While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in “Platoon.” And medical professionals are dropping f-bombs. All of this would give the pearl-clutching crowd palpitations (and I know because I used to belong to the pearl-clutching crowd). I had a sheltered childhood, but I have learned that “the real world” is profane. And sometimes, it can feel like the only words to describe unspeakable things are words that are unspeakable in communities along “The Bible Belt.”

Imagine seeing injuries sustained from a shotgun being inserted inside a woman and fired. The question on almost everyone’s lips is not, “Who was the reprehensible person who did this?” but, “What kind of sick f*ck does something like that?”

Imagine being in an operating room with ten other people, and when the scalpel opens the patient’s belly, it sounds like a balloon popping and everyone in the room is instantly covered in poop. It is everywhere — the ceiling and walls, the surgeon’s glasses. It is quite literally as if the sh*t hit the fan. Put yourself in that room and then add to it that the person on the table is dying in front of you. What words come to mind?

Any?

Maybe some do, but I’m pretty sure “fecal matter” isn’t among them.

Imagine caring for this toddler:

Those welts are from a whipping with an electrical cord. It might be nice if a medical professional could walk out of a room with a kid like this and say:

“I am bereft. The unimaginable horror of that child’s life is incomprehensible, and I feel shamefully impotent in my ability to heal the seen and unseen wounds in that room.”

But that kind of response requires more composure and vulnerability than most can muster in the moment. So what you get instead is “Holy sh*t. That’s awful.” OR “OMG, I want to hurt the m-effer that did that.”

Recently, I was describing a patient’s injuries to a fellow physician and we “jinxed” ourselves by saying, “burned the sh*t out of her foot.” It was almost as if that was a genuine medical description like “projectile vomiting.” A foot doesn’t actually contain excrement — so you can’t literally burn the sh*t out of it, but somehow this is the way two, highly educated people simultaneously chose to describe a bad burn. Twitter and Facebook are littered with similar nonsense expressions like LMAO and IDGAF. They’re silly, really, when you think about it.

I suppose, in some ways, medical culture has simply followed the arc of popular culture. Swearing isn’t the taboo it once was. Rest assured, however, we still guard some of the bleached and starched air of white-coat professionalism that was established by our predecessors and most patient rooms and public spaces are still profanity-free.

On the potty-mouth scale, I am far from the extreme end (which would be comparable to a porta-potty at a county fair). Some of the expressions from my sheltered childhood have stuck with me. I still say, “holy smoley,” and “jeez, oh man.” My potty mouth is like a toilet at a moderately priced hotel (clean, but it can surprise you with a stray hair or two).

I will not defend the use of profanity. Maybe medical professionals should be using expressions like “gee willikers,” “fiddlesticks” and “glory be!” I will only say that profane words are often accurate descriptors of profane circumstances. Ugly words for ugly things. Behind the front desk, it can feel like a war zone. And sometimes, battle requires the heavy-duty artillery words banned by the FCC. We spend our days dealing with bodily fluids that best belong in a toilet, being called names like bi*ch, seeing patients who are seriously sh*t out of luck or massively f*cked up, all while getting kicked in the as* by the state of medicine. And that is why medical professionals have potty mouths.

P.S. – I really do love my job — porta-potty smell and all. It is a privilege to practice medicine, and I apologize if this explanation of a phenomenon I have observed was offensive.

Kristin Prentiss Ott is an emergency physician who blogs at her self-titled site, Kristin Prentiss Ott.

Image credit: Kristin Prentiss Ott