Into the dark dungeon: my 2 weeks of radiology

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Radiology is a field I hadn’t appreciated until I spent 2 weeks on this rotation. My doc did mostly PET/CT scans with the occasional wrist, ankle, or shoulder fracture. To fulfill every cliche possible, my preceptor worked in a dark room, staring at a computer screen in the basement of a VA building with zero cell service (not that I text during my rotation, but it’s nice to be able to look things up online… And that wasn’t an option here). My doctor was old, probably in his mid-70’s, and had watched a huge transformation of the field of radiology from developing film in a dark room to digital scans to the invention of MRIs and CT scans. His book collection (originating seemingly from the dawn of time) was impressive and had every special imaging modality detailed in hundreds of pages. On any given subject he had multiple huge textbooks. Example? Musculoskeletal MRI (x4). Atlas of Positron Emission Tomography (x7). Chest Roentgenology (x9). You get the point. The truly impressive part was that people from all over the hospital would come and ask him about a specific topic, and he could pull a book from his extensive collection, turn to the exact chapter, and find them their answer. He actually read and reread all of his textbooks! It was unbelievable!

Like I said, my doc was older. But he wasn’t one of those medical dinosaurs that you hope will retire because he’s endangering patients with his shaky hands or failing memory. Quite the opposite. He was more like an encyclopedia of information. And he was very knowledgeable about disease processes- arguably more so than any other specialty I’ve followed thus far. He could figure out a patient’s entire medical and surgical history by reading their CT scan. “Oh look, this patient had his gall bladder out and has this certain type of lung and his kidney looks a certain way, I bet he has hypertension and he’s smoked for __ years and has stage __ chronic kidney disease.” We would check their medical history taken by the internal medicine docs, and sure enough, he was usually correct!

Because he was old, he also had those qualities you can only find in someone from another generation, like his flip phone that he used to text (where he had to push 4-4-4 to get the letter “i”). When I told him David and I don’t have a landline in our house, he genuinely asked, “yes, but what do you do for fax?” He stared at each key as he typed, then looked up at the computer screen to see if there was a typo. It was all very endearing. And he had a vested interest in my learning. Every day he asked what I wanted to learn that day. He had me read CTs and chest X-rays and asked me where the abnormality lay. This was intimidating at first, but his gentle teaching style actually worked and I found myself more and more able to navigate the anatomy and those globs on the CT scans slowly started becoming recognizable organs.

Since I was back at the VA, I saw a very specific slice of the population: mostly elderly males with multiple comorbiditites (high blood pressure, diabetes, smoking or drinking history, etc). So when we saw scan after scan of metastatic cancer, it wasn’t shocking. These were people my grandpa’s age dealing with disease we all expect in that age range. There’s one particular case that will stay with me, though. We got the scan results for this healthy man with a history of prostate cancer (treated and resolved) who didn’t smoke and didn’t drink and didn’t have a long medical history compared to our other patients. This scan was for a check up to make sure his cancer hadn’t recurred. We pulled up the scan, and as they say (and maybe this is a little insensitive near the holidays), he lit up like a Christmas tree. I didn’t understand that expression until we saw this scan. He had metastases everywhere- his brain, his liver, his spine, his pelvis, his legs. The thing that got me most was when I glanced up to see his date of birth: almost 1 year to the day older than my own dad. And a week before Christmas, he was about to find out he didn’t have much time left with his family. It made me really rethink my definition of “old” (after all, my own dad isn’t old! He can’t possibly be in that population of people who get cancer and other aging processes!). It also made me really appreciate the time I have with my grandparents and parents, because you never know when you’ll see a doctor for a routine check up and be given a countdown to your demise.

Another aspect of radiology I realized quickly was that while we saw some horrible cases, we also saw good ones- ones where the cancer hadn’t spread, but had instead completely resolved! In every case we simply wrote a report and submitted it to another physician who would deliver the news to the patient and his or her family. It was really odd to me that all medical students train and sharpen our physical exam and communication skills with patients, only to have some fields of medicine not ever personally interact with patients. I asked my doctor once if he ever saw any patients. He replied, “why yes. I see them sitting in the waiting room waiting for their scans.” …not what I meant, haha. When I mentioned my observation about how strange it was to me that one would train in this field and never see patients, the resident I was with replied with “yeah, but patients are gross.”

I can’t really pass judgement on this observation because some would claim surgery is gross, or kids are gross, or ____ is gross. Really, I’m just happy others are called to radiology. I can really appreciate their passion because their work matters. Any other field isn’t equipped to read scans or X-rays, and without imaging, we wouldn’t be able to diagnose disease accurately. Just like I love peds and others can’t stand kids, my doctor loves radiology and doesn’t enjoy seeing patients. While not something I would do, after spending two weeks in a dark basement with his textbooks and his endless knowledge base, I can respect his expertise and his choice to go into this field.

I found a quote on his wall that I really loved:
“To study the phenomena of disease without imaging is to sail on an uncharted sea, while to evaluate imaging without a knowledge of the patient is not to go to sea at all (if not to be totally lost at sea)”.

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One thought on “Into the dark dungeon: my 2 weeks of radiology

  1. And you found a link in that pediatric bible. Family story: Way back in 1978 Jim was doing a surgery rotation with grandpa at Roosevelt hospital where dad was a surgeon. Jim started co of chest pAin. He told dad it had started during the night and was stabbing again. Jim just finished 10 days of bed rest for a compressed disk. Dad sent him for a chest X ray, simple, no contrast or scanning; the results came back. Grandpa commented Hmm… you must have had histoplasmosis in your younger days, did you spend much time on a farm, and then came the dx pulmonary embolus. So true to your observation and experience there is so much more to this diagnostic world than the protocols let on.

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