Dr. Rae D. Atian liked to start her day with her “boobs and babies.” Mammograms and ultrasounds were fast and easy, and patients were good about keeping their appointments, so she wasn't dealing with emergencies. Women were used to getting their hooters in a vice on a regular basis, and the discomfort was nothing compared to a colonoscopy. She got to deliver lots of good news. She also got to take part in early detection, so patients didn't mind hearing that a dark spot might need a closer look. Patients would be nervous, but knew they'd been squishing their tissues for a good reason. And the dark spots in an ultrasound were usually the first signs of a healthy new life.
Some of her friends (and family) accused her of being a robot, but she wasn't anti-social, she just loved science, technology and researching. After she logged into the PACS (Picture Archiving and Communication System), she could lose track of time for the rest of the day. After reviewing her B and B's, she pulled up the results of the morning’s CT scans and MRIs.
The first was an X-ray followed up by a CT scan of a young woman's lungs. ABC reviewed the doctor's notes. “Patient with persistent cough, non-smoker, no cold or flu symptoms. Family history of lung cancer.”
The X-ray was a little alarming. On the upper right lung was a smoggy cloud that looked blurry and nebulous. She knew right away that the CT scan wasn't necessary. Why did doctors always refer to the big C? If only they would trust us, she mused as she looked for another image the doctor might use when he explained that the patient must have been exposed to birds. She had a classic display of an avian infection. She wrote up her notes and emailed everything back to the doctor with her findings. She didn't have to think twice: antibiotics, return for a follow-up X-ray in two weeks and everything would be clear. Good to check for scarring though.
The entire process took 10 minutes. She was glad she wasn't at the hospital anymore. That was intense. The extreme pace meant she had to make snap decisions, sometimes with vague or arbitrary images. Worse, undertrained or harried technicians didn't always take the best pictures. There were blurry areas, too many “artifacts,” or dust and other particles distracting from a clear image. Knees were especially tricky. Such a complex structure with bone, cartilage and muscle, all in a three-dimensional placement. It wasn't always easy to locate a tear or a strain on a guy who twisted his leg during an afternoon softball game. Older hospitals had equipment that got a lot of use and were becoming extinct.
Her new “call” in this smaller, suburban clinic was more like controlled chaos, but she also had more time to meet with patients and take the pictures herself.
She pulled up the next case. She zoomed in and magnified the CT scan on her screen. Was that air in the bowel? She skipped to the next shot. It could be appendicitis. She checked the notes… nope, appendix removed. What was it? Something was hemorrhaging, that was certain. She couldn't ask the patient for more scans, so she drew up a series of suggestions for the attending physician—blood work, more interviewing, some Gas-X—so he could come up with some treatment options.
The rest of her day was challenging, and she drew on her knowledge of every specialty in medicine. A surgeon needed information on a blocked bowel—should the object be surgically removed or allowed to naturally evict itself? A neurologist needed to see inside a patient’s head after falling from a ladder—was the brain bleeding? How badly and from where?
She had a monthly staff lunch conference which was good news and bad: it stopped her momentum but the food was free. She always scheduled colonoscopies for after lunch. All the escaping gas was great cover for her own digestive acoustics. The nurses never let on that they knew the difference between the smell of a barium enema fart and a good after-lunch air biscuit.
Her next case was at 2:00. She scrubbed in and after reviewing the stress test to determine if a patient’s heart muscle was strong enough, she inserted the life-saving material into the patient’s heart.
That night was supposed to be a big party for all the graduating residents. After a long, intense tenure, they tended to start the party early and end late. Going to a bar or strip club wasn't the same as it was when she graduated. When all the students were hooting and hollering and trying to pick up women, all she could think was, wow, I bet she has a really nice skeleton.