Why? How come? Explain...

Being a resident, and in particular a very young resident, means... Asking a lot.

Everything is new. And even when you think hou have enough information and go to your supervisor to discuss, he/she will ask you: why?

Some cases...

A patient with obstruction complaints of the intestinals, due to cancer. The doctor wants a CT abdomen. Quite a valid argument, I thought. Patient had an MRI previously, where an intestinal tumor was seen, including liver metastasis.
Supervisor however did not agree, and said: 'Go and play a game with the doctor. Ask why they want a CT now, while they know the patient has a tumor, and why the patient has not had surgery in the time between MRI and now.'
'Why...'
'To learn... To learn from others, and to learn from decisions they make. And maybe you can even learn them something. Maybe they did not have thought about what you are asking them.'
So I asked. And it seemed that the patient went in palliative traject, and in the meantime he did not have obstructive complaints, so there were no reasons for surgery.
Back to supervisor.


A resident calling me, a patient needs a galbladder and biliary tract fluo. Gives me the pager number of another resident.
I try to arrange the examination, hear from another radiology resident that, when the patient has a galbladder drain, the examination will be very easily done. So I have to ask...
Call the pager number. Not available! Now what....
So I called the operator, asked to be forwarded to the specific ward, asked for the pager number of the resident (which was not the non-available pager number), to ask if this patient has a galbladder drain.
How complicated ;-).


*Beep beep*
'Yes, this is Dr Lexii, radiology resident.'
...
'So you want to order a CT abdomen for a young man, because you think he might have appendicitis or colitis, and he is immuno-compromised? Did you perform an ultrasound? Yes? What was the result? Inconclusive? Agree.'
Looking up patient details before going to supervisor. No ultrasound done???
Calling back, but I got someone else on the phone, so I could ask the specific person why he gave me the wrong information. I asked the other resident, why the ultrasound was not done, and why they wanted to overrule ultrasound with CT abdomen. Not very valid reasons, mainly because the surgeon wanted it so, and because the patient was in pain.
On my way to the supervisor, I said: 'I learned from the other cases today, so I kept asking! And I still don't agree with their question for a CT. I'd like to perform an ultrasound first.'
Supervisor said: 'Normally I agree with you, but this patient is immuno-compromised, so that's why we prefer CT above ultrasound.'

Sniff test

Today a radiology nurse came to me and said: "I have two patients waiting for you, to undergo the sniff test."
The sniff test?? What is that? And is that my job to do that? I have never heard of it. But I am willing to learn it.

So there I went, to the fluoro room. With instructions from an experienced nurse practitioner.
Both patients listened very well to the instructions I gave them.

What the sniff test meant? Breathe normally, take a few deep sighs, and finally sniff. (Pretend to sniff some coke, as another resident said. I did not say that to the patient! I showed them what I wanted them to do.)  And all this, while fluorospotting (x-raying all the time) to see how the diaphragm was moving.

When in the beginning I thought it was a very difficult thing to do; at the end, after two patients, it felt so easy, and I was very proud I did these examinations myself.

And now I'm writing this down, I realize they were my first unsupervised examinations.

Consult

December 30th 2014

A resident consulting me: ‘Could you please have a look at this X-thorax (bedposition) and the position of the feeding tube?’
Me: ‘Oh yeah sure. It looks like its position is a bit too shallow. I suggest you should run it up a bit further.’
Resident: ‘And what is that on the right below?’
Me: ‘I don’t understand what you mean. The right of the screen, or the right of the patient?’
R: ‘The right of the patient.’
Me: 'That's air in the colon, that's normal.'
R: 'No, I mean, more to the right.'
Me: ‘Oh that… That’s air. Nothing to worry about.’
R: ‘But… in or outside the patient??’
Me: ‘Outside of course.’

To explain, as I don't have the accompanying image here;
The patient was a bit overweight (according to the x-ray findings) and the love handles rolled over each other, with trapping some air.

Welcome to Dr. Radiologica's Blog!

December 30th 2014

I recently started as a Radiology resident somewhere in the Netherlands. I grew up in the capital city, where I finished medical school. My final two internships were Radiology (of course!), and Sports Medicine.

After some job interviews, the Radiology group accepted me as their youngest radiology resident, starting as soon as possible.

That meant: finding an apartment, moving, and arrange a hundred-and-thousand things at a time. And I managed so.

With this blog, I'd like to keep some stories of the life of Dr. Radiologica. I've been working for a month now, and I already found some interesting cases and conversations with colleagues, that are worth to share.

I won't publish images from my patients, or use names from patients or colleagues, nor will I describe features that will make you recognize people.