Merry Christmas! You have cancer!

Trauma CT

 

When bad things happen, radiologists tend to be the first to know. Anytime you ski into a tree, or drop your baby, or have a stroke, anytime you go to the ER and get an X-ray or CT or any kind of imaging, you are being seen by a radiologist who makes the diagnosis behind the scenes. In fact, with the exception of psychiatrists and dermatologists, I really can’t think of any doctors who could practice medicine as they know it without radiologists.

As a radiologist, my X-ray vision is skewed toward negative outcomes. Day after day, bad things happen to (presumably) good people. This year I worked the weekends of Thanksgiving, Christmas, and New Year’s, and I got to thinking about how many people had their lives ruined during the holidays.

On Thanksgiving, I saw a guy actively bleeding out from complications of a botched gallbladder surgery.

On Christmas Eve, I had to call several patients to tell them that they had breast cancer. I did my best to offer support and give them a plan for moving forward, but in the end there is just no appropriate way to say, “Merry Christmas! You have cancer!”

On New Year’s day, the first case I opened up was a head CT for a lady who went to sleep on New Year’s Eve and never woke up. She had a brain bleed larger than the brain that she had left.

Why do so many bad things happen on holidays, and especially on my shift? Because they happen every day. If I simply show up to work on a holiday, I am guaranteed to meet unfortunate people. And I’m also bound to interact with hospital staff who are grumpy about having to work on a holiday.

You can imagine that this can turn some radiologists pessimistic and paranoid. Our experiences tell us that skiing, horseback riding, and shoveling snow from rooftops are rash, often fatal, activities. So are pregnancy, driving long distances, and even walking down the street minding one’s own business. In our work, we never meet the thousands upon thousands of skiers who do not ski into trees.

Since I started radiology residency a year and a half ago, I haven’t done much writing about my job. I’ve been missing the meaningful interactions I used to have with patients as a medical student and Internal Medicine intern. No one who’s been through the process would say that medical school was a happy time, yet I wrote a book about all the times and places I found joy. Happiness was a commitment I made on a daily basis. I was really good at being happy!

The past year and a half have slowly taught me that even the most grounded and solidly-learned of lessons can be forgotten with disuse and complacency.

One of my Christmas cancer patients, on hearing the bad news, nevertheless told me how lucky she felt that I had been a part of her care. She said, “Dartmouth should be very glad to have you as part of the team. If you hadn’t been looking at my mammogram, who knows how much this cancer would have grown in another year.”

It had been one of the rare circumstances when, as a resident whose job is largely to duplicate the work of supervising physicians, I caught something subtle that my supervisor had missed. I had been feeling particularly ambitious that day, reading about twice as many mammograms as residents normally do in a day. I just felt an urge to push through all the patients that had been scanned that day. This patient came up near the end of my list. The “normal mammogram” report had already been sent out. We immediately called her back for further imaging and then for a biopsy, and sure enough, it was cancer.

It was the first time since starting residency that I thought, “Thank goodness I came to work today!”

I’ve since tried to take that attitude more often, acknowledging and valuing the good that I can bring to the patients who will never know I have been evaluating them. When I’m asked to interpret a study that feels too difficult, or contains a bad outcome, I try to remember that I may be contributing something that no one else can. And more often than not, I’ve felt grateful to have been there for that patient.

In 2016, I would like to renew my commitment to being happy in the things I have to do. Happiness is truly a choice. As I’ve learned, it’s a choice we must continue to make time and time again, no matter how well we think we’ve got the hang of it.

 

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