Wednesday, November 6, 2013

6 November 2013 I remember that… But it didn’t sound so dirty then


Cassi Creek:  I had an 0800 neurology appointment at Mountain Home this morning.  The drive in was uneventful.  Checked in on time and waited. 
          An LPN did my vitals.  She was suffering a migraine and trying to keep her work cubicle as dark as possible.  She hooked me up to the auto-monitors, got a pulse ox and temp result but wasn’t sure why I had no pulse or BP.  I was wondering, simultaneously, why the auto-cuff wasn’t auto-inflating and crushing my bicep and radial nerve.  I finally noted that the pressure line to the cuff was not connected and handed it to her.  Suddenly, pulse and pressure resulted. 
          Then arrived the resident on Neuro service.  Each time I’ve been seen by neuro a different resident has done the exam.  This young woman was carefully taking an Hx and performing a neuro workup.  At one point, she stopped and said, “I’m trying to remember the cranial nerves.”  Then she regained her focus and finished the exam. 
          Generations of medical students have used various mnemonics to recall the cranial nerves. 
The cranial nerves are:
·         I - Olfactory nerve
·         II - Optic nerve
·         III - Oculomotor nerve
·         IV - Trochlear nerve
·         V - Trigeminal nerve/dentist nerve
·         VI - Abducens nerve
·         VII - Facial nerve
·         VIII - Vestibulocochlear nerve/Auditory nerve
·         IX - Glossopharyngeal nerve
·         X - Vagus nerve
·         XI - Accessory nerve/Spinal accessory nerve
·         XII - Hypoglossal nerve
The old mnemonic I learned decades ago was “On Old Olympus' Towering Top, A Finn And German Viewed Some Hops”

Like every other group involved with anatomy, the actual study of anatomy, medical students will take such a memory device and personalize it to render it more memorable to them.  The easiest way to do that is to change the tool from socially correct and safe for use in a patient’s room with family present, into something ribald, politically incorrect, and just plain vulgar.  If it helps, it helps. 
            The increasing numbers of women who now enter med schools  has made some dents in the social and cultural practices related to medical education.  Language and behavior that were still common practice during my clinical rotations and hospital jobs might result in censure in today’s hospitals and schools.   This is not a proclamation that women are never vulgar or politically incorrect.  I’ve known many RNs and female MD’s who could embarrass a statue and never miss a beat in charting, suturing, etc. 
            The difficulty in remaining a dinosaur  is in figuring out who is easily offended and who fields such comments and drives back at the pitcher. 
·               I didn’t offer a cranial nerve mnemonic this morning.  She appeared to be a first year resident, doing good job of examining and listening.  It wouldn’t have been fair to meet her admission of need to recall information with either
·         Oh, Oh, Oh, To Touch And Feel Vagina God Vaginas Are Hot,
·          or
·         Oh, Oh, Oh, To Touch And Feel Various Guys' Veins And Hotdogs
·         Political correctness demands this post be gender preference neutral.
More examples of such devices can be found at
Not all examples cited should be used in polite gatherings.

For today’s history item:

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