After cleaning my garage this past weekend, I stumbled upon some clinical reviews I kept from my nuclear medicine school clinical rotations. It reminded me of how differently two nuclear departments may assess your skills, knowledge and abilities. My first clinical site while in school was at one of the largest level I trauma centers in the city. The halls were alive with action and excitement as the E.R. was constantly keeping us busy with scan requests. During my rotation at this hospital, I earned the trust of my clinical instructor and the seasoned nuclear techs that worked there. It wasn’t long before they were allowing me to perform several studies with minimal supervision. I greatly enjoyed my time there, and when it was time to jump into my next rotation at another reputable hospital, I felt more prepared than ever to handle any situation that might arise.

From the very start, it was obvious my second rotation was going to be a completely different experience than that first one. I quickly learned that I was going from doing no wrong to doing nothing right. I had been warned by a classmate to decline being sent to that particular hospital that would be my second rotation. That hospital happened to be his first clinical site, and he informed me that it was quite a terrible experience. It wouldn’t be long before I understood what he meant.

It was a tale of two vastly different environments. My first clinical rotation was run like a well oiled machine. The techs worked well together, and they were very knowledgeable and knew how to teach. This was not the case with my second rotation. It was very chaotic with very little flow in the way things were scheduled. By comparison, any testing requests from the E.R. would throw the department into a state of such disarray that it would never recover. The techs were lazy and constantly took shortcuts in their work to get through tests faster than was appropriate. The quality of the scans being produced was quite poor in comparison to my first clinical site. I wasn’t being taught much of anything at that second rotation. The techs seemed bothered to have to teach a student their craft. So I began to learn from them anyway. I took every encounter with them and learned from them. They didn’t know it, but they were teaching me how not to do things by their constant examples of taking short cuts, being rude to patients and staff, not using their time wisely and their lack of detail in the job they were doing.

When it came time for the evaluation of my skills and performance, I was clearly evaluated unfairly. It seemed impossible to me that I could be given glowing evaluations at my first clinical rotation, yet be given an almost failing evaluation at my second site. I simply told the clinical instructor that if her techs actually demonstrated the standards by which they graded me, she would have the best techs in the state. I showed her my evaluation from my first site and asked her to explain to me how I could earn such a great evaluation from them, yet earn such a poor one from her department.

Of course, the answer was simple. If you are good at what you do, then you don’t feel threatened by a student you are supposed to be teaching. The first group of techs I was taught by was an example of the kind of tech I wanted to be. They were strong in all areas and it showed in the way they treated their students. The second group of techs was an example of the kind of tech I didn’t want to be. They were weak in all areas and because of that, they were never going to evaluate a student fairly. It wasn’t long before the site was no longer part of the clinical process for the nuclear medicine program.

While going through your clinical rotations, compare your experiences with your fellow classmates. If something doesn’t seem right, inform your program director of your concerns. You only have so much time to learn as much as you can while in your rotations, and the worst thing you can do is waste your time being taught by people who don’t want to teach you properly.

In today’s saturated market, it has become more vital than ever to have connections if you have hopes of finding a job in nuclear medicine. In years past, you had a great chance of being offered a job by your clinical site while still in school. Those days, however, are long gone. We all know by now that there are more nuclear techs than there are jobs, so the chances of earning a job offer while still in school are virtually nonexistent. Many of those graduating from a nuclear medicine program these days are waiting months, if not years before finding a job in the field.

More than ever, the art of networking has become a necessary part of hoping to secure a job opportunity. I attended a dinner presentation about one year ago, and something very unusual happened that night. These presentations and lectures used to be more of an intimate affair. There were always just a handful of techs in attendance, and you had plenty of one on one time with the guest speaker after the event. At that particular presentation, people were actually being turned away simply because every seat available had been taken.

I would like to think that more and more nuclear techs were interested in learning and keeping up to date in regards to the information on new drugs, isotopes and new methods in performing their job duties, but the harsh reality is simply that these dinners and presentations are now opportunities for techs to network and establish connections that could potentially lead to a new job. It truly was an eye opening experience to see for the first time people being told that all the seats were taken and they had to be turned away.

