Saturday, January 12, 2008


"Toxic" is one of the most-often used terms in the secret language of Filipino doctors and nurses. It is more a part of our everyday conversation than the abbreviations, acronyms, and the host of medical jargon that roll off our tongues when we meet. It is the catch-all description of our lives.

And it has become such a huge part of our consciousness that we forget that the rest of the English-speaking world uses it in a completely different way.

In the Merriam-Webster Dictionary, the word "toxic" is defined as follows:

1 : containing or being poisonous material especially when capable of causing death or serious debilitation
2 : exhibiting symptoms of infection or toxicosis
3 : extremely harsh, malicious, or harmful"
No wonder I am met by the long blank stares of my non-medical friends when I explain why I can't do something fun with them this weekend by saying, "I'm toxic." They probably think my stint in medical school has completely obliterated my lessons in English vocabulary.

But what do your friends from the Pinoy health-worker universe really mean when they use the world "toxic"?

Putting it loosely, we use the word "toxic" to describe people, places, or things that have the ability to cause inordinate amounts of stress and exhaustion.

A first-year medical student who says he's toxic could mean he's presently swamped studying for several examinations. In contrast, an intern who says he's toxic probably means that he's in charge of many patients that are difficult to handle. A surgical or obstetric resident will probably have a completely different idea of what is toxic compared to a resident training in pediatrics or general medicine.

A toxic rotation is one that is so busy and demands so much of someone - both academically and physically - that she probably won't get to go home longer than the time it takes to bathe and change into a new uniform.

A toxic duty is one where a doctor is called on to handle one patient-related crisis after another - with some occurring with different patients at the same time for good measure - that she barely has time to breathe. This may be due to his patients' sheer quantity (i.e. too many patients for the hapless doctor on duty to handle) or quality (i.e. unstable patients under your care, diagnostic dilemmas) or a combination of both. The toxic duty also goes under the name of "Duty from Hell."

A toxic consultant is one who could be: a) an exacting mentor with impossibly high standards who asks a lot of questions during rounds or small-group discussions; b) an obsessive-compulsive attending physician who is very particular about how you manage his patients and is only too happy to chew you up and spit your bones out if you interfere with his management; c) an intimidating, stern superior whose patients you must know down to the last intake-output determination or else...; or d) all of the above.

A toxic patient is a one who is unstable, with multiple problems that need to be addressed at the same time, and requires close attention and intensive think work. The toxic patient is one who demands a great chunk of our time and effort - but is only one of many other toxic patients you are also responsible for.

A toxic magnet (yes, believe it or not, these people do exist) are people who seem to be eternally cursed by Murphy's Law - to whom anything that can go wrong will go wrong at the worst possible moment. They are the ones whose duties are always toxic duties; those who are buried in an avalanche of "quality" patients. Medical disasters are attracted to their mere presence and occur with alarming regularity to them through no fault of their own.

I've tried to do some research on this particular piece of medical slang on the Internet, and I haven't been able to find an actual definition of "toxic" in the context in which we use it. Apparently, it is only part of the vocabulary of doctors, nurses, and other health-workers in the Philippines - or maybe even just Manila - who have trained or worked in the medical system in the recent past. I don't know how long it has been since the medical community took the word and ran away with it, but I do know that it's probably been around for at least a decade because friends who made it to medical school a couple of years before I did were already using it even then. Chances are, it's been part of the hospital sub-culture a bit longer than that.

To those of us moving within this particular world, "toxic" is more a concept than it is an adjective.

It evokes memories of common experiences and elicits a complex mix of amusement and sympathy when it's the current state of someone else. We have all been in fluctuating states of toxicity since we began our medical journey. We have all had our share of toxic duties, toxic consultants, and toxic rotations. And knowing that there are other people who understand what we're going through does not make our stress-sources go away, but it does make the burdens we bear lighter.

If you're a non-medical person reading this, it's enough for me to know that the next time I say that I'm toxic, your first instinct would no longer be to think of sending me a dictionary or giving me a vocabulary lesson. But I'd like to think that after reading this, while you may not have lived our toxic lives, you have a pretty good idea of what I and my other colleagues mean.


Leon said...

Toxic? That's a strange slang.

Manggy said...

Hahaha-- that reminds me of one Summary Rounds where Dr. Luna was asking Dr. Andal (the OOD) can you define "toxic?" after she'd described a particular patient as becoming toxic. She proceeded to really DEFINE toxic like it'd come out of Williams Obstetrics, like "Toxic is defined as a patient whose condition suddenly.. blahblah..." Medyo natameme si Dr. Luna, he was not expecting that. The residents and students were all giggling like crazy, it was a really cute moment. I forgot what Dr. Luna said in reply, probably something to the effect of "Saan mo nakuha yan? Williams?"

I never used the word toxic to apply to myself-- I always just used "busy." In fact, I don't really recall using it to apply to a patient either, not that I talk about my patients/endorsed patients on duty with my blockmates. It's just something I never picked up :)

morks said...

i hear this a lot from my cousin who's a doctor also, especially when she was still studying and doing her intership. we would see very little of her and she would always be indisposed during social functions :)


dr_clairebear said...

thank you for dropping by!

@leon: i have yet to know who first coined this use for the word; nevertheless, it really captures what we go through. :)

@manggy: "busy" works, but somehow it doesn't carry the same angst - which is why i prefer toxic. it lets you get some of the stress off your chest. :)

@ris: is she from Manila or another province? I haven't gotten around to doing a survey of whether Pinoy docs trained outside Manila also use the term. :)

cardiogirl said...

Hey woman, I tagged you for an Entrecard meme over at my place. I also gave you a tiny plug.

p.s. I always refer to my Family of Origin (FOO) as toxic. And not in a good way.