Pizza, The OR and a Skull Series

Week of: 2007-07-23

Abstract: Pizza, The OR and a Skull Series.

Mood: Happy

What went well: I showed a high level of independence.

What needs work: Speed and accuracy in moving in and out and centering on the affected part with the C-arm

Elucidation: Monday was a slow starter but ended big. Early on a spent I lot of time sitting around in the dispatch office waiting for exams to come up. I thought I was going to do a Lap Chole, but the docs didn't request a C-arm for the procedure. I was somewhat disappointed because I wanted to comp it but I know it will come up soon. I waited most of morning for this exam so it was a waste of time. I made up for it by doing a wrist.

Later, I had the good fortune of participating in an exam that was termed speed surgery. The surgeons inserted the plate quickly due to the poor health of the patient (although cram would be a better descriptive verb.) It was interesting because the team worked like thieves in the night: quickly drilling holes and turning screws around the shattered portion of the femur. The patient's EKG demonstrated a very irregular heart beat, often slowing to the point of stopping for a count or two. The anesthesiologist was working constantly at a fevered pace to stabilize the patient, pushing drugs into the IV. The surgeons began closing before they had even put in 60% of the screws, something you don't see everyday.

Other days were rewarding on many counts as I showed a high level of independence. I was assigned a tibial plateau reduction and reconstruction. The patient's proximal tibia was in pieces. The axial MR images showed the pathology plainly. I observed as the surgeons placed plates in the medial, lateral and anterior aspects. I provided the images for the placement and anchoring of the hardware. The surgery stretched from 08:30-14:00. It was a nice step for me because I did it solo.

On Tuesday, The education coordinator celebrated our transition to second year status. By ordering two large pizzas and watching us stuff our faces. We got to leave early: bonus!

I witnessed a distal ulnar dislocation from the carpals. It clearly projected at right angle and one could see the articular cartilage after the part had been dissected. It was challenging for me because I was moving the C-arm base a lot. The tech observing me noted, "We need you to build some strength." He's right, I'm the 170 pound, under-muscled tall dude.

I also participated in a distal femur case involving a 14 year old child. The fracture was quite large and extended from knee to mid femur in one way or another. I watched and provided images as the surgeons reduced the fractures and put an ginourmous articulated plate into the area. The leg was rolled medially and the C-arm had angle to match this rotation rolled toward the base. I did several plain films which are numbered to demonstrate timed placement of hardware. Both residents commented on the serious aspect of the fracture.

The first exam on Thursday was very interesting. It was a pilon fracture. In the case, I ended up getting a C-arm with a lot of artifacts showing in the images it rendered. The doc was a real type-A. She's definitely intelligent and articulate but somewhat abrasive and aggressive in her manner. And I do appreciate the she speaks up. Many docs mumble. She made it clear that a tech needed to come in to help with the C-arm.

When she saw my ID she said, “Why did they send a student here.” And Later when I was rolling the c-arm over for a lateral, “Come on,” She said while tapping her toes impatiently, “Step it up; we're on a tight time line.”

I was able to develop skills as I progressed in spite of the imposed pressure these statements induced. I want to comment that this is a sign of growth as I'm learning how to perform well in those situations. I throughly enjoyed myself in the case because my images improved as the case progressed. One of the residents gave me an OK sign as her eyes smiled.

Skull, facial and sinus series exams are few and far between in standard radiography. This is because CT has taken over much of it. For those exams we rarely see we do a mock, where the student demonstrates skill in producing the images requisite in a series. I did a mock comp of a skull series on Friday.

Week 3/3 in the OR ends Friday, Ortho rotation follows.


Stay cool and in touch.

Goals for next week: Continue to develop skills and confidence in the OR. Do a tibial nail case solo.

Selfless Service: A Manifesto

Week of: Supplemental

Abstract: I expound on Acts of Service

Disclaimer: What follows is philosophy and contains no information about x-ray school or radiologic technology.

