Lay it on Me Straight

There are times not to use metaphor.

This is a view out over the north pasture as an ominous storm rolled in from the west. We are enjoying the last of fall color here in the subtropics of the southern coastal plain, and the sweet gums have been astonishing.

I got to investigate hospital life again this week with my mom. What I want to tell you about are some observations regarding doctors and language.

On Friday I drove my mother into Savannah for a PET scan, where everything went great until we were headed home. We were at the edge of town, in line at a fast food restaurant to buy milkshakes (yes, true, I admit), when we got a call from a physician’s assistant to turn around. They had found an air pocket in my mom’s lung.

She had to present to the ER in Savannah, and life got wild for a while. Two security guards were trying to keep a mentally ill man subdued. A child in a corner was coughing with the flu. Another man had a hole in his leg. (Sorry for the gory details.)

During the hours that I spent with my mom, I noticed something about how doctors talk. They are presented with the constant problem of having to explain complex medical situations to morons like myself.

Take this air pocket, for example.

“What is actually happening?” I would ask.

An older doctor, fifty pounds overweight and with a stethoscope hanging around his neck, said, “Well, it’s like a brick in a toilet. If you put a brick in the back of your toilet, that displaces water. So you’re not getting enough water to flush your toilet.”

“The air pocket is like the brick?” I asked.

“This is called a hydropneumothorax,” he said to me, as if a six-syllable Latinate word would intimidate me from trying to understand what was happening. “Just take my word for it—if you don’t get it out of there it could get bigger and put pressure on the lung. It could get infected, all kinds of things could happen.”

I understood growth and I understood infection. “How do you get it out?”

He threw me a look of exasperation. I’m sure he was tired. I mean, there were people lying on stretchers in the hallways. One woman had apparently been hit in the cheek with something, and she was moaning and sobbing. Another woman was standing beside her, wiping away tears from the unhurt cheek.

“Well, we just have to lift the lid of the tank and take out the brick,” he said.

I put my hand in front of my mouth and actually muttered, “Oh my god, I hate metaphors.” Thankfully the doctor didn’t hear me. He was too busy trying to charm my mom with the fact that he wouldn’t be doing the procedure because he was born with ten thumbs. He even stood in the doorway and wiggled his fingers.

“Thank you for the info,” I said. “You’re a peach of a guy.”

You know how much I love metaphors. In writing and storytelling, they are incredibly important. From the Greek “meta” (meaning “across”) and “phero” (meaning “to carry”) a metaphor is a rhetorical device that uses one concept, idea, action, or object to describe another. In this case, the doctor is trying to use a common concept to describe an uncommon one. The brick in the toilet is a bridge that will “carry across” this idea of a hydropneumothorax.

Doctors seem to especially love to use metaphors. Once I was with a friend when a doctor began talking about gardens. “You have a garden growing roses and one growing weeds,” he said. “You have another patch of bare ground. Something goes to seed and the seed flies into the bare garden and it starts growing there. We have to figure out what that is.”

“Are you trying to explain metastasis from two differing cancers?” I asked kindly. My friend could barely talk.

He threw me a glance. “Yes,” he said.

“We understand metastasis,” I said.

My mom’s problem is fixed, and I’ve been thinking about metaphors, and I realized that they can be used to clarify, and they can be used to obfuscate. I think when doctors don’t have confidence in a family’s intelligence, or when bad news is hard to deliver, they couch the message in gobbledegook. Maybe they are trained to do this. Maybe there’s a class in med school on coming up with good analogies for your patients.

Later I asked one doctor about this tendency. “I like to use analogies,” he quipped, “because I’m not smart enough for parables.”

“I’m okay with plain language,” I thought.

In the case of the brick in the toilet, and in the case of the errant garden, the metaphors actually don’t work. In neither case are they sound, well-constructed bridges that carry one idea across to another. The brick implies that my mother’s lungs are a toilet, and the weedy garden implies that roses propagate by seeds or that some cancers are rose gardens.

All of this is to say, pay attention to language. Metaphors can be your friends, and metaphors can be your enemies. It’s all in the framing.

Your Biceps are Thanksgiving Turkeys

The younger doctors seem to vie for “Most Fit.” They’d came into my mom’s room with muscles bulging, no fat anywhere. One ER doctor breezed in, talking fast, and I had to focus hard to hear what he was saying, not because he was speaking in metaphors but because he was really sexy. (Apologies to my sexy husband and to all my sexy men friends.) His biceps were mountainous. His eyes were sky-blue. When he left, my mom and I looked at each other and raised our eyebrows. We both agreed, that was one cute guy.

I said to myself, Always dress up when you go to the ER.

A few minutes later he came back. He sat way too close to me on a stool at the end of Mama’s bed, and he started trying to explain what was happening in my mom’s chest. I was trying to control what was happening in mine. (smile) Then he did something I have never seen a doctor do. He decided to sketch out the medical situation. He quickly scanned the room for something to write on, and finding nothing, he ripped a ballpoint pen from his scrub pocket and smoothed out the starched, pressed, and very white bed sheet. He began to draw on the cotton.

Four of us were in the room, including a young nurse, and for a moment I felt a charge of electricity zip around the hospital bed. Then all of us acted as if this were the most normal thing in the world.

The man didn’t stop with one diagram. He had to draw two. I was thinking about the housekeepers who would have to bleach and scrub the sheet. Later I asked the young nurse, “Will that wash out?”

“I doubt it,” she said.

Have you ever seen a doctor do that?”

“Never,” she said.

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A Woods of Fannin County Update

Orlando Montoya interviewed me for the Georgia broadcast of All Things Considered. I’ve known Orlando for a long time, plus he was so smitten with the book that he put me instantly at ease. Here’s the link for that 8-minute conversation.

And the in-person launch with the Woods family went well. Richard Woods drove in from Alabama, accompanied by his wife, two daughters, and a lot of other family. This was our first time meeting in person, and it was nice. Jimmy’s widow Vicky was present. We packed the courthouse in Baxley, Georgia. Even after all the interviews I did over many years with many members of the family, I still learned stories and facts that I had not known. One very poignant piece of information was that Jimmy first saw Christmas lights when he was being taken from the mountain cabin to the first orphanage in Hapeville. He had never seen Christmas lights, and the sight was burned into his memory forever. After that, every year he strung Christmas lights all over his house, hoping to bring joy to even one child.

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Writing Your Own Stories

A few spaces are still available for the creative nonfiction course that starts in early January, as well as the circle of support for women writers at work on a longer project. More information can be found on my website.

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Goal-Setting for the New Year