My Secret Hiding Place

Tomorrow is my last day of Radiology and the start to a week of glorious, glorious vacation.  I’m kind of excited because that means I finally get to stop asking people if it is okay if I watch them do their jobs.  Plus, we are going to New York, so everything has to be awesome.

It is hard to find someone to watch do their job.  Especially when there are at least 4 other elective students floating around.  I have counted.

On Tuesday, I tried to go to two other places before I realized where I could go actually learn stuff… PET/CT.  The secret world of diagnostic imaging.

First of all PET is awesome because it falls under the Nuc Med umbrella and thus is totally within my comfort zone.  Plus, it is one of the most modern imaging techniques on the go clinically, particularly in cancer care.

Most importantly, nobody else really knows about PET/CT.

It really is sad that they don’t.  I think most assume they get to see it if they go to do some Nuc Med or CT.  I don’t know.  It doesn’t come up a whole lot outside of oncology, so I get that not all people know about it.

But, to add to it, PET/CT isn’t included on the list of places we can have ticked off on our signature sheet.  I write it in.

And the scanner isn’t by the rest of the radiology department.  And it is behind a coded door, so you have to ring to get in.  And they don’t do PET scans every day.

I like that it is so mysterious because it is the one place I know there won’t be another learner in when I am on the prowl for work and having little luck.

I go down there and get let in and ask the radiologist if I can hang out and watch him read a few scans.  He says yes, but the first one won’t be done for an hour, so I can come back then, if I want.

If I want?  Of course I want.

I come to find out that I am one of the only elective students he has seen wander down there.

I tell him that PET/CT is my secret place when all the students are everywhere else.  That it isn’t on the list.  He tells me to keep it my little secret.  That way he can continue to have peace and quiet (and get other work done).

I like that I have my secret hiding place option.  It feels so stealthy and spy like.

Radi-what?

Today, I met Radiology again.  We meet daily on most of my rotations, but for the next month, we will be spending some quality time together.

It is new rotation day.  And my new rotation of the month four weeks is Radiology.

And just to clarify, in case you, like many people in my life, are thinking “That’s great, your home service,” the answer is no.  My home service is Radiation Oncology, not Radiology.  They are commonly confused.  Radiology takes pictures and uses imaging to take biopsies or put in certain devices.  Radiation Oncology treats cancers with radiation.

I have done Radiology rotations before.  I did job shadowing as a med student, then a full week in a summer med student program and two weeks of selective in fourth year med school and now this four week stint.  I have a whole degree in Nuclear Medicine.  A degree.

It is important stuff.  Seriously, without being able to read images and without the help of Radiologists being a cancer specialist, especially a Radiation Oncologist would be pretty freaking rough.

That being said, it isn’t easy to teach.  A lot comes from seeing the normal stuff over and over and over again.

And I have a ton I need to learn.

The thing is with Radiology rotations is that they are different from you usual clinics, consult or floor services.  You basically watch and listen to people do their jobs.  Sometimes, you get to try to do it too, but really, you are generally a bystander.  Because nobody wants someone random reading their CT scan without assistance.

Image from diagnosticimaging.com.

Because much of the day is watching people do their jobs, it requires consumption of mass amounts of coffee.  At least it did when I was a med student.  I am sure it will again.

Also, because it is a lot of watching people do their jobs, it is a lot of being told “Why don’t you go read for a bit and we can review the cases together later?” or “It is just boring stuff now, so you can go.”  And I get it.  I wouldn’t enjoy someone hovering and I wouldn’t want to feel like I was boring someone.  But, that is what I need to do to learn.

The good thing is that I have four weeks and lots of different things that I want to see and do.  Hopefully, I will accomplish it.  Plus, I can always go do some Nuc Med to make myself feel better inside from time to time (how often do you hear that phrase?).

That being said, it does also make for some excellent hours.

Stranger

I always seem to be behind on the Daily Prompts… Probably because I don’t seek out to do them, but every once in awhile one of them catches my eye… This is the second one this week… Crazyness.

The prompt I am choosing to follow is entitled “Stranger.”  It asks, “Have you ever had a random encounter or fleeting moment with a stranger that stuck with you?”

