This is a passage from Time’s Arrow, by Martin Amis (which I highly recommend everyone read):
"If John’s moral life came to me I would say:
There is malocclusion and diplopia. The pulse is thready. Auscultation would reveal dyspnea, rich in rales, also tachypnea, suggesting mediastinal crunch. Eyes show strabismus and nystagmus, also arteriovenous nicking and silver-wiring. In the mouth of the buccal mucosae are lesioned, the oropharynx inflamed. The heart: thrills, lifts, heaves, rubs, with a systolic ejection murmur at both sternal borders. Mental status: alert, oriented; memory, judgment, mood – normal.
Meanwhile, on their beds and trolleys, the victims look on with anxious facies."
I All the big words are spelled as they are in the book, in case he’s making something up. The book says “facies” as well.
Silver-wiring on the eyes… is that a medical term, or does he simply mean glasses? In keeping with the tone of the book, I’d suggest it’s imagery for glasses, but this influx of words that I don’t know has me confused.
My wife is a doctor, so I asked her to define all the terms of your post. Here is her answers, filtered through my non-medical (engineering) brain:
malocclusion – not closing properly
diplopia – double vision
Auscultation – listening (as with a stethoscope)
dyspnea – shortness of breath
rales – noise
tachypnea – rapid breathing
mediastinal crunch – area in the chest
nystagmus – twitching eyes
arteriovenous nicking – minor defects in the edges of the blood vessels of the retina
silver-wiring – descriptive term for defect seen in eye?
buccal mucosae – inside of cheek in mouth
oropharynx – inner throat
The heart: thrills, lifts, heaves, rubs – terms for beating of heart. thrills is a vibration, rub is just a noise, lift is having a hand on chest and feeling pounding, and heave is like lift only more pronounced
sternal border – about the sternum
strabismus – no idea (I think she just got tired of me asking)
Since it’s been pretty well answered, I’ll add the drive-by that I had to think twice about looking at a thread with this title started by this particular poster. :eek:
Silver-wiring is a change seen on the fundoscopic exam (that is, when the doctor shines that really bright light in your eyes and tells you to stare at a spot on the wall). The arteries of the retina get sclerotic and resemble silver wires. This is sometimes seen in patients with high blood pressure.
Systolic ejection murmur: systole is when the heart squeezes and pumps blood out. (Diastole is when it relaxes and fills.) This pumps blood through the aortic and pulmonic valves. If those valves get all hardened up and don’t let blood out as easily, it causes turbulence and makes noise, heard as a “murmur”. This happens most often to the aortic valve, and happens to most people to one degree or another as they get older.
The word “facies” is most commonly seen in association with Parkinson’s disease. Patients with PD are often described as having “mask-like facies”.
Rales are crackling sounds heard in the lungs; they are now almost always called “crackles”.
Mediastinal crunch (had to look this one up) is a crunching sound heard in the chest that is synchronized not with breathing (as usual crackles would be) but with the heartbeat. It suggests pneumomedistinum, or air in the chest outside the pleural (lung) and pericardial (heart) sacs.
The larger point is that this would be a description of a patient who is, to use the proper medical terminology, jacked up.
