Friday, 20 May 2011

Radiology - knowing ahead

In the literary world, it's called the "dramatic irony". It is when you, as the reader, knows a particular information about a character or an event that the character knows nothing about. Consequently, you know what is coming whereas the character has to suffer from not having the same knowledge.

Spending four weeks in radiology rotation granted me the pleasure---and the irony---of knowing ahead. A radiologist is the first person who knows exactly what is happening with a patient. A radiologist could also be the first person who is prepared to see a smile fading and hope losing.

Of course, sometimes we can only suspect. After all, imaging is only supportive of clinical presentations. Results may still be inconclusive, and maybe, maybe it's all just some technical errors or a very bad dream.

But other times, radiographic images can be as glaringly obvious as the screen you're staring at right now, Consider the following images:

Multiple metastases to the lung. (Image source)

Staghorn calculi. (Image source)

A CT image of a holoprosencephalic brain. (Image source)


We know these conditions. We are aware of the dangers and the consequences. We know what is imminent.

What do you do when you have the knowledge? Keeping it to yourself? Telling that person? Secretly trying to cure / repair / reverse the situation while still pretending to be ignorant, just to be sure that you have done some Samaritan good?

Unfortunately hospital management system doesn't work that way. The most Samaritan you can get if you're working as a radiologist is to write the best imaging interpretations to be sent to the referring physician. That's all. Then it's that physician's job to find the best way to inform the patient about what's in store for them.

When I was presented with an old X-ray of metastatic cancer in the lung taken of a man 12 years ago, I immediately wondered: Did he survive? How has he been doing? Where is he now? Is he still eating his favourite food, watching his favourite TV show? What would he be now if this all had not happened? The X-ray displayed a silent horror more morbid than any other creep show. It was real, it was a human being, and it kind of reminds us about the similar endpoint we all have.

Some people find solace in radiology because there's no need for an actual contact with the patients. Therefore they can be spared from the old dreadful thing called breaking bad news. In some ways it is nice. Ignorance is bliss, indeed.

But I feel a tad bit disturbed as well. Often times, a patient would ask me or my attending about the imaging result. Most of the time we just smile and say that the result needs an interpretation, and that he/she can check with the referring doctor later during the next visit. But God, we already know what's wrong at that very moment!

There are times when I cast a look at the patient, wanting to tell, but the attending usually hurries me to his office for yet another teaching and another writing.

That knowledge sometimes gives me pain. I want to just scream whatever's in it to the patient's face, as honestly as I could, but that's just not the way it works, is it?

To know first-hand precisely what is, earlier and better than most other people, can pretty much haunt your conscience.

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