At the end of the presentation, the entire room became a scene of personal business cards emerging from nearly every person’s pocket at the dinner. Introductions were being made with questions about job opportunities or whether or not anyone knew of any jobs that might be available. Countless people just out of nuclear school handed me their cards and asked me if my office was hiring. I knew from personal experience that the market was dim, and my only saving grace was that I had contacts I established years ago keeping me in the loop. My years of experience, which was something I could always count on to help me find job opportunities, now seemed to be working against me as employers wanted to hire new grads for less pay. That would appear to help the new grads, except for the fact that there are so many of them now.

The local nuclear medicine program was and is still graduating students at a rate that continues to crash the market. The more students the school can graduate means the more money they can make off of those students. It is vital in today’s market that you know how to market yourself. Learning how to separate yourself from everyone else who has the same skill set and education you have can prove to be quite taxing, but persistence just might be the key to landing your first job.

During my career in nuclear medicine, I have had the honor of working alongside some of the most brilliant people I have ever known. I’ve forged some great friendships along the way, and even though I live in a different part of the country now, my friends and I stay in constant touch with each other.

Having a superior knowledge in regards to your craft is crucial in performing the duties and responsibilities of your chosen profession. Knowledge, experience, and continuing education are just a fraction of what constitutes a great medical professional. It’s great to read a professional article or to listen to a presentation when it’s written or presented by someone who is very knowledgeable in the particular subject being presented or discussed.

As nuclear techs, we all know the importance of being technically sound in the acquisition, processing, and presentation of the vast array of nuclear studies we perform on a daily basis. Physicians place their trust in the abilities of the nuclear staff to deliver accurate scans, and patients trust the nuclear staff to perform their scans properly and to the best of their abilities. Sound technical abilities and expert knowledge are expected from technical staff, but what about the other “intangibles” that transform a good tech into a great one?

If I could construct a drink that would represent all the ingredients that constitute a great nuclear tech, I imagine it would be something like this:

-         2 oz compassion

-         2 oz great communication skills

-         1.5 oz continuing education

-         2 oz of listening skills

-         2 oz of working well under pressure

-         2 oz of problem solving skills

-         1.5 oz of IV skills

-         2 oz of motivation

-         2 oz of integrity

-         2 oz of attention to detail

-         2 oz of organizational skills

-         2 oz of technical ability

-         A splash of thick skin (not taking things too personally)

-         A splash of ability to resolve conflict

-         A splash of believing in a team concept

-         A splash of a sense of  humor

Shake all ingredients (never stir) and strain over ice.

For those of you who don’t drink, simply enjoy a non-alcoholic beverage while sampling the wide assortment of mixed nuts you will find in your department.

A friend of mine was telling me the other day about the different types of personalities she is surrounded by in her department at work. It made me think about the different personalities I have encountered in my nuclear medicine career. The following is a list of some of the types of personalities I have worked with. Please feel free to add more to the list.

The burnout – This is someone who has been in the field for a respectable number of years, and has stayed too long and has no drive left to do the job. They spend the majority of their work day trying to find ways to get out of doing their job and thrusting their responsibilities on other members of the department.

The Boss’s Yes Man/Woman – The one who goes out of their way to impress the boss. They will like everything the boss does, every decision the boss makes, everything the boss says and will agree to every department policy (or lack of) that the boss imposes. They will never question the boss in any way, shape, or form.

The Slacker – This is the tech that chooses when they are going to act busy. They are not to be confused with the burnout tech, and their similar characteristics should not be misinterpreted. The burnout tech is simply burned out and doesn’t want to do the job anymore. The “only busy in front of the boss” type of tech is simply lazy. They want to fly under the radar and hope that they go unnoticed by those around them.  They will still do the job, but only when the boss is present.