My response is heck yes.

I tend to attract random encounters.  I am the person who talks to people on airplanes, helps you find an item in a store or runs head on into in the hall.

This particular encounter played a massive role in me settling into Nuc Med and into Medicine as a career.

I call it a God-moment.  Some people call it fate.  Others randomness.  Whatever it was, I am grateful for it.

So, flash back to February or March 2005.  I am a first year Science student, it is the one afternoon a week I don’t have class and I pick up a flauta from the nice man at the City Market (who is still there, might I add) and hopped on the bus back to the hospital.

It was the day of my Nuc Med interview.  If I got in to this program, then I would transfer degrees and I would be set for a career at the end of this.  No pressure.

I went to the hospital cafeteria to kill time and eat my flauta.  It was super busy, but I found a seat at a table for two that overlooked the lobby, hauled out my flauta and a book, popped in my headphones (aka my anti-social devices) and planned to kill the next 30 minutes studying for whatever quiz was upcoming (and trying to ignore the serious case of butterflies I had).

This adorable elderly lady came up to me with her tray… A sandwich and tea.  She asked if she could sit with me because the place is packed.

In my head I wanted to tell her no.  That the last thing I wanted to do was share my table and actually possibly have a conversation.

My Mother did not raise me to say such things.

So, I invited her to sit down.

She was stressed.  Her husband was in the hospital.  Cancer and there was something wrong with his heart too, she thought.  He went for tests, so she came down to eat something.

She asked what I was doing there.  I told her I was there for an interview.  She didn’t really understand what for and asked if I was going to be a doctor.

This was something I was toying with at that time.  It was a possibility.  A distant one, but something that had bounced around in my head.

I told her maybe, but that this interview was to be something like a person who does x-rays.

She then told me about how wonderful everyone was with her husband.  She assured me I will be a wonderful doctor and that my interview would be fine.  She then went on her way.

I never saw her again.

I thought the encounter was a bit funny.  I thought it was just an old lady not understanding that I wasn’t going to be a doctor.  That I might actually wind up becoming and engineer or some sort of scientist.

She did make me feel more at ease.

The interview went well. I got in.  And years later I became a doctor.

It sounds silly, but I felt like God stuck her there to encourage me.  To keep me from freaking out.  And maybe to keep me pointed in that direction.

I wonder what became of her, and of her husband.

I may never know.

But, her simple words, that random encounter sticks with me.

Weekly Photo Challenge: Up

This week’s photo challenge with the Daily Post is entitled “Up.”

I thought of a few places where up would be appropriate to describe the photo.

I narrowed it down to two… I know, photo challenge and decisiveness fail.

The first photo is from when we were in London last May.  We saw the London Eye and this picture was taken looking up at it and the sky from a point still down the road.  I like how the upper bit of a beautiful building was caught in the shot too.IMG_1231

The second photo is from when I went on a trip with my Nuc Med class to a conference in Washington.  We were being touristy and wound up at the old post office building on a glass elevator to the best view in the city (or so someone told us… And I think it was true) when we discovered the mirrored ceiling, which then brought on a strange photo opportunity.  We are looking up, but it is like the camera is looking down on us.Washington_0396

Be sure to check out the other entries on the Daily post page.

Weekly Writing Challenge: Truth is Stranger Than Fiction

This week’s writing challenge from The Daily Post is called “Truth is Stranger Than Fiction.”  It prompts writers to find a photo of someone looking truly happy, then write the truth about what was going on in the photo and what were the people thinking/doing before and after the photo was taken.

100_1365It was Christmas time again and thus, it was time for the Radiology department Christmas party wherein the radiologists take all of the staff in the department to a golf club for fancy buffet dinner (translation: eating competition), free booze (translation: drinking competition) and dancing (translation: a chance for a certain creepy physician in particular to man-handle all of the young techs).

This year was a bit different in the C, A and I had a History of Psych exam the next afternoon, but really, who needs to study when there is a chance for free food and entertainment.

