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Sep 11, 2010

Rays

In all honesty, radiologists are really pretty cool. They usually have some interesting hobbies or cute, overprotected kids. They’re pale, sure, but are not blinded by the sun when they see it, nor have they forgotten what it looks like. They are funny and like to listen to music while they work. Looking at images is exciting to them, and gratifying. They are able to see what the clinicians can’t, look beyond the pain and words and sweat and grimaces to focus in on the causes. The pictures show them the answers and they see it first.

And they breathe a sigh of relief that they are not the ones who have to call the patient.

This is where I leave them. This disconnect between diagnosis and patient, between disease and person, is not why I went to medical school. I do not pursue this business to be safe or protected from the bad things in the world, nor do I want to shield myself so completely behind a wall of professionalism and order that I no longer recognize a human being in pain. I want to be the one to deliver that news, because I might be able to make it a slightly less awful moment that it might have been.

I went to a conference for the radiologists where images were shown on screen in relatively rapid succession and the attendants had to interpret the image, one after another down the row. It was a radiology version of Show and Tell, as the images were some of the biggest and baddest things they had seen and collected. It is certainly interesting, and requires an incredible breadth of knowledge to be able to recall the anatomy of the entire body as well as the specific disease processes and terminology of all the specialties. And I saw how quickly the patient aspect falls away when the images go by so quickly.

Normal chest x-ray, next.

Normal abdomen-pelvis CT, next.

Normal, next.

Normal, next.

Normal, next.

Then, lymph nodes look big. There is some swelling. Looks like some invasion around that structure. No blood flow here. Architecture is distorted. Hm. Interesting. Highlight of the day! It’s cancer!

The images went by and the budding physicians trained their eye on the abnormalities. Spinal fracture. Testicular torsion. Ruptured appendix. Cardiac anomaly.

Then, "Ooh! Here's a good one..."

I was in the back with my friend, another OB hopeful. Our eyes widened with excitement when we saw it, something rare, a treat for us: a CT of the abdomen and pelvis of a very pregnant woman. We looked at the fetal skeletal outline, clear as day, encased in the belly of the patient. Unusual because radiating a baby is bad form, but indicated in an unrelated emergency.

They had been in a car accident, said the staff doctor, who sees the problem here?

Both of us saw it before the radiologists. We knew what to look for, recognized it immediately. Abruption. The placenta, the lifeline for the baby, was coming away from the uterus because of the force of the accident. A true, terrifying emergency.

The radiologist on the “hot seat” for this case slowly saw the problem. “Is that blood behind the placenta? Separated a little from the uterine wall?”

“Bingo! This is a devasularized placenta, meaning there is no longer any blood flow. This baby is dead, we never saw a heart beat, died before this scan. Great job! Moving on the next case… what do you see here?”

I saw nothing after that, nothing but that dead baby on the screen. Felt nothing but my mouth drying up from hanging open and my stomach moaning from the extra acid. I heard my friend try to breathe, but fail.

This is why I will stay up all night and all day and the next night, come in on my days off, skip meals, miss family get togethers. I will do this so that a woman who had a living baby just this morning, but now has to deliver a dead one, will have someone to hold their hand, cry with them, and acknowledge the moment. This may not be the reason I went to medical school, but it is the reason I want to be a doctor.

6 Readers rock!:

Rachel said...

Katie this brings tears to my eyes. After only doing this for 3 months, reading this is a good reminder of why we do what we do. Thanks so much for posting. Hope you, Patrick and Colin are doing well.

barrie said...

Kind of explains why the radiology techs in training were completely freaked by my completely abnormal LP done under fluoroscopey ;-) Stay human!

Pennsy said...

Kinda makes me wish you could be my doc...

mary martha said...

Katie, too bad they could not show your heart and soul on the screen...
I am always awed by your compassion and caring. You are going to be one of the best docs around...
love you

Brit said...

Thanks for showing us that big of passion and care you have. I would let you be my OB if I lived near you.

Long Family Chronicles said...

Wow, what an excellent post. You are an amazing doc!!