I’m better than everyone else – This tech thinks and acts as though they truly are smarter and better at what they do than anyone else. They typically don’t play well with others and act as if being part of a team is offensive to them. They constantly try to point out things that the rest of the team isn’t doing, or isn’t doing as well as he/she is. In some cases, I have seen these types of techs tell patients about their test results before the doctor even looks at the exam. They don’t like other techs knowing the same information, and they will go out of their way to not be helpful to the rest of the team.

I’m easily offended – This is the tech that is offended quite often by things that are not offensive. They want everyone around them to act a certain way so that they won’t be offended by things they hear or see. The only thing offensive is that they truly believe everyone should care about that.

The Unsung Hero – This is the tech who allows the slacker and the burnout to exist, simply because they do the work the others don’t do. They don’t look for rewards or recognition. Being recognized would be appreciated, but they are all about what’s right for the patients and the department.

During my career in nuclear medicine, I have had the privilege of performing a variety of nuclear medicine exams on entertainment celebrities as well as professional athletes. These types of patients are given the all star treatment complete with a separate waiting room away from the general public, as well as having their tests done after regular department hours to allow for maximum privacy. There has been only one time in my career in which I was actually nervous while performing a nuclear exam on a celebrity. I am proud to say that I didn’t allow myself to act like a star struck fan, but rather more like the medical professional that I was expected to be.

I must admit, however, that it did take much effort on my part to act as if I wasn’t in the presence of someone I truly admired. Unfortunately, I have seen the repercussions suffered from former coworkers and their less than professional behavior while performing medical exams on celebrities. Regardless of the situation, medical professionals must control their behaviors and maintain the integrity of their profession as well as the integrity and reputation of their employers.

I recently met someone who is considering applying to nuclear medicine school. When she asked if I thought it was a good idea, I gave her several reasons why I think it’s not the best decision she can make. Nuclear Medicine has changed so drastically since I first dipped my feet into its pool. Nuclear medicine programs continue to graduate more students than the profession can handle. This saturation of the market continues to lead to a dramatic reduction in jobs, and lower tech salaries.

I never thought the basic rule of supply and demand would actually impact Nuclear Medicine as a profession, but the cold, hard truth is that there are too many techs and too few jobs. No longer is nuclear medicine considered the specialty it once was, at least not according to salary ranges over the last few years. For the new graduates who don’t know what the profession was like ten years ago, they won’t realize how much the profession has changed. For those of us with 20 years experience, or more, witnessing how the landscape in nuclear medicine has changed has been a difficult pill to swallow.

Longer hours, smaller pay scales, placing holds on pay raises, reduced staff, and more responsibilities are just a few of the consequences dealt from the failed economy. I’m thankful for all the possibilities that the nuclear medicine profession has allowed me, and I hope that more possibilities exist for those just now graduating from a nuclear medicine program.

While at work the other day, I greeted a patient from Ethiopia. She arrived for her appointment with her daughter by her side. As I began explaining the procedure to her, her daughter reached into her bag and pulled out a notebook. She opened the notebook to a page with explicit instructions for her mother’s stress test. She politely asked me to slowly review the notes she had written.

I was under a time constraint, but I realized that this was an opportunity to give them the time they needed, and expected to be given in regards to explaining the test and helping them both feel comfortable. Nuclear Cardiology can be like a cattle call these days. Schedules are packed and if you are the only tech working that day, you can feel the strain of different variables that can cause your schedule to be overwhelming. Whether it’s a delay from a difficult I.V. start, a patient arriving late, or a number of delay causing factors, once you fall behind with the schedule, it may be very difficult to catch up.

The woman standing in front of me with her mother wanted to fully understand what was about to happen to her mother. She wanted to know every detail of the test; what her mother should expect from the injection of the radioisotope, and what exactly a radioisotope is. How is it made, where is it made, and how is it administered. Why is there a need for an I.V., and why she should have a chemical stress test vs. a treadmill stress test.

