Tuesday, October 31, 2006

Hard at Work

And this is when the class work takes over. I'll have had three intense exams in a weeks time by this Wednesday. I'm studying the shoulder, clavicle and AC joints as I write this.

I want to say that last Thursday in clinical was much easier to take. I'm getting better at not investing my emotions into the experiences with patients. I provide the care as quickly and efficiently as possible. Again, I do try to leave them with something: a smile, an ear for the their concerns, ect. I got three comps today.

Saturday, October 21, 2006

Of Suffering and Empathy: Trauma Rotation Part 2

What a week. That seems to be my refrain. Last week in clinical was extremely demanding for me. I tend to a little on the sensitive side: I haven't completely learned how to separate my emotions from the trauma that's in front of me. Going in to the program I knew it would be an issue for me.

I've journaled extensively about the difference between sympathy and empathy. I'm working on being more inclined toward empathy which is the intellectual identification with or vicarious experiencing of the feelings or thoughts attitudes of another. More about this later.

On Thursday, I saw a lot of difficult cases: young children with broken bones, men and women returned from the scene of MVAs. When we get the call, TRAMA IN RESSUSATION ROOM 8,” for example, we roll in a portable machine and proceed to shoot a trauma series: CXR, pelvis and cross table cervical spine.

I'd have to say that my tendency during those exams was more toward sympathy: the emotional identification with the suffering of others. For me this is especially true when it comes to pediatrics. I won't go into any particular detail on the trauma itself except to say that in several cases it was grievous.

My mentor, J. has counseled me on this topic and I paraphrase here: It's important to mentally observe suffering. Don't allow your emotions to come into it. Do your job as a Radiologic Technologist never allowing the suffering of others to penetrate your shielding.

Understand suffering with your intellect but don't go beyond that. Be a professional and observe the ethics and guidelines of your field. Give people a voice. Be a good listener. They need to be heard. It's never helpful to the patient or yourself to internalize their suffering.

In the book, The Secret Life of Bees by Sue Monk, the character, May is unable to separate the suffering of others from her own. She goes into fits of misery upon learning of the suffering of the world. What a wreck she was. When reading this, I wondered is she helping anyone by this identification? The answer is an emphatic no.

I need not wrap my emotions into the concern for the suffering of others. I'll use my intellect and understanding. I will employ heed and caution to always do the right thing for my patient according the the ethics and guidelines of my profession.

A healthy approach to the observance of suffering is toward understanding of the level of pain my patient is going through. Ask, “How would I want to be treated?”

So by now you must think I'm a mess of emotions. I say perhaps. I'm working on the above issues and I'm not exactly there yet. I'm close. But it's extremely rewarding to know that each time I produce an image of diagnostic value I'm contributing in a definite way toward the patient's recovery toward productivity.

Thursday, October 19, 2006

Morning Portables

I had a interesting experience with a technologist today. We were doing portable CXRs this morning. One patient we imaged was adamant that we avoid jostling his right side which was festooned with tubes. I put the cassette in on his left.

After we did a couple we returned to radiology do the paper work. The tech said, “That guy looked like a real gang banger.” He was referring to the young gentleman we had imaged earlier.

I replied to the tech, “I don't like to think that way.”
“Yeah,” said another, “isn't that profiling?”

We inspected the image on PACS. The tech pointed out that I clipped part of the anatomy. "And," the first tech said, “look at his lower right quadrant.” Lodged in his abdomen was a small, blunt radiopaque object. “A bullet. What I tell you?”

This exchange didn't make me feel very happy. I don't like to assume.

Saturday, October 14, 2006

Worry Be Gone

Some of my fellow students have encourage me to not be so hung up on getting my comps. But I feel it's important for me to be on top of it. We're only expected to get four comps Fall quarter.

One tech, I call her Wendy, Said, “I hope you don't feel like I'm pushing you.” Then she shoved me into a room and insisted that I grab a portable chest requisition and do the bugger myself. I did OK I guess. I pushed the cassette a little low and she corrected it. Then I set technique and that was a little hot. But at school our instructor is fond of quoting, “Better hot than not.” Seriously, she corrected my technique stab. My collimation and tube placement was good.

It's important to have initiative in clinical. I'm feeling very good about many aspects of my clinical experience. I'm very new with the hospital experience so I feel like a bit of sponge; trying my hand at various exams when it's appropriate; when not, I stand back and watch attentively. I try to remain on my feet at all time except to do paper work. When a tech seems to need help I step up. In short, I'm loving the experience as a whole. I try to ask periodically, "Is there something you need help with."

The area that I'm unsure about is comps. We need a minimum of four to get a satisfactory rating for Fall quarter. So far I have a double comp on CXR and a single comp on a wrist. I feel that I'm about to really pull in a bunch of comps now that we're cleared to do upper extremities. I want to be careful of mistaking being comfortable with an exam and being complacent. It can be a trap to say, I'm a beginner I'll sit out comping this one. That's easy to do for a beginner student in trauma because of how fast paced it can be there. I can be extremely reserved in new situations.

At the same time, Josh and Wendy, staff technologists have been taking upon themselves to push me saying, "Have you done a humerus before?" for example. And then allowing me to make my best effort at a trauma series. I love working with trauma techs because it does feel like an accelerated learning experience.

