Monthly Archives: March 2025

The Language of Medicine

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“63 yo M with a hx of DDKT (2019), ESDR 2/2 membranous nephropathy, DMT2, ischemic cardiomyopathy, HFrEF (EF 30% in 2023), Afib (on apixaban), CAD s/p stent and CAGB who presented with SOB with exertion and orthopnea. Admitted for CHF exacerbation 2/2 rhinovirus and missing medications. Course c/b Afib with RVR and AHRF requiring BiPAP.”

The above is an example of a typical “one-liner” in medicine using a fictional patient. A one-liner is a summary of a patient meant to communicate to other physicians the most important features of a patient’s medical situation. The spelled-out version of the above one-liner may be slightly more comprehensible for non-medical people, but likely not by much:

“63-year-old male with a history of deceased donor kidney transplant (2019), end stage renal disease secondary to membranous nephropathy, type 2 diabetes mellitus, ischemic cardiomyopathy, heart failure with reduced ejection fraction (ejection fraction 30% in 2023), atrial fibrillation (on apixaban), coronary artery disease status post stent and coronary artery bypass grafting who presented with shortness of breath with exertion and orthopnea. Admitted for congestive heart failure exacerbation secondary to rhinovirus and missing medications. Course complicated by atrial fibrillation with rapid ventricular response and acute hypoxic respiratory failure requiring bilevel positive airway pressure.”

I present these patient summaries to illustrate that medicine has its own language. Much like one might learn Spanish if planning to work in Mexico, part of becoming a doctor is learning the language of medicine. What makes medicine even more challenging is that each specialty has its own dialect which comes with unique acronyms and fancy terms. In part, the reason it takes so long to become a physician is the time needed to master medical language.  

Yet, despite so much effort spent understanding medical language, the best physicians don’t just communicate with each other. Physicians also communicate with patients. It’s a unique language mastery to be able to translate complex medical terms and concepts into language that nonmedical people can understand well enough to make informed decisions about their healthcare. Part of the physician’s job is to be a translator between medicine and everyday language. At times, this can be more challenging than one might imagine.

Becoming a physician takes at least 7 (usually more) years of training. And since being a physician is a job, physicians spend their entire work week thinking about medicine. Spending so much time lost in the language of medicine makes it easy to forget which phrases are medical jargon and which aren’t. The seasoned physicians I most admire are those who, despite so much time spent thinking in medical language, can easily code switch (going between different languages and cultures) to everyday language when working with patients. I strive to be like these physicians. Often, it takes a lot longer to explain medical information in nonmedical terms because medical language provides a means of synthesizing information. The extra time is worth the effort to ensure patients understand their medical situation. 

So, to break down the above one-liner into everyday language as an example:

“This 63-year-old man has a complex medical history. He has a condition called ‘heart failure.’ Heart failure is when one’s heart does not pump as well as a healthy heart. He has heart failure because the blood flow to his heart was blocked before he had his heart surgery. When the heart doesn’t pump as well as a healthy heart, fluid can build up in the body. One place that fluid builds up is in the lungs; this causes trouble breathing.  This man came to the hospital with trouble breathing, likely because of a heart failure exacerbation. A heart failure exacerbation is worsening of heart function usually because of a stressor. In his case, he likely had worsening heart function because he got a common cold (caused by a virus called “rhinovirus”). He was at particular risk of severe cold symptoms because his immune system is weaker than normal because of the medications he takes for his kidney transplant. His heart failure also likely got worse because he missed medications for his heart. While he was in the hospital his heart rate was very fast because of an abnormal heart rhythm. He was at risk of developing a fast heart rate because of his history of an abnormal heart rhythm called “atrial fibrillation” (“Afib” for short). Also, while he was in the hospital, his breathing got worse. When his breathing worsened, we placed him on a machine called “BiPAP” which helped him breathe and gave him oxygen.”