I took a step back and realized that this woman truly loved her mother and wanted to make sure she was fully aware of what would happen to her mother. They moved here from another country, and healthcare in the United States can be completely different, even scary than from other parts of the world. I hear all the time that we are a nation of convenience; we want everything when we want it, and not a minute later. When patients arrive for their tests, a large percentage of them feel as though their visit to a doctor’s office should be like a trip through the drive through of their most conveniently located fast food restaurant.

I often wonder why they expect their doctor’s appointments to be “drive through” medicine, complete with a menu of diagnostic tests they may select as they pull up to the order window with a medical scheduler ready to input their order into a computer. The answer, of course, is simply that they don’t want to spend their day in a doctor’s office. On the flip side of this equation, many healthcare workers have become more like traffic cops as they wave one patient through while prompting the others to wait their turn.

As busy as I was that morning, I took the time to answer all of the patient’s questions in full detail. The patient’s daughter thanked me over and over for showing them patience as they asked question after question. She told me that she feels like she is bothersome to most of the healthcare workers she has met when she asks questions about her mother’s diagnostic tests.

     “They get frustrated with me, because they are rushing patients in and out, and I slow them down by asking them questions,” she said.

It’s easy to forget at times that communicating with our patients is one of the most vital forms of patient care we as healthcare workers may provide. As crazy as a concept as it may seem in an extremely busy practice, try and take the time to make each patient feel important by communicating with them.

Upon completion of her test, the patient was so grateful that she insisted that I accept an invitation to her family’s home for dinner. I told her I appreciated the offer, but I couldn’t accept it. I was simply doing my job.

Several factors are set in motion when you choose a particular career path. The most obvious is preparing yourself by earning an education in your chosen field. Athletes spend their entire lives preparing to get to the “next level” in whichever sport they choose to pursue. They train their bodies daily for years in their pursuit, learning the basic fundamentals of their sport early on, while continuing to hone those skills with countless hours of practice. When an elite athlete struggles with the skills necessary to maintain an elite level of performance, one phrase is always mentioned as a means to overcome the struggles. “He or she will have to get back to the basic fundamentals of the game.”

Those of us in our chosen careers will spend years doing homework and research while we earn an education. Depending on the career you have chosen, you may be required to supplement your education while being trained in a clinical environment, in addition to a classroom. There may be an intense level of dedication and sacrifice involved on your way to fulfilling your dreams, but in the end, it’s all worth it.

I’ve learned more than I ever could have imagined when I began my education in Nuclear Medicine school. Twenty years later, I find myself continuing to learn new things. One thing that has remained constant, however, is the way in which you conduct yourself while in the presence of a patient. I have witnessed people who are truly brilliant in their knowledge of medicine and have admired them for their brilliance.

Whether it is an emergency situation, or a scheduled imaging test appointment, patients assume that the medical staff tending to their needs will have the required education, skills and experience necessary to tend to them. They also expect that the medical professional tending to them will have the required people skills as well. I have learned over the years that many patients lose faith in highly intelligent medical professionals, simply because of the way those professionals dealt with them.

You can be brilliant in your knowledge and skills, but if you have a cold and unfriendly personality, your patients will lose faith in you. Your patients expect a doctor’s office, or an emergency room to be cold and uninviting. They realize they aren’t checking into a luxury resort filled with every possible way to make them feel pampered. What they do expect, however, is that not only will the medical staff be proficient at their job responsibilities, but that they will have the skills to comfort them as they enter that “unfriendly” hospital or clinical environment.

Patients are nervous, sometimes even scared when they walk through the doors of a hospital or clinic. As a medical professional, I learned very quickly how to develop the skills necessary to provide a calming environment for the patients I see. While explaining their tests to them, I do so with a smile and reassurance that they are in good hands. Treating each patient with kindness and consideration will go a long way in helping them feel that they truly are important. It’s a valuable skill that has become more difficult over the past few years with the flailing economy and resulting cuts to medical staff and equipment. In every practice I work in, I am the only nuclear tech working that day I’m there. The volume of patients hasn’t changed along with the cuts to staff, so making time for each patient to make them feel comfortable has proven to be a strain more times than not. However, I honed my skills in making each patient feel comfortable and important, rather than rushed and scared. If the day is met with equipment failures, doctors being delayed at the hospital, or even scheduled patients arriving late for their appointments, you must have the ability to deal with each situation in a calm and professional manner.

