Happy X-Ray Day!

On this day in 1895, Wilhelm Conrad Röntgen discovered the X-ray.

V0029523 X-ray of the bones of a hand with a ring on one finger

He was a physics professor in Germany, and had been working with cathode rays. His experiments involved discharging streams of electrons through various vacuum tube apparatuses. In one of these experiments, cathode rays were allowed to exit the vacuum tube through a thin aluminum window. He covered the aluminum with black cardboard to shield the fluorescent glow, yet he still noticed the beams escaping onto a barium platinocyanide detector plate several feet away. Figuring he had discovered a new form of radiation that could penetrate opaque objects, he called it “X,” the mathematical designation for the unknown.

After various repetitions of the experiment with different tubes and metals, he went on to take the first clinical X-ray: a picture of his wife’s hand. The produced image was of her skeleton, as X-rays could pass through human tissue but not through bone. When she saw the picture, she exclaimed, “I have seen my death!” This turned out to be a prophetic statement, as she and most of the scientists who played with X-rays in the early days would eventually die of cancer.

Röntgen initially continued his experiments in secret because he feared for his professional reputation if his observations were in error. He published his initial paper, “On a New Kind of Rays,” in December 1895, and by January 1896 the news of X-rays had swept the world. Soon commercial fluoroscopes came to common usage in such unlikely places as carnivals and shoe stores. At the same time, X-rays found their use in various clinical settings such as surgical operations and diagnosing bone fractures.

Röntgen was awarded the first-ever Nobel Prize in Physics, and is recognized as the father of Radiology. Indeed, the whole medical specialty grew up surrounding his technology, now encompassing fluoroscopy, computed tomography, mammography, ultrasound, nuclear medicine, and magnetic resonance imaging.

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Why I Chose Radiology

One night, months or years ago, my husband looked up from a collection of short stories he was reading, and said, “This one is interesting. The protagonist is a radiologist.”

To this, I laughed out loud. “Why would the protagonist be a radiologist?”

Judging by the lukewarm reactions I’ve received this year when I’ve told people that I was going into Radiology, I suppose most people feel the same way I did: that there is nothing interesting about a radiologist.

Don’t get me wrong, I absolutely adore Radiology and honestly feel that I’ve made the best possible career choice. But, given that my interest in Radiology did sneak up on me at the last minute after I’d already changed my mind half a dozen times between other specialties, perhaps I owe everyone an explanation.

In the beginning, as I’ve mentioned, my intention was to be a neurosurgeon. I never felt like it would give me the life I envisioned, but the work sounded challenging and heroic, and that was what brought me to medical school. I quickly realized that being away from my family for 120 hours a week was even less tolerable than I imagined. The neurosurgeons I met on my Surgery rotation, though very nice, made it clear to me that working one-third time (a normal 40-hour workweek) was not acceptable, even for a woman. In fact, I got the impression that having ovaries was entirely incongruent with Neurosurgery—people simply didn’t make time for babies and lives in that field. A Surgery resident gave me this valuable piece of advice: “Is there anything else that you like besides Surgery? Because you should do that instead.”

Then I thought for sure I would be a psychiatrist. I loved brains. Surgery was invasive, but Psychiatry was also invasive. Coming from a Psychology undergrad, analyzing people was second nature to me. The patients were interesting beyond belief, and I found plenty to write about, so I knew it would make an entertaining career. In particular, I felt at home with the idea of being a child psychiatrist—I had a knack for working with children, and I was inspired by their ability to heal and overcome. But I did not know just how difficult it would be. Halfway into my Child Psychiatry rotation, I was exhibiting symptoms of PTSD. I begrudgingly admitted that I did not have the mental resources to cope with the side effects of being a child psychiatrist.

Next on my list of “brainy specialties” was Neurology. I considered it only briefly. It wasn’t part of the curriculum, so I didn’t get a fair chance to explore it beyond my dealings with stroke and seizure patients. From what I gathered, the diagnostic aspect of Neurology was highly complex and elegant. But the treatment aspect was almost non-existent—for all the time spent figuring out exactly which part of the brain was damaged, there was usually nothing to be done about it.

