Monday, April 2, 2012

Before We Found Words

     Until recently, the most interaction I've had with infants and young children has been in the clinical setting, usually around Christmas or in the summertime. These are the times of year when otolaryngologists typically perform lots of tonsillectomies, myringotomies, and adenoidectomies on their pediatric patients. Those of us who provide anesthesia for these little ones find pediatric anesthesia somewhat challenging, and sometimes, a little frightening. It takes a special personality, and plenty of medicine, to engage (and render cooperative) a child who's about to undergo anesthesia. Although pediatric anesthesia isn't my subspecialty, I've always enjoyed this age group of patients. For the most part, they're refreshingly honest and devoid of pathological anxiety: what you see is what you get. Because they are too young to comprehend all the devices we have to attach them to in the operating room before we render them unconscious, we use neologisms to explain what we're doing. When we neologize, we invent words or phrases to describe something which is already "named." For example, a pulse oximeter finger probe becomes a "finger light", a tightly squeezing blood pressure cuff gains acceptance as a "muscle tester", and EKG pads are "heart stickers." These newly coined words seem to give devices a life of their own, as if we're inviting them to come and play. With children, understanding the function of machines and medications comes secondary to the actual sensory experience; what they care about is how something tastes, looks, feels, sounds, and smells, what it will do to them, instead of for them.
     My twins, who are now almost 22 years old, had a "secret" language until they were almost three. Although Nick and Rory seemed to comprehend the language of adults, they'd respond to our questions with a string of neologisms which were intelligible only to the two of them. (The private language of children is called idioglossia, which often contains neologisms. Cryptophasia refers specifically to the secret language of twins). Their father and I began to wonder if they were developmentally delayed. We scratched our heads, wondering what the heck "Goggums" meant. Because they'd been born eight weeks prematurely, it was conceivable that their brains could be running a bit behind schedule. But, none of their other physical milestones were delayed. Both boys seemed active and bright, interacting appropriately with people and objects in their environment; they seemed normal in every way, except for language skills. Shortly before their third birthday, they began talking in complete, non-cryptophasic sentences. Today, they don't remember their twin language at all, but they did manage to retain some of their primal idioglossic ingenuity, my favorite being their corruption of the word "contaminated." Here's a typical yesteryear scenario. If Rory sneezed or coughed accidentally-on-purpose all over Nick in the back seat of the car, we'd immediately hear Nick loudly admonishing, "Rory, stop taminizing me with your germs!" This neologism actually seemed to express a more nuanced and urgent meaning of its original root word. I still think this is absolutely brilliant.
     I've recently started spending a good amount of time with my 4 1/2 year old niece, Jerney. She's delightfully inquisitive, uncannily observant, and candidly, sometimes frustratingly, spontaneous. To put it bluntly, she's brutally honest. Like most young children, her mind is still relatively open to the concept of duality and pure wonderment, where opposites co-exist, instead of being at odds with one another, where the names of things aren't essential in knowing what those things are. To illustrate, Mom and I recently took Jerney on an excursion to the North Georgia mountains to visit Babyland General Hospital, where the Cabbage Patch Kids are "born." About halfway through our trip, she became fidgety in her car seat. Mom suggested that she keep an eye out for horses, and to let us know when she saw a black horse. As we drove past a large pasture, full of all kinds of horses, Jerney excitedly pointed to a "Dalmatian horse." Without even seeing it, I knew from this neologism that she was talking about a spotted Appaloosa. (Real Dalmatian horses, or British spotted ponies, are unique to the UK, and are quite rare). It didn't matter that she hadn't identified the horse by its established name: her primitively communicated observation, based on the presence of spots, intuitively made sense, underscoring the elusive threshold between knowing and understanding. Jerney already knows a lot more than she understands. In this sense, her knowledge is pure and unfettered, stemming from her interactions with everything and everyone around her. Her mind hasn't yet been corrupted by the limitations that accompany understanding.