Elucidation: I want to see what I do during the day as more than the typical, “I punch in, I punch out for lunch, I punch in, I punch out and go home.” I want to see work as the pure expression of acceptance and offering of sharing and listening of giving and taking. Work is, in large part, what makes us human. It helps me to think of what I do during my shift as service.

I want to see the people I serve: patients, families, other staff, doctors – as the truest expression of what I aspire. I try to see them as wonderful contributions to humanity. I lend my best listening. I offer my heart of compassion. But I don't feel their pain. Instead, I open my eyes to their beauty and truth. I listen, through intuition, to the meaning behind their words. I've seen many people wracked with pain, beset with injury, but I always look for the unique aspect of the individual. And often I find that they have something to offer me even though I wasn't looking for it.

How do we bring the spirit of service to are lives? Methods will differ. For me, it always comes down to introspection. It comes down to several questions. How can I see this patient in their best light? How do I involve myself in a more deeply held involvement and commitment to Quality work? How can I learn to see my work as service?

Many of us will remember times when we gave selflessly. Mothers and Fathers do it everyday with their children. Selflessness refers to a removal of attachment to the fruits of our labors. When I get a paycheck I see it as a gift. I know full well that I worked very hard for the money. But I aways want to feel gratitude in my heart. It's possible to give generously with out spending a cent.

I remember one day I stood at one of the most busy intersections in which the city I live. An older man stood, leaning on this walker. “Sir, Will you be OK crossing the street,” I asked. His appearance was infirm. He indicated that he could cross with some difficulty but would like some assistance. I offered my arm to him and carried his walker. I told him to hold on. His grip was like iron. We walked at his pace: slow. The light changed before we had made it half-way across the four lanes. No drivers blew their horns or yelled as I feared they might. We crossed the street safely after some time.

On the other corner he smiled and with a bright presence in his eyes said, “You Sir are a gentleman and a scholar.” I know I could have left him in the dust. My purpose is to offer an illustration of how we can be unconditionally selfless in the way we approach action. Selflessness does not mean we loose a sense of self. Rather, we gain a sense of self. Each action that helps someone else can be an opportunity of selflessness. I believe seeing our daily occupation as service allows us to experience, as Abraham Lincoln said in a different context, “the better angels of our nature.” It's liberating. It also helps us avoid burn out; selfless service recharges our batteries. When we sustain it, the act of it sustains us.

Those of you who are still reading will ask, “Well fine, how does this apply to imaging technologists and the larger medical field.” I say, there's no finer field for it to be applied. As we well know, the people we see professionally are in many stages of life and health. Suffering runs across social and economic boundaries. How better to affirm then why many of us go into the medical field in the first place: to help people. And for that matter why limit it to patients. I try to say mentally, I offer this action to the individual I see before me. We all want to love what we do. Selflessly offering our actions in the form of service is one method of maintaining a high level of satisfaction and a love for our work.

I will never be able to say this as well as others more involved than I in the expression of selfless service. I have found this book helpful:

How Can I Help

Das and Gorman

Paperback: 256 pages

Publisher: Knopf (March 12, 1985)

Language: English

ISBN-10: 0394729471

I Rock the OR

Week of: 2007-07-16

Abstract: An amazing first week in the OR passes in a flash. I get paid as technologist for the first time.

Mood: Somewhat tired but optimistic

What went well: I rocked in the OR. I did many cases solo.

What needs work: Speed with turning equipment over after cases. Changing the views in the rooms.

Disclaimer: Some descriptions of cases are graphic in nature and not suitable for all audiences.

Elucidation: I've had a delightful week in the OR. Something just clicked for me: I'm doing exams on my own. Crazy Uncle, the OR lead tech remarked to the visiting instructor of my program how I just go out and grab a req off the board and do it from start to finish. And how he can throw me into a room with the expectation that I will pick up where the previous tech left off. As I left on Friday, I remarked to a group of techs, “Thanks for helping me feel so successful.” One of them said, “You're doing exams on your own. Keep up the good work.” I feel so lucky to be in this program.

