pericardium. Joe had a favorite instrument for the job, a huge clamp with a curved, rounded tip. This he referred to as the "Giant Noogerer."

In those early days in its development, open-heart surgery could be tense and, often, very lengthy. As an intern on the service, because there was always work waiting to be done, stretching into sleeplessness, time in the cardiac room was -- depending on who was in charge -- often unpleasant. With no opportunity to do anything but stand there and answer gotcha questions, the hours dragged on, pushing the day's work further into the night.

With Joe, though, it was fun. Among other reasons, I looked forward each time, as the moment approached, to hearing him ask for the tool. "Giant noogerer," he'd say, hand out, and it always arrived with no need for clarification. With his gentle accent, it sounded like "jahnt nurgrer." If I ever knew, I’ve forgotten what the real name is. In my practice, I never used one. But I noogered, more times than I’d like to count.