I recently earned a contract position at a local Cardiology clinic. I work there one day per week, along with my other contract positions at four other practices. I trained one day with the tech who was leaving to start a full-time position at another clinic. The tech would only train me on that particular day. I attempted to rearrange my schedule to have more than one day of training, but the tech only agreed to train me for one day. I had a brief phone conversation with the tech, and I learned very quickly that this was someone who did not have good people skills.

The day I trained with that tech proved to be a lesson in futility. She went through everything so quickly that I didn’t have a chance to write down any helpful instructions. The camera is an older camera, so the technology is outdated. We had two patients scheduled all day, yet she insisted that we didn’t have time to cover everything she needed to show me. When I asked to write something down, she was arrogant and condescending. That’s another skill that you must have in any career field you choose to pursue – the ability to not take things personally (thick skin).

She treated me as though I took the job away from her, rather than her voluntarily leaving for greener pastures. As I watched her with the only two patients scheduled for the day, I realized the abrasive personality she displayed towards me, was the same abrasiveness she displayed towards the patients. Both of the patients turned towards me to answer their questions, rather than dealing with the other tech. The other tech prided herself in her knowledge of the camera and the department, failing to realize that she lacked one of the most important skills – dealing with people correctly.

Prior to my start date at the new clinic, the tech who left placed a call to the doctors at the clinic, informing them that the position for which she left their practice wasn’t a full time position after all. The doctors called me and asked if I would be willing to help her, because she has a mortgage and bills to pay. Once I informed them that her situation was no different than any other employee they staff, I agreed to listen to her proposal. It was a very difficult call for her to make as she had to swallow her pride and ask for my help. The bottom line is simply that you either have people skills, or you don’t. Treat people with respect and politeness, and don’t burn bridges.

This new contract I earned was supposed to be two days per week. I now found myself agreeing to give up one day, to help the other tech. During my conversation with her, I told her I would work on Thursday, while she could work on Wednesday. She then informed me that she would have to check her schedule with her new employer to see if she could cover Wednesday.

     "Since I've agreed to surrender a day that I was promised in order to help you, the offer is not open for negotiation. You either take the day or you don't," I said.

When dealing with patients and other staff members, there are several ways in which to present information. How you present yourself and any information will determine how everyone will perceive you. It's all in the delivery.

Very early in my career I was faced with a situation in which my lack of prior experience could have led to my untimely demise in my first job in nuclear medicine. As I was preparing to perform a study on an inpatient in the hospital where I worked, I realized I didn’t have the most important information I needed to execute the test. When looking through the patient’s chart, I quickly learned that there wasn’t a written order for the test. Also, I couldn’t find any pertinent history in the patient’s chart indicating that the test I was preparing to perform was actually the correct test. When trying to communicate with the patient, he simply couldn’t reply with anything that could be interpreted. He merely was capable of mumbling lowly, rather than speaking clearly.

So there I was, preparing to perform a study on a patient without a written order for the test, and without any indications that the test was indeed the correct one for that patient. So I decided to take the case to my department manager with the expectation that he would call the nursing station on the floor where the patient’s room was situated. Upon explaining the situation to my manager, he simply told me to do the test anyway.

Now here is where my lack of experience came into play. Despite my protests to my manager of how uncomfortable I was following through with the test on that patient, he insisted I perform the test or he would write me up. I think I was in shock at that point by the very fact that he didn’t seem to care about the lack of information on the patient. He surely didn’t care about the position the situation had created for me. Instead of doing his job and backing me up, he completely made it my responsibility.

