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.

Nooger. A Word.

My next newspaper column:

Like coal ash, Trumpic horrors keep fouling the waters; but here’s a note from my surgery days anyway:

It’s said medical students learn over twelve thousand new words. Some I enjoyed just for the saying: Inspissated. Radiculopathy. Tachyarrhythmia. Intussusception. Pancreaticoduodenectomy. Bezoar.

Bee-zore. For fun, say it like "air-ball" at a basketball game. (Digression: It's been shown that the chant is always in the same pitch, the same notes on the scale. F - D, matter of fact.) 

There’s also a more esoteric lexicon: words or terms that bubbled into the vernacular unofficially but have become universally understood within various medical sub-cultures: gomer, Q-sign, lipstick sign, chandelier sign (definitions on request). One of my favorites has it all: nice sound, excellent meaning, and, in my case, a connection to a beloved mentor. The word is “nooger.” 

In “Cutting Remarks,” my book about surgical training, I described learning to dissect through distorted, inflamed tissues, calling the method "delicate brutality." (Too late, I realized that would have been a better title for the book.) Central to the technique is the ability to nooger; namely, judiciously insinuating a finger into a scary space, wiggling, pinching, until you find a way through without poking a hole into something important. 

Noogering can be done with other blunt instruments: a sucker, closed scissors, a blunt clamp, often along with the finger. Indeed, it requires a combination of delicacy and brutality, plus some sort of either learned or innate sense of touch; of tissue turgor (there's another good word: turgor) and confidence of anatomy. If you can't tell where a thing is, you need to be fairly confident in where it isn't.  

Not all surgeons need to nooger. Orthopods and neurosurgeons don't. Bone isn't noogerable, and brain, well... But a general surgeon incapable of noogering is bound for trouble. In a situation demanding it -- precarious as it usually is -- I'd rather do it myself than try to tell someone else how. Bad noogering can lead to death, or something a lot like it. 

Among my favorite characters from training was the chief cardiac surgery resident, a gangly, good-humored, soft-spoken, slow-walking but fast-thinking southern boy, Joe (full name: Joe) Utley. In stark contrast to the other men populating that department -- who were volatile, egomaniacal, crazy, nasty, or pretty much any combination of those characteristics -- Joe was laid-back, engaging, and highly talented. He told dumb jokes, quoted lines from movies, played the flugelhorn while wearing a sombrero, and treated me -- his over-worked intern -- with respect and caring; 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. (Joe died not long ago. 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 made me feel good.) 

In connecting a person to a heart-lung machine, it's necessary to control blood returning to the heart via the venae cavae. That requires (did then, anyway) slinging the veins in a sort of noose around the tubes inside. That necessitates dissecting within the pericardium, behind those delicate structures, completely encircling them. Joe had a favorite instrument for the job, a very large clamp with a curved and bluntly-rounded tip. This he referred to as a "Giant Noogerer." 

Open heart surgery has a certain drama, and, in those relatively early days on the time-line, tension compounded by lengthiness. But as an intern on the service, because there was always lots to do, 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 from the chief of service, the hours dragged the day's work further into the night.  

Except with Joe. I found myself looking 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 Carolina accent, it sounded like "jahnt nurgrer." In his hands, it was a delicate instrument; on his lips, though, it sounded like something you’d find deep in the Everglades, at night. 

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