Hitting a Nerve



Recently I was reading an article on the histories behind great songs, and one section featured Procol Harem’s “A Whiter Shade of Pale.” It mentioned the verse that incorporated a reference to Chaucer (“As the Miller told his tale”).

This surprised me, as, since I’d first heard the song (1983, in “The Big Chill”) until I read this piece, I thought the line was “As the mirror told its tale.” The idea that it was a misheard Chaucer reference had never occurred to me.

These are called mondegreens. The brain translates the phrase into what it hears, often giving it an entirely different meaning. Manfred Mann’s version of “Blinded by the Light” is absolutely full of them. Even the national anthem isn’t immune (“José can you see by the donzerly light?”)

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

I’m sure there’s an interesting study idea about the brain and mondegreens, probably involving PET scans, somewhere in there.

The whole thing reminded me of an incident early in residency, I suppose you could call it a medical mondegreen.

During training I never went anywhere without a clipboard and notepad, frantically scribbling tidbits down during rounds, lectures, meetings, whatever. I’d go home and reread them over dinner, trying to commit them to memory.

And somewhere, on rounds early in my first year of training, an attending told me that you can sometimes see a Bell’s palsy cause a mild ipsilateral hemiparesis. This surprised me, but hey, I was the newly minted doctor, there to learn. So I wrote it down, memorized it, and moved on.

Even then, though, it made no sense to me. Of course, I was too afraid to ask other residents about it, for fear they’d think I was an idiot (a point that’s still debatable). And questioning the attending involved seemed unthinkable.

But I wandered through my hospital library (back then, young ones, we used paper textbooks and journals) trying to figure out why a peripheral VII palsy could cause an ipsilateral hemiparesis. It would not let me be.


Finally, one day after a lecture, I asked the attending involved. He had no recollection of having tossed the point out a few months ago, and said there was no reason. This confirmed what I’d already realized – a standard Bell’s palsy couldn’t possibly cause an ipsilateral hemiparesis (I’m not going into the crossed-brainstem syndromes here).

Maybe he’d misspoken and not realized it. Maybe I hadn’t heard him correctly. Maybe a little of both. Hospital hallways are anything but quiet. He also had a pending vacation to the coast which could have distracted him.

Like mondegreens in songs, it was just an error, and looking back on it with 30 years perspective, it’s kind of funny. Fortunately I never sent anyone with a hemiparesis home from the ER thinking they had a Bell’s palsy.

But it makes you realize how flawed human communication can be. By the time I asked the attending about it I’d realized it couldn’t possibly be right. It still leaves me wondering about how much we think we heard correctly but we didn’t – and that we don’t notice.

Sometimes you may think your ears are open, but they might just as well be closed if you don’t hear correctly. In medicine the consequences of such can be a lot worse than screwing up on karaoke night.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recommended Reading

Active shooter drills may be harming children, but doctors offer help
MDedge Neurology
Polio: The unwanted sequel
MDedge Neurology
Patients who won’t pay: What’s your recourse?
MDedge Neurology
MDedge Neurology
Dig like an archaeologist
MDedge Neurology
Hearing aids available in October without a prescription
MDedge Neurology
Doctors using fake positive reviews to boost business
MDedge Neurology
At 100, Guinness’s oldest practicing doctor shows no signs of slowing down
MDedge Neurology
Early dementia but no specialists: Reinforcements needed?
MDedge Neurology
Physicians’ bad behavior seen at work, online by colleagues: Survey
MDedge Neurology