The beginning of the evening was fun.  Almost all of Team Nuc Med 08 was there, minus Z, who had some sort of creative excuse.  It was rare we all hung out as a six-pack since the whole thing the year before.  Awkwardness all around from time to time.  But the core four of us were more of a gang than ever.

The five of us spent the early part of the evening laughing at the people who were already drunk while we sipped our virgin drinks and passed around History of Psych notes that were a special feature in several other of the evening’s photographs.

The boys, as usual made an eating competition out of the night, including consuming plate upon plate of mussels.  The girls and I preferred to moderate our real food and focus on dessert… Namely the cheesecake.

By the time dinner was over for everyone else and they boys slowed their pace to groans and the odd bite, we giggled through speeches about how lovely our department was and something about the students.  The Radiography folks did skits that were funnier if you worked in that part of the department.

It was getting close to dance time and we decided we should take some pictures.

At this point, A  has to leave.  Because her SO is a psycho and didn’t want her out late.  Surprise, surprise.

We were kind of okay with it, as terrible as it was.  Things were so complicated at this point.  It was nice for it to be just the four of us (and the million other people at the party).

We reminisced about the time so-and-so puked over there in the corner the year before last and how funny it is that said group of people over there were taking pictures by the tree that looked like awkward family photos.

Then it hit us… We could take awkward family photos.

In our defence, this was before the time that awkward family photos were in vogue.  I like to think we are ahead of our time.

Plus, the four of us were like a family.  Really, the six of us were like a family, but then that whole thing happened with the other two and, well, things changed a bit.  Therefore, we needed family photos.

We were playing around with the timer and such, when one of our lovely techs from our department came up and volunteered to take our photo.  We arranged ourselves to look sufficiently creepy.  We giggled a little as she staggered around and talked about how we are just like a little family with two Daddies and two Mommies or two Daddies and two daughters (and every other permutation possible), which made us start laughing.  Then, just as she was about to snap a photo she counted us out loud and asked, “Where are the other two, on a hot date?”    To which A (back right) muttered, something inappropriate (I have forgotten exact wording) to the effect that the other two had a sort of relationship that was incest and was not okay in our family.  And then he kicked his leg back… And almost knocked the Christmas tree behind us over.  We all cracked up and laughed through this picture and at least two more tries.  The photographer was oblivious to our reason for laughter and just thought we thought her joke was funny, as opposed to the inside joke and overall situation and less so what she had said.

It sounds funny that I would say we were truly happy as we laughed about some awkward comments and events.  But, I think we really were.  We had a fun night.  We were enjoying each other’s company.  And, it was just one of those moments where we were getting to be “normal” not students or people trying to save face for other people.  And honestly, the whole sequence of events was much funnier in person than I seem to be able to portray in writing without giving a bunch of backstory that is not mine to share.

We were all rather annoyed at the turning of events the year before when our class dynamics got altered by some awkward poor decisions on the part of those two.  Since that time we were still all close, but it was very much the four of us and the two of them came in and out.  It drove us crazy that it happened and we could not wrap our heads around why they avoided the rest of the class and why they did what they did.   It sounds awful, I know.  And it was.  It took us a while, but we dealt a lot by laughing about it.  And about the fact we could have been on a weird reality TV show.  So, as soon as it got brought up as a sort of joke, we all couldn’t help but laugh at how it must look to other people, like they are together because they were never with us, when in reality it was actually now quite the opposite.  We also couldn’t help but smile and laugh knowing that we were making it out the other side in one piece despite the drama around us.

We did, in the end get a good shot of the four of us.

The photographer was oblivious to the reason for our hysterics.  She just wandered off to dance and told us we were funny.

I love our faces in this picture.  We all have slightly different reactions.  Which is kind of how we dealt with the overarching situation.  And that is how I think we worked so well together.  We laughed together, but we also balanced one another out.

Later that night, we laughed about the whole thing some more and discussed how we were still the only people to actually know what happened and there were few people that even realized the divide amongst us.  We talked about how sad it was that it happened and how much we missed being a family of 6, how funny it is that people are still oblivious and how great it was that we are such a great “family.”