     Although Jerney is remarkably unfiltered, uncensored, and unspoiled by preconceived notions of how things "should be", there is evidence of social convention creeping into her lexicon. Regarding our trip to Babyland General, Jerney was initially a bit hesitant. You see, to Jerney the word "hospital" has come to mean a place where people get "shots." It's become a "bad" word. She went on to tell us about how she went to the doctor a few weeks ago and "got five shots in my arm." In an effort to reverse this unfortunate word association, Mom and I reassured her that happy things, like babies being born, also take place in hospitals. We reminded her that she was born in a hospital, to which she casually replied, "I know, I was born in Atlanta." Later, Jerney heard Mom use the word "hate" during one of our conversations. Jerney corrected her, saying, "Grandma, you can't say 'hate'! Hate is a bad word!" Apparently, one of her pre-school teachers has told the children in her class not to use the word, "hate." This prompted a brief discussion of how words, in and of themselves, cannot be bad or good; they are just words. We talked about how one word can have many different meanings, and how sometimes, we say we "hate" something, like lima beans, when what we really mean is that we "don't care for" them.
     I think we were all a little surprised that Babyland General looked so much like a real hospital. The front desk is manned by a nurse with a starched white cap. There are doctors and nurses in uniform bustling about, running to "deliveries" that are being stat-paged overhead, caring for these newly "plucked" infants in the nursery. Thankfully, Jerney quickly overcame her fear of "the hospital." She even became a mother that day. After an exhaustive search through cribfuls of wide-eyed, pudgy-faced dolls, she was drawn to Susan Betsy, a newborn baby girl with a shock of blonde hair, wrapped in a pink blanket. During the adoption process, Jerney had to sign papers and take an oath to care for Susan Betsy. Despite our encouragement to consider a different name for her baby, Jerney decided to stick with Susan Betsy. The next day, I received an e-mail from Mom, telling me that Jerney was having trouble remembering the name, "Susan", and was now referring to her doll as "Betsy Lou." Mom described how tenderly Jerney cared for Betsy Lou, even scolding Mom for waking Betsy up. When Mom replied that she didn't hear Betsy crying, Jerney responded quite seriously, "But, I'm a mother now." In Jerney's mind, her experience as a mother seemed to transcend the importance of what her baby doll was actually named; she cared for Susan Betsy and Betsy Lou with equal intensity and devotion.
     The cusp of self-consciousness is heralded by the development of communication skills. As babies, we experience people and objects in the world around us as a unified whole, without the need for words. Our pleasure or discomfort is expressed by laughing or crying. It doesn't take long for our parents to recognize from the inflection and timbre of our crying whether we're hungry or wet or tired. With time and reinforcement, the sounds we hear become organized into words. Words begin to take on meaning, and in an attempt to help others understand what we're feeling and experiencing, we string words together: "Mommy, I'm hungry!" In this pre self-conscious state, we use words to alert others to what it is we're feeling, but haven't yet assigned positive or negative values to them. We're aware of "I", but haven't yet come to view ourselves as entirely separate from our surroundings. We are still very central to what we're experiencing. This is the realm where "Dalmatian" means a spotted dog and a spotted horse, where a hospital is both a happy and sad place, where words aren't "taminized" as being bad or good, where changing your baby doll's name is not much different than changing her outfit: the words themselves mean less than the overall experience. The wisdom of idioglossia is simultaneously incomprehensible and intuitive. It only seems esoteric. Perhaps it's an extension of the wisdom we once knew, the childhood innocence and open-mindedness we spend our lifetimes trying to recover, the knowledge we had long ago, before we found words.

Dedicated to my friends, and former colleagues in anesthesia, Ben Rooke & Wes Wolfer.



  1. Kris, as usual your post is full of amazing insights gleaned both from your medical knowledge and your personal observation of the world. Until children are "taught" what is good and bad, right and wrong, worthless and worthwhile, they see the world around them entirely in their own terms, using the words and expressions that reflect their own feeling and experience. I think you're right in saying that that's the state of freshness and aliveness we strive to recover, so that life becomes once again a great voyage of personal discovery rather than conformist behavior and dull routine. When I read your posts I'm constantly reminded of aphorisms I've written, since we both seem to touch so often on the same subjects. Here's one of my personal favorites which, I think, compliments your observations here: "Maturity is the moment one regains one's innocence."

    1. NP, I always look forward to your insightful comments, as well as to your aphorisms. It's such an amazing talent you have, distilling complicated concepts/ideas/feelings, into a few well-chosen words. This aphorism really strikes a chord within me, and I am grooving on it. Thanks for sharing it with me! Kris

  2. I think you should use all those "new terms" on all your patients...i know I would feel a heck of a lot better knowing I was just getting "heart stickers" and showing you how strong my muscles were! ;) But then again, I'm a pre-school teacher, so I guess I just relate to that way of thinking!