On Monday I did a procedure where involving a patient who's epidermis had been completely pulled away from the underlying tissue of his hand. This is called degloving. In this case, his hand had received the blunt force of a falling cinder block, sufficient to pull the skin away from the muscle, tendinous, connective, nervous, and osseous tissue of the hand.

I watched as they flushed his hand which was missing a couple of fingers. This was a difficult exam to see. But if I do say so, I maintained a clinical attitude of professionalism throughout. As one tech said, “Humpy Dumpty.” Meaning the docs would put the hand back together bit by bit. At the same time I felt my heart swell not in resonance of the pain, but in expression of kindness: seeing the true nature of the individual as a whole healthy person, seeing the person well.

I also so a degloved leg procedure. This one was more interesting, again the epidermis had been completely pulled free from an areas stretching from mid-thigh to mid tib-fib. The dermal tissue had been completely destroyed. There were muscle groups hanging loosely from a bloody mess. They had put in antibiotic beads to assist in fighting infection. To close, I'm sure they used grafted tissue to surround the enormous wound.

During my first two terms, the lead tech tried to shield us from such extreme cases. I appreciated that. I'm telling you this because this is my blog. Yo. I've kinda snuck into the last one. I need to let Crazy Uncle know that I'm sufficiently hardened to observe this type of case. I don't resonate with the pain or the injury, I resonate with viewing the patient as healthy and whole as the process I'm participating in. I see myself as a participating member of the team, headed my the physician, bring the pt back to health.

There's a counterpart program to my program that is across the State from us. They live an area of the state with a farm based economy and low population density compared to ours. We've been sharing our classes with then via internet link as I'm sure I mentioned earlier.

They've been visiting our sites this week. It was a wonderful experience because I was able to demonstrate my knowledge of the C-arm: the controls, sending images to PACS, how you line up the C-arm to the axial line of the part. If the pt is rolled up so the affected part is higher, you might need to incorporate multiple angles to achieve an AP and Lateral to adjust to the rotation of the pt, to explaining how increasing kilovoltage increases apparent brightness of an image. It was fun to meet these students.

I participated in a couple of Cystography exams. this week. One included lithotripsy and associated basketing of the stones. It was interesting following the scope up the ureters to the kidneys. Also of interest was viewing the scope feed on an LCD monitor next to the spot films of the c-arm.

For my part, it was very simple: follow the scope from the bladder to the right kidney, then from the bladder to the left kidney, as they flushed contrast into the renal tissue providing shape of those structures. They inserted a basket through the ureters to grab the stones broken up by the lithotripsy. It was wonderful to do the procedure solo all the way through. And I liked the feeling of being an integral part of the OR: providing diagnostic images for the physicians.

I worked my first paid shift as a Imaging Technologist Trainee on Saturday. I did at least six CXR portables today solo. I enjoy ports. I think there's something very calming about walking the corridors of a big county hospital as portable machine rolls noisily along. Even though I've been at the same hospital for a year I haven't spent a day doing them. It helps in learning the layout of the floors.

I like when patients talk back or ask me questions. One woman asked about the large body of water she saw from the sixth floor window. I went from floor to floor, introducing my self to nurses. I suggest playing nice with nurses; they're there to help the patient and by extension the technologist.

There were a lot of trauma cases. Nothing really to write about. Except for one fellow who was brought in from a high-speed motorcycle wreck. In a situation like this you do about 50 images. We worked quickly. But multiples take time.

Goals for next week:

Pick up prescision in lining up the C-arm with the affected body part.

Start, work and finish an ankle case.

Pick up my overall speed.

OR Ratation, here I come

Weeks of: 2007-07-01 & 2007-07-09

Abstract: Summer quarter is a sweet reprieve from the rigors of scholasticism yet amidst a marine heat wave.

Mood: Cheerful and even minded

What went well: I concentrated primarily on fluoro. My comps are rolling in.

What needs work: Fluoro demands detail oriented work

Elucidation: Wow! This quarter is interesting. It feels like a full time job only I'm not getting paid. I am learning about the flow of patient care from the time the EMTs roll 'em in, until their discharged. It's reassuring that I'm having fun.