I used to code switch often when I was in the Peace Corps. I transitioned between Spanish, Guarani, and English depending on who I was talking to and the topic of conversation. I never expected how much practicing code switching then would help me now. But, every day at work I shift between medical and everyday language. When I forget to switch to everyday language, I’m quickly reminded by the confused look on my patients’ faces. I enjoy being able to explore different worlds. Transitioning between medical language and everyday language is one example of exploring different worlds. The better I get at translating the more I feel like a bridge connecting the medical world to the rest of humanity. It’s rewarding to be an expert in medicine and a guide who helps nonmedical people understand the strange world I’ve spent years mastering.  

Quandaries of Liver Transplant

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In the US about 10% of those on the liver transplant list die prior to transplant and over 20% are removed from the liver transplant list after being listed1. The hospital where I’m completing residency is a major liver transplant center. While living donor liver transplant is an option for some people, the patients I take care of are awaiting a liver donation from someone who died and donated their organs to others.

The patient was the color of a yellow highlighter. Perhaps you think I’m exaggerating that a person can be so yellow – I’m not. People turn bright yellow when their liver fails. The color comes from a pigment called “bilirubin” that the body can’t eliminate easily when the liver is sick. The patient’s eyes gazed off into the distance, into the future, or perhaps they gazed into nothing. They told me their name and answered questions, reassuring, but the slowness of their speech hinted at how sick they were. They were under my team’s care as we did the workup to determine if they were a liver transplant candidate. To be a transplant candidate patients must go through a thorough social and medical review to ensure they have the social support needed for post-transplant recovery and that they have no other medical conditions (like cancer) that would disqualify them from being a liver transplant candidate. If deemed a candidate for transplant, then a patient will be placed on the liver transplant waiting list (“transplant list” for short) which means they can receive an offer for a liver when one becomes available.

The workup of the patient the color of a yellow highlighter was ongoing. People whose livers have already failed are in a precarious state. They are at risk of confusion from toxins building up in their blood because their liver doesn’t filter the blood anymore. They are at risk of infection which can quickly kill them because without the liver working properly their immune system is weakened. They are at risk of both bleeding and forming clots. (Yes, these are opposite problems, and a failing liver puts one at risk for both through several complex mechanisms.) When the liver fails it disrupts the fluid dynamics of the body. Blood and other body fluids pool where they shouldn’t which can lead to swelling in the abdomen (and other places like the legs) and possible damage to the kidneys, heart, and/or lungs. In short, when the liver fails it causes just about everything else in the body to fail too.

When someone needs a transplant, it becomes a race to see if death or transplant will come first. The workup is prescribed. We hurry to send off the tests and complete the exams and procedures that the patient needs. Besides the workup, there are other barriers to liver transplant. For example, there is no road to transplant without health insurance. Just as there is no road to transplant if patients do not have friends or family to take care of them after their transplant. One also must have stable housing. Many people are not placed on the transplant list because they are disqualified or die along the way. Those who do make it on the transplant list frequently don’t survive until transplant. Livers are scarce. When a patient is on the transplant list, they are waiting for a person to die who has a liver that matches their body. Not any liver can be transplanted into any person. The liver and person receiving the liver must match so that the body of the person receiving the liver doesn’t reject it.

There are many people who need livers. When a liver becomes available who gets it? The answer is a combination of luck, being the sickest, and being the best match for the organ (like having a matching blood type and being the right size). Is it fair who gets a liver? Unlikely. There are race and gender disparities. Geography matters in terms of access to organs. Many patients never qualify for the transplant list because of the social determinants of health including problems related to poverty and lack of social support.

I thought of the patient the color of a yellow highlighter as I left the hospital for the day. No one could predict what their outcome would be. Even though experience and science told me the odds were against them, I hoped they’d get a new liver and recover well from the surgery. After all, I went into medicine not because I thought all outcomes would be happy but because I wanted to help people fight for the best outcome they could. Getting a liver transplant and having it work was the best outcome for this patient; it was the outcome the patient was fighting for. I came to work every day to help them survive until transplant. It was a big task, but few things are more motivating than the chance to help change another person’s life for the better. No matter what happened, I was grateful to be on the patient’s team. Grateful they trusted me to help support them through this challenging stretch of their life. Grateful we can transplant livers – giving hope for a new life in a situation where death used to be the only outcome.

  1. Annual Data Report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) from HRSA: https://srtr.transplant.hrsa.gov/ADR/Chapter?name=Liver&year=2022