I approached the patient again, and this time he was trying to tell me something with hand gestures and continued incoherent speech. Once I figured out that he was trying to tell me he needed to use the restroom, I called the nursing station on the patient’s floor and asked them if he was mobile at all or if I would need to attempt to help him with a urinal. The patient’s nurse assured me that in spite of his appeared incoherent state, he was mobile enough with assistance to walk to the nearest restroom. I then informed the nurse that I couldn’t find a written order for the test, nor any pertinent history on the patient. She told me that those pieces of information had not made it into the patient’s chart, but she would deliver them to me immediately.

The entire situation went against my better judgment, but this was my first job out of school, and it took me three months after graduation to earn the job. I didn’t think at the time I could refuse to do the test until I had the correct information necessary to execute the test. I feared being disciplined for not following my manager’s orders. I attempted to help the patient from his cart, only to have his legs buckle as he fell to the floor.

Several things happened at that point, none of which were positive. Once all the hysteria cleared and the patient was back in his bed, my manager continued to insist I perform the test. At that point, I refused and asked him if he would do the test after what had just happened, and without the proper information needed to perform the test. He turned several shades of red before he stormed out of the room, slamming the door behind him. I called for a transport team to escort the patient back to his room, while I immediately paid a visit to the director of radiology in his office.

I learned many lessons in that situation. The most important lesson I learned that day was to trust my instincts. That was the only time I allowed myself to doubt what I knew was the right thing to do. When my manager continued to insist I perform the test without a written order and without any history or indication for the test, I should have reached out to other resources at my disposal. I allowed my inexperience and the fear of losing my job influence my judgment. I not only allowed myself to be placed in an inexcusable situation, but I also placed the patient in harm’s way.

I later learned that the patient had undergone a kidney transplant – information that I didn’t have at the time as I was preparing to perform a renal study on him. Had I performed the test, I would have positioned the camera detector in the posterior position to the patient, which is standard procedure when performing a renal study on a patient with native kidneys. However, since he had received a transplanted kidney, the camera would have to be placed in the anterior position, due to the placement of the transplanted kidney.

I never did truly understand why my manager sternly insisted that I perform the renal study on that patient without any of the required data that day; even going so far as to threaten my job security if I didn’t follow his request. I did learn, however, that I wasn’t the first employee he had placed in a bad situation. He apparently had a history of doing so. Needless to say, his employment at the hospital came to an abrupt end following the incident.

If you ever find yourself in a situation that doesn’t seem right to you, don’t hesitate to take your concerns to the resources in place. There are tiers of resources that you must attempt to reach out to in trying to resolve a situation. Don’t hesitate to try several of them if one doesn’t seem to be helpful. In the end, you could be compromising the safety of the patient, as well as your own.

With the New Year comes a fresh start for all the resolutions that many around the country will spend the first few weeks of 2013 trying to accomplish. Perhaps you vowed to get back in shape, or perhaps you told yourself that you will try to slow down your pace just a bit; taking time to stop and smell the roses more often. Whatever the case may be, the New Year seems to bring new hope and positive thoughts.

So what do you do when you discover that as a patient, your medical imaging tests will no longer be covered if they are performed on the same day at your doctor’s office? An announcement was made with the New Year of hope that 2013 will bring, Medicare will now require patients to say goodbye to imaging exams being performed on the same day. Medicare has ushered in a new policy that will require a patient to return multiple days for the different medical imaging exams their doctor has ordered for them.

This means that a patient can no longer have an Echo test performed on the same day as their Nuclear Stress test. They will now be required to have their Echo on one day, while returning another day for their Stress test. One physician I spoke to about this stated that Medicare will still cover exams performed on the same day, but they have reduced the monetary amount they will cover if the tests are not done on separate days.

This may provide obstacles to those patients who live in a care facility, while making it more difficult for those patients who rely on family members who have to take a day off from work to drive them to their appointments. It probably won’t make much of a difference for the patients we see who are retired, but in one of the practices I work in, people take their golf games rather seriously. If given a chance to come in a day earlier for their appointment, they usually decline because they will be playing golf that day. People want their time to be exactly that – their time.