Wednesday, October 11, 2006

Trauma Rotation

Yesterday was my first day in trauma rotation. What a blast. As you can imagine it was very fast paced. But what made it a good experience for me was that a couple of the techs let me do the positioning. I took my first AP shoulder xr yesterday. It was a trauma shoulder. I missed: I cut off the acromion. But it was like this, I'd position the patient in a way that my limited knowledge would permit and then the tech would make adjustments. What I found humorous was that sometimes I'd set up the patient and the tube perfectly, for a stretcher T-spine for example, and the tech would come in a make some adjustments. Several times they moved the tube and patient right back into the location I'd placed them.

It's amazing to me that I'm in such a terrific place. A graduate of my program introduced him self as an OR tech. He said you, meaning all the RT students in my program at this hospital, are going to be so far ahead of anyone else in your class, and by inference anyone in the entry level job market. That made me feel excited. I want to work there when I'm eligible

One of the techs, I'll call him Josh, typical of many trauma techs, told the two of us newbies stories to curl our toenails. One of the more tame stories involved a woman in small town beauty salon. Apparently she was sitting in a dryer chair. A significant distance away ,a boulder made its way crashing through the valley at a great speed. She was oblivious to the danger. The boulder crashed though the brick building of the salon a pinned the hapless woman still in the chair against the opposite brick wall.

Her upper leg was completely de-gloved; the tissue of the leg was completely removed. This conversation came under the category of things I learned not to do. My take on the story was that sometimes it just your time to have boulder pin you and your chair against a brick wall.

I know I'm so lucky to be where I am: A major metropolitan trauma center – the best community college RT program in the NW. I try to see both sides of every interaction. I don't always succeed, but it's my job to get in there. I try to give each patient something: a smile, a kind word, a brush of my hand to their brow when the pain is too intense, a warm blanket, and although I haven't tried it yet: a softly sung song. I have a calming countenance.

Many new RT grads go directly into CT, MR ect. Some of my fellow students entered this program because they weren't accepted to sonography school or med school. That burns me a bit as I had to wait a year for entrance. I can understand it, but it still bugs me. Radiography was my first choice field, my school was my first choice program, and my clinical was my first choice setting.

The key to successful patient interaction is communication and customer service. It helps the patient to explain the exam or ask if they have questions.

I know I'm being overly romantic not to mention hyperbolic, but I feel like ("like" is the key word here) I'm being initiated into a secret society entrusted to hold, maintain and share the chalice of sacred knowledge and the torch of illumination, as we, the ethical practicing acolytes, illuminate the darkness of the inner body with our diagnostic alchemy.

I'm smiling now. I've been smiling for a while now. Sure RT school is tough; I'm writing this as I prepare to for a five-hour study session; but I'm having much more fun than I could have imagined.

Saturday, October 07, 2006

My Wrist Comp

It's been a wonderfully active week. I had two exams and one practical in the didactic portion of my education. I managed to comp a wrist exam in clinical. I did well in all.

I spent a lot of time shadowing techs in fluoro. I observed techs setting up sterile trays for contrast injection. Usually the radiologist operates the equipment and the tech supports the doc.

My wrist exam was a challenge for me. I had read the department protocol book on upper extremities. It was difficult keeping straight what was textbook positioning and what is hospital protocol. I ended up dumping my first wrist comp attempt because I coned in to far vertically. What I'm finding is that every tech has their own way of doing things. I might have passed the first try with another tech grading me. This facilitated a learning situation.

Later, the tech who had initially failed my effort offered me a chance to re-comp. She spent time going over the protocols with me.

Our CR instructor told us that El Nino is becoming stronger. Our normal weather for Fall is rain until mid-December. Which translates into ski weather in the mountains. Snow means hours if you work in outdoor retail. El Nino casts this in doubt since it seems we can expect a warm dry winter.

Yesterday, my bus sideswiped another bus. The experience was startling but no one was injured. The driver for my bus is one of my favorites. I like his style because he whistles show tunes during the commute. Sometimes it can be distracting. But I always enjoy his good natured greetings.

Sunday, October 01, 2006

The commute

One thing that concerned me about going back to school was the commute. Because I live in the Suburbs:

Home to school is a 51 mile round trip.
Home to clinical is a 42 mile round trip.

It's a 237 mile commute each week. The area I live in has some of the worse traffic in the US. When you add up gas, maintenance and parking (there's a long waiting list at the clinical site) it's easy to see how using an alternate form of transportation could save a lot of money I don't have. And because of the way the school and clinical schedule is set up I commute during peak times.

I 'm not working very much outside of school. Even so, the amount of information communicated in class and clinical is fairly staggering. I don't recommend trying to work full-time while doing this. It's Just too much. So unless you consider sleep and occasional fun optional... BTW, I don't mean to be overly flippant about the situation. Several people in my class are trying to support themselves and perhaps children too. My situation is a gift.

Imagine my delight upon finding out that I could get a three-month regional transit pass for under $65. The retail value, if it were available, is about $500.00. My clinical site funds it and my work place will pay half. I can get around for about $11 a month. I live less than two miles from a major transit center where I can catch commuter buses to school and my sites. So far so good, if I stick to commuter trips the commute takes about the same or less time than if I were driving.