Four words of mine sent a woman into a hospital hallway to find out whether her father was dying. Every one of them was true.
I found her there an hour later, phone 6 inches from her face, the search box readable over her shoulder. Shadow on lung. The results were what you would expect. She looked up and said, “You said it was just a shadow.” She was right. I had.
Her father’s admission film showed a gray patch at the base of the left lung. The radiologist, correctly, called it likely atelectasis. Lung not fully inflated, common in a man who has lain flat for two days breathing shallowly because his ribs hurt. At the bedside, I had pointed to it and said what I always say. “It’s just a shadow, probably from not taking deep breaths. We’ll get another picture tomorrow and I expect it’ll be clearer.” I meant every word. She carried one of them out of the room.
In my dictionary, “shadow” is the gentlest thing I can say about a film. It means denser than it should be and not yet named, and far more often than not it turns out to be fluid, or collapse, or the angle of the shot. In hers, which is the one most people own, a shadow on a lung is what the doctor says before he says the other word. She’d heard “shadow” at her mother’s bedside eleven years earlier. The other word followed within the week.
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I couldn’t have known that. I didn’t need to. I only needed to know that the word has two meanings, and that I’d used mine.
She didn’t mishear me. We were reading the same word in different books, and neither of us knew there were two. This is not rare. When researchers asked more than a hundred members of the public about words taken from real cancer consultations, more than a third didn’t know what “metastasis” meant, and about half took “the tumor is progressing” for good news or couldn’t say. They were fairly confident in their answers, the wrong ones included. A later American study found about a fifth of people still hearing “progressing” as good news.
Confidence is the dangerous part. A confused person asks. The daughter didn’t look confused. She nodded. She had understood me perfectly, in her dictionary.
I call this two dictionaries, and medicine is full of it. “Positive” is good news everywhere except pathology. “Progressing” is good news everywhere except oncology. “Stable” means fine to a family and not yet better to us. “Benign,” “unremarkable,” “conservative”: words the patient already owned, quietly redefined without telling them.
Nor is it only medicine. Wherever there is a profession there is a hallway, and someone standing in it with a phone.
So now I say both, in the same breath. “There’s a shadow at the bottom of the left lung. The report will call it atelectasis, which means a patch that didn’t fill with air all the way. Nothing here looks like a mass or a growth. It happens when people breathe shallowly, and it usually clears.” The professional word first, because the chart will say it, and patients, and often their families, can read the chart on the portal now. Then the plain word, because the report does not translate itself.
It costs me about four seconds, many times a day. That is still less than one conversation in a hallway.
I can defend this habit; I cannot cite it. The misunderstanding is well documented, across several studies and decades. The fix is my own, and as far as I can find nobody has run the trial. Teach-back, asking the patient to say back what they heard, catches the same error from the other side, and has been studied, with mixed results.
There’s another cost. Saying “mass” and “growth” to a daughter who has not yet said either word aloud puts them in the room. I would rather put them there myself, with “nothing here looks like” in front of them, than have her find them alone in a corridor. But I understand the physician who hesitates. The plain word is the frightening one, and the professional word is where we go to avoid it.
The second film was clear. When I told her, she told me she had searched again, this time for “atelectasis,” and that it had been “a relief to read a word that meant what you said it meant.”
Her father’s film cleared in a day. The word took longer.
Gurdev Singh is a physician-writer whose work centers on one idea: Most misunderstandings don’t occur because no one spoke, but because meaning did not transfer. Singh studies the gap between what is said and what is heard, especially in high-stakes settings such as illness, aging, and difficult decisions, and explores how trust is formed or lost within seconds, why reassurance sometimes increases distress, and how presence can succeed where explanation fails.
Singh writes literary nonfiction, research-informed essays, and fiction, and gives talks on empathy, communication, and human dignity. The aim is not to teach scripts, but to deepen awareness of what people carry away from an encounter, because that, more than information, shapes outcomes. In Singh’s words, “Where words end, meaning begins.” Singh’s writing appears on Substack at The Two Wells.