This new Medicare policy will be sure to cause some distress for quite a few people. As with many things, only time will tell how it will all play out. It’s hard enough to stay true to your New Year’s resolutions in regards to your health and wellness, without any added obstacles from your health insurance.

There have been moments in my career that have impacted me in such a way that I am quite sure I would be a different person today if I had never experienced them. I have the utmost respect for any healthcare worker who deals with children. Early in my career in nuclear medicine, I worked at a children's hospital. I learned very quickly that I am not one of those people who has the strength (and I believe it takes an other worldly type of strength) to work with children in dire need of medical attention. I have the greatest admiration for those people who can provide the help these children need day after day.

My first life-altering case was when I was summoned to the hospital on a late night call. All I knew was that a doctor had requested a brain death study on a patient. I was first introduced to this type of study while fulfilling my clinical rotation in nuclear school. The protocol is you inject a patient with a radioisotope and follow its path to the brain. It is a very quick study in comparison to others we perform in nuclear medicine.

I drove to the children's hospital that night once I received the call, wondering what I would find once I arrived. Unfortunately, I wasn't prepared for what I was about to see. A transport team escorted my patient to the nuclear department on that late night. As they arrived, I quickly discovered that my patient was a young boy not more than six years old. I was shocked since I had never performed this type of study on someone so young.

The boy's mother was right by his side as they positioned his bed in the nuclear department as I prepared the dose I would administer for the test. As the transport team moved aside and found their places to sit, the boy's mother asked me what I was going to do.

"Will this hurt him?" she asked with tears filling her eyes.

"No, it won't harm him in any way," I replied in my best attempt to reassure her. I couldn't imagine her grief. I wasn't a parent at the time as I am now, but I will never forget the sadness in her eyes as she brushed back his hair from his face. She leaned over him and kissed him on his cheek, right before she wrapped her arms around him and cried like I had never seen anyone cry before.

That was the hardest time of my career at that point. I had to fight back my own tears at what I was witnessing. She kept apologizing to her son for allowing this to happen to him. I eventually performed the test the doctor had requested that night. I couldn't believe it when the test confirmed this beautiful little boy was indeed brain dead. I didn't want to believe it, but the results were right there in front of me.

I would find myself in other situations such as that one as I continued my employment at the hospital. Eventually, I decided I could no longer continue to work there, simply because I couldn't get used to seeing things like that, no matter how many people told me I would get used it.

The events that occurred in Connecticut on Friday brought back those memories of the children I saw in that hospital. Now that I am a parent, I still can't imagine how all those parents who lost their children on Friday are feeling. I can't imagine the level of grief they are going through right now, and will continue to go through. I had so many questions in my mind after that night at the hospital. Life truly is fragile and much too short. That's why I tell my son every day that I love him. That's why I will tell him every day, even as he becomes an adult and has his own kids, that I love him.

The next time you find yourself in the presence of a pediatrician, or a pediatric nurse, or any pediatric healthcare provider, thank them for the job that they do. I'm sure they will greatly appreciate it.

When I graduated from Nuclear Medicine School in 1993, I decided to apply for a job in Saudi Arabia. I was eager to use my hard earned degree in traveling to another country for employment. I received the application and filled it out with great anticipation. My mind began to race with thoughts of all the different things I would learn about Saudi Arabia and its culture. After the first two weeks came and went without any word on my application, I began to fill my time with interviews around the country. The nuclear medicine market at the time wasn't one in which I would be finding a job anytime soon in the city I called home.

The entire time I was enrolled in the Nuclear Medicine program, my classmates and I were being told we could "write our own ticket" in regards to where we wanted to work and the type of living we could expect to have while in the profession. It all sounded great to those of us studying hard and making the sacrifices we made while going to school. The reality of the situation was simply that there were no jobs to be found in the field of Nuclear Medicine upon graduation from the program. I ventured to the many hospitals and medical centers in the area to introduce myself to the proper departments and staff while leaving them with a copy of my resume, but to no avail. I was always told that everyone was looking for someone with a minimum of one year's experience.