We then danced to bad pop music while making fun of it and the boys protected B and I from the creepy radiologist as he made his rounds.    Neither of the boys got sick, much to our surprise based on the sheer volume of food they consumed.

We were all home by 10.

We all passed our exam the next day.

The picture that resulted from the events of the evening was in our departmental graduation slideshow.  They called us the party kids because we all looked so strangely happy to be there and missed exams (unlike the other two) to go.

 

Procedure

Image from hoMed.

“Hello, my name is Trisha.  I am the junior resident.  No, this is not my home service.  Please, let me now stick a needle in your abdomen.  Of course I know what I’m doing.”

Such is life off-service.

I am now back in the world of livers again, which means I am back to doing paracentesis (aka draining extra fluid off of people’s bellies).  It is an immediately satisfying procedure in that you see instant results.  It is dismaying because people often reaccumulate the fluid quickly and you have to do it again in a few days to months.

I am not a procedure person.  I never have been.

Don’t get me wrong, I do them.  And I am decent at them (although also a bit slow and shaky).  But, I don’t derive the same sort of joy other people do in performing procedures.

Most of the people I went to med school with liked their given field for the procedures.  You get to do blah to people.  And they get a big kick out of that.

This is what happened to us on procedure day… Casts, IVs and blood draws all around. Plus some pig guts and dummies to boot. Image from medschool.lsuhsc.edu.

I remember med school procedure days.  I thought they were neat.  I love the feeling of fresh casting material and it was fun to be better at taking blood and doing IVs than average (thank you undergrad), but I was never as pumped as some of my peers.  They could practice hand ties and sew pig guts until the cows came home.

Maybe part of it was that I have always struggled with fine motor skills.  And I hate not being the best at something (and I will never be the best at most surgical-type interventions).

Another part of my procedure issue is that I just plain find it bizarre how we learn in medicine by practicing on real people.  Its not like we can learn on fake people.  And we do sometimes get to do stuff with dummies or each other first.  Some things just need to be done on real sick people.  But, nothing is more awkward than telling someone, “yes, you are indeed the first person I have done this to.”  I don’t know many other professions where you actually torment live people (under adequate supervision) for the sake of both learning and their theoretical betterment.

I am a person who learns by reading and understanding, so the whole “see one, do one, teach one,” thing is irritating when I have yet to read about one.    I generally like all procedures better once I have a few under my belt.  Because then I don’t feel like a bumbling fool (or at least less of one).  Competence is a requirement for me to like something, me thinks.

When I was in Nuc Med, I loved injecting radionuclides.  I loved taking blood.  But, it was that along with the other stuff.  The other stuff made the bits of hand-eye coordination cool.  I worked in Specimen Collection for a summer and it was quite possibly the worst job ever.  In fact, I use it to this day as a standard to compare all other terrible jobs… Gen surg is the only thing that came close.  I liked taking blood.  I did not like doing it 8 hours a day, 5 days a week.

My Nuc Med buddies teased me because I have a ridiculous tremor when I do take blood and such.  It scares people at first, but I really am quite competent (and the tremor diminished with increased practice and caffeine tolerance).  They made me promise when I got into med school to not do surgery ever.  Because my tremor would terrorize everyone.  Have no fear folks, that isn’t the only reason I won’t do surgery.

I picked my field for the variety.  And because once I am out, I have the option to not do a whole heaping lot of time-intensive technical procedures.

I like giving immunizations.  I am cool with the odd blood draw (just not an 8 hour day consisting of 100+ draws).  I will do your pap or use a scope to peer at your larynx or sew something up once in a blue moon.

I, however, can’t do that all day.  Or every day.  I love my sit-down chats with people.  I love clinical medicine and tolerate procedural medicine.  I enjoy paperwork and computer work, but most of all people work.

As cool as it is to impale people with large needles and suck fluid out to make them feel better, I like making differences in other ways (like prescribing drugs or radiation or talking).

My kind of instruments! Image from benitaepstein.com.

It is a personal preference.  I know it is an important part of medicine.  And some aspects of Rad Onc are super procedural as well.  It is all about what you make of your practice (and what sites you focus on and how much time you spend on certain sites).

