Swami! How I Love You, How I Love, My Dear Old Swami!

During my internal medicine residency one of the surgical residents at our hospital got into the habit of addressing us by the moniker "Swami," as in "This guy's going down the tubes - better get the Swamis to see him." As is the case with most jokes, this term of endearment soon came into widespread use. Whenever a surgical patient mysteriously developed chest pain, or liver failure, or anything short of a leaky carburator the alarm was sounded: "Call the Swamis," which meant the doctors who know everything but can do little but surround the afflicted's bed and chant in unison, or upon request, debate the manifestations of infection with Anaplasma phagocytophilia. We medical residents laughed it off as merely a defense mechanism used by surgeons to reinforce their delusion that hacking things off or out of human bodies made them superior to us in the medical pantheon. Listening to surgical residents one would think that we "swamis" were afflicted with such infirmities as mousiness, donnish condescension, dithering, prolixity to the point of fomenting suicide and pants-wetting.

Of course, they were partially right. In medical school even I, a future internist, could identify those students who were bewitched by the cerebral, milksoppy allure of swaminess. They were the ones who could recite on demand the differential diagnosis for erythema nodosum , or correctly identify such things as cutis rhomboidalis nuchae. Swamis-in-waiting were easy to spot by their distinctive costume or their insatiable desire to study. They not only knew all the answers but knew which genetic polymorphisms were responsible for the right answer. They were the students designated as "worthy to serve the suffering," whereas the rest of us were torn between giving 50 to 75% effort or skipping out to form a "Donkey Kong" tournament at the nearest bar.

Now that years have passed since I first encountered the mystic chords of swamihood I realize I have developed the ability to identify one who is practicing the swami lifestyle. The clues are these:

If your hospital consultations are more than five typewritten pages long (single-spaced)...

If you have ever used the term "ululating" when describing a patient...

If you have ever diagnosed someone with "Ganser's syndrome," or even know what it is...

If it has taken more than three planetary rotations for you to come up with a treatment plan...

If your dog hides under the couch whenever she sees you holding a stethoscope...

If the phrase "gene expression profiling" produces the same effect on you as Esquire magazine did on your grandfather in 1955...

If your children feign deafness, unfamiliarity with the English language or narcolepsy whenever you offer to help them with their homework...

If you have ever used any of the following during a dinner party conversation: "c-KIT," "Bayesian," "constitutive," "totipotency," or "hubba-hubba"...

If your idea of a wild Saturday night is to work in the lab with the overhead lights off, or do your evening rounds an hour earlier, or curl up with a racy paperback, or get into an argument over the latest controversy on epidermal growth factor receptor polymorphisms and sensitivity to receptor tyrosine kinase inhibitors...

YOU MIGHT BE A SWAMI. Please take this under advisement, and good day.

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If only a swami is meant to know some of this, then why O Cheerful Oncologist of ours, do you know this too?

Mighty suspicious.

Five page hospital consultation? What a slacker!

The Cheerful Internist

By James Wilk, M.D. (not verified) on 29 Jun 2007 #permalink