From there, Pediatrics was a no-brainer (you guessed it—pun intended.) Cute sick kids, stuffed-animal stethoscope covers, doctors acting goofy in exchange for a peaceful listen to the heart and lungs. The idea of being happy all the time won me over almost instantly. Plus, this opened a new slew of possibilities for subspecialties: Pediatric Cardiology, Pediatric Endocrinology, Pediatric Whatever-ology. Since each of these would entail an additional three-year fellowship after residency, I was secretly buying myself more time to really decide what I wanted to be. (What? I like to dilly-dally over life-changing decisions!) It was a great plan, and I felt confident enough to start telling everybody about my decision. This was mid-January of my third year, and many of my classmates were jealous that I’d made up my mind so early. I went forward with it, collecting recommendation letters and setting up visiting internships, until August.

Because I kept telling myself that I loved children and hated adults, as pediatricians tend to do, I thought I was destined to hate my Internal Medicine rotation. As it turned out, I loved Internal Medicine because it was the first rotation in all of my medical training where I felt like I was personally and legitimately a doctor. Much of that feeling came from being introduced to the systematic approach to reading a chest X-ray. We were taught by a pulmonologist whose hobbies happened to include Radiology and Physics. He opened his first lecture with a discussion of radiographic density. I believe “density” was the word that changed my destiny—it activated my inner Physics geek and thereby illuminated what had previously been a black box.

Radiology is glossed over in medical school. This is a mistake, because Radiology is ubiquitous and crucial to the practice of medicine—rarely is a diagnosis made without some kind of imaging. I may not have considered radiologists to be real doctors at the time, but I wasn’t about to call myself a full-fledged doctor if I didn’t have a proper understanding of Radiology. So I scheduled two full months of it right in the beginning of my fourth year.

Those two months were tumultuous. I started out with a lukewarm feeling: The work was engaging to varying degrees depending on who was teaching me, and sitting in a dark room all day was marginally tolerable. I often felt like I was watching other people play a video game that I didn’t understand. That is, until one of the radiologists handed me a textbook to leaf through when times were slow. It was the best book I’d ever read in medical school, and I was raving about it to my husband when he asked for the millionth time if I was going into Radiology already. (My husband is himself a huge fan of Radiology.) I retorted that I did not come to medical school just to sit in an office and be nobody’s doctor. But as I became more and more intrigued by what I was learning, I found myself in a dilemma. I started to question my commitment to Pediatrics, and indeed my whole paradigm of doctoring.

It was at this time that I re-read some of my old blog posts to start compiling this book, and I came across a piece I’d written about how to choose a specialty, called “How To Make Lifelong Decisions: Don’t Compare Apples to Oranges. Just Make the Lemonade.” I had forgotten all about this, and it took me completely by surprise. Apparently, I had figured out at some point that choosing a specialty wasn’t about the nature of the work so much as about the kind of person I wanted to be—and I knew, undeniably, that radiologists were exactly the kind of people I wanted to emulate. Besides being the smartest of the smart, radiologists were sensible, sociable, happy, and generally wonderful to work with. And they all loved their families very much.

So then my gears were churning frantically. I only had a couple weeks left to submit my residency applications, and I had everything set up for Pediatrics. Radiology is a much more competitive specialty, and I frankly wasn’t sure if I would be able to get in, especially with such little preparation. I finally came to the Dean of Student Affairs, Dr. Dupey, whom I consider the “Sorting Hat” of my medical school and to whom I give full credit for ensuring that we all match into residency. She looked at my credentials and gave me the thumbs up! I still wasn’t 100% ready to burn the bridge on Pediatrics, so she challenged me to write a personal statement for both (which I’ve included in the following pages.) I found it extremely easy to say why I wanted to go into Pediatrics; that essay took me about an hour. The Radiology one took me an entire weekend. I thought really hard, I got frustrated that my writing was inadequate to express my feelings, and I cried a lot. But when I emerged from this process, I was convinced that, one way or another, I would be a radiologist.

Seven grueling months later, I opened an envelope that fulfilled all my hopes and made all the trials worthwhile: I am going to Dartmouth to become a radiologist!