Will I do procedural stuff?

Heck yes.  Everyone does.  And some of the sites I think are cool may require me to do procedures.  And I am fine with that, if I like the procedures and I get the variety that comes with the career I chose.

I will also enjoy the procedural stuff more when it is better within my comfort zone and training niche. Knowing what one is doing and its relevance to the care of your own patients is huge in enjoying it.  At least it is for me.

It is good to know what you like or not like.  But, sometimes I wish I could get the same kicks out of sewing or impailing that other do.  Instead, I grin and bear it and take joy in the fact that it helps that person and that once I grow up, I will be able to somewhat tailor my practice (or defer to the off-service junior resident… Muahahahaha…. Okay, not so much).

Nuclear Cardiology

Some processed images of a MIBI scan… Shows a heart with a fixed perfusion defect. Image from http://journals.tums.ac.ir.

Today, we were rounding, we decided to do a particular nuclear medicine test on a patient.  I internally got a bit excited.  And then the med student asked what it was and I gleefully explained.

It brought me back to my real Nuc Med days when I had a delightful teacher named Debbie who was extremely smart, but not always quite so aware of how ridiculous some of what she was saying is.  She is up there in my favourite teachers count.

You see, the patient was female and I pointed out the high false positive rate (especially when we were using this as a test to rule out a problem).  The reason for false positives… Breasts.

Hmmm… Ya know, my breasts could attenuate 80keV.  You just have to flop those dog ears of the way. –Nuc Med wisdom said while holding one’s chest.

Breast tissue attenuates (decreases) the radiation from the tracer that is deposited in the heart.  The center I worked at used a different tracer than the one here.  Where I trained, it was only 80keV as opposed to the 140 keV.  Still there could be some decreased detection and a possible false appearance of cardiac ischemia.

Of course we are still doing the test.  But I apparently even taught the cardiologist that new fun fact.

In those days of Nuc Med we had a secret quote board.  There, we kept track of all kinds of ridiculousness that came out of our faces those three years together.  And there was a lot of it.

We are such a nerd full of vans. –A

The trip in which we were a nerd full of vans... A Molecular Imaging conference in San Diego.  This is my class with the class from the year ahead of us and my favourite physicist ever.

The trip in which we were a nerd full of vans… A Molecular Imaging conference in San Diego. This is my class with the class from the year ahead of us and my favourite physicist ever.

Truth be told, I wish I had kept a copy.  I only remember a few gems.  Like the fact our patient care instructor couldn’t pronounce technetium, that Debbie asked us one day if she had an S on her head and that the condition cardiac tamponade will always make me chuckle more than the average person because one of the guys thought it was a tampon to the heart (and we all got assigned an extra reading assignment).

Our styling "star trek" lead vests.

Our styling “star trek” lead vests.

But, despite not remembering all of the ridiculousness, I still conveniently have a strange knowledge of bone metabolism, cardiac perfusion imaging, thyroid function and conditions and a variety of small niche type imaging techniques.  The stuff comes in handy from time to time, strangely enough.  Plus, the whole radiation safety and physics training is pretty handy now that the whole rad onc thing has started.

Our full lot at our hospital graduation celebration.

Our full lot at our hospital graduation celebration.

It made med school seem easier.  It helped me appreciate the health care team more.  It increased my laughter to schooling ratio.

If I ever catch you wearing scrubs outside the hospital, I will cut your fingers off… Using appropriate sterile technique. –Patient care instructor.

And the friends that I have are pretty awesome too.  Even if we only get to have approximately semi-annual outings together due to our spread across the country.  Very few people share fond memories of hanging an inflatable santa out a window with a noose, blowing bubbles out the same window, just to see people’s reactions and the joy of playing catch in any season, in any location.

All dressed up for our last day of clinical... With a stand-in.

All dressed up for our last day of clinical… With a stand-in.

It hit me… Right in the thyroid cartilage! -Me during a rowdy frisbee match… Indoors…  During the lunch break between the two halves of our licensing exam.

Hooray for Cardiology.  It brought me back to my good old days in my bizarre little radioactive niche.