The program director has visited us twice. He reminds me of a charismatic but unknown rock musician. I'll call him Perkins. He's been throwing our understanding of the rationale for exams under the wheels. It's cool. I know that real learning always need to start with some mental dissonance.

He often asks us questions an then watches with amusement as we struggle to answer. Example: Why center slightly medial on a lateral scapula? Answer: it throws the scapula slightly away from the ribs because of divergence. If you center right on the scapula divergence will project the scapula over the ribs.

Another fun one: What's another name for the talus? It rhymes with asparagus. Someone guessed asperger's to general laughter. Answer: Astragalus. We should have known that one.

Being in the hospital 40 plus hours a week really makes it easier to rake in the comps. I comped a cross-table hip. I'm happy about that one because, for me at least, it's that culmination of a lot skills from the past year.

Line the tube up with the grid to avoid cutoff. Quadruple your mAs because it's a axial projection to produce a lateral. This through a lot of tissue. Multiple positioning criteria including: Place the affected hip on a pad. Raise the unaffected leg out of the way. Angle into the joint space. What comes out is a pretty film of the femoral neck, without the foreshortening that a frog view creates. What is demonstrated is a true lateral showing the ball of the femur in the acetabulum.

I'm able to call back to the tech at the panel what technique I want. I apologize that this is turning into another self-congratulatory post. But yo, this be my blog. I'm particularly pleased because this happened most recently during a trauma case involving a post-fall 85 yo female. It pulled three comps from that case alone.

My level on independent work is on the rise as well. I've been running the fluoro exams on my own for significant periods. I've taken initiative more often in regards to patient care.

It's important to me for my service to others be done with the right attitude. I'm trying to see each patient as an individual whether or not they're out cold or raving mad.

I start my employment as a Radiologic Technologist Trainee next Saturday. I'll be working in the ER department 08:30-19:00 to start.

I'm a happy camper. Let me know what you're thinkin'.

Peace out.

Goals for next week:

Next week I'm back in the OR. I plan to take it one day at a time.

I'd like to be doing femoral nails by the end of the rotation.

For next week I want to complete an ankle procedure.

Happy July!

Week of: 2007-06-25

Abstract: The first week of the, 40hr/wk clinical only, Summer Quarter

Mood: Chipper

What went well: I got in and started and ended fluoro exams. It took control of my experience.

What needs work: Being open to new experiences and as usual, taking initiative.

Elucidation: It was quite a week I think. I was able to spend the entire 40-hour first week in fluoro. I learned a lot, from setting up exams to the flow of spots (which the radiologist takes) to overheads (standard radiographs) which are the responsibility of the technologist.

The setup consists of setting out various materials including contrasts dyes, other compounds to be injected. I observed the checks and balances that go into securing a safe experience for the patient.

I was involved in one exam called a Myelogram. In this exam contrast is injected using a long needle inserted into the nerve roots of the spinal column near L5-S1. The patient experienced a mild form of shock. She was in extraordinary pain and sat up quickly which caused the situation to become worse. I talked to her calmly while holding her hand. I asked her about her family. I patted her shoulder.

She had expressed fear when I brought her back from the holding area before the exam. I told her when I have a medical procedure in which I'm afraid I always take deep breaths and imagine it's happening to someone else.

When the episode started I got down to her level as said, “This would be a good time to do some deep breathing.” She took it well. But her pain was stupendous.

She calmed down after getting an injection of pain meds. We were able to complete the study. The radiologist explained the pain as being caused by truncated nerve roots. The contrast was forced farther into the area by her insistence of getting up. I can't blame her. I'd be jumping up too if my butt and legs seemed to be on fire.

I seem to be doing well. I made six comps last week I want to finish them all up during the 440 hours this quarter.

Just a reminder to take not to take anything personally if you can help it. It always seems like there's a type-A in the department. And fluoro is no exception.

I had fun last week. It nice not to have to worry about exams.

Keep in touch.

Goals for next week: Comp two fluoro exams. Continue knocking down other comps.