I wasn't sure what to do at that point, so I browsed through several editions of medical magazines known for advertising jobs within the medical imaging community. Since it was rare to see a job in nuclear medicine being advertised at the time, I decided to send resumes to all the hospitals in the magazines advertising for CT techs, MRI techs, X-ray techs, Ultrasound techs and Phlebotomists as well. I wasn't sure if my efforts would amount to anything, but to my surprise, I was called by several of the hospitals to which I had sent my resume.

I secured several interviews all around the country, and I felt a sense of relief in that at the very least, I would have the chance to try and impress someone enough to earn an offer of employment as a nuclear medicine technologist. The interviews took me all over Texas, Oregon, Baltimore, Boston, Washington and a few other states. I learned a great deal during that time, and I would carry the lessons I learned with me for years as I honed my skills in the profession.

Once the last interview was completed, I raced to the airport to catch my flight back home. As I sat in my seat on the plane, I looked out the window and realized that none of the interviews I had been on over the last few weeks were even remotely similar. My first interview was the most surprising since I wasn't asked one single question about nuclear medicine. Another interview I had was actually conducted while on horseback, which was actually one of the best interview experiences I've ever had. One interview found me at a beach restaurant with the physician offering me a job. I accepted the offer, which sounded so good after too many shots of Jack Daniels (he kept ordering them for the both of us). Once I sobered up several hours later, I had to tell the doctor I needed time to consider the offer. Another interview was conducted by someone who had never interviewed a potential candidate for any job. I actually gave her questions to ask me, and she thanked me for them with a sigh of relief!

I took every interview opportunity that came my way. I was trying to gain as much experience with the interview process as I could in a short period of time. When a position became available in a city I always wanted to live in, I was confident in my interview skills after all the experience I had gained from all those interviews I went through. I was offered the job I wanted, and I moved to a new city to start one of the best chapters of my life. Oh, and about that job I applied to in Saudi Arabia – they denied my application because I didn't have enough experience. However, my twenty year journey on the road to experience has been very rewarding and enjoyable.

Many studies have shown, and continue to show the impact that stress can have on someone. It is well known how emotional stress can wreak havoc on the human body; causing us to feel a multitude of physical symptoms that mimic those found in cases of heart disease, lung disease, gastrointestinal disorders, and many others.

I was in Seattle in 2000 when Boeing was downsizing, eliminating a number of jobs in every department. We began to see a rise in the number of people being scheduled for nuclear stress tests in our department at the hospital where I was working. When interviewing each patient in regards to their medical symptoms prior to their stress tests, each one of them who had just lost his/her job with Boeing began to complain of chest pain associated with shortness of breath. Most of these patients were healthy individuals without prior history of medical ailments, nor any real significant family history of heart disease. However, when dealing with very specific symptoms of chest pain and shortness of breath, you can't be too careful.

The majority of the stress tests we performed on those patients who now found themselves dealing with the very stressful repercussions of losing their jobs, turned out to be negative. However, the symptoms prompting their doctors to order the stress tests appeared to be quite real, and couldn't be explained as just simply anxiety. The impact of the stress they were feeling over losing their jobs, and as a result, worrying about how they would pay their mortgages and their bills, along with supporting their families, can't be overstated.

While living in Boulder, Colorado, the hospital in which I worked was within walking distance of the University of Colorado campus. During the time the students would be preparing for their final exams, we would see an increase in the number of Lung Scans that would be ordered through the emergency department at the hospital. The physical symptoms of those students being prepared for lung scans were basically a manifestation brought on by stress and anxiety. Even though the chances of any one of them having a pulmonary embolism were very slim, the physical symptoms couldn't be ignored. Also, being within a short distance to the university, we would perform lung scans on college kids having just gone through a breakup. The emotional toll of a rollercoaster relationship and a breakup can lead to a plethora of physical symptoms.

I can only imagine the impact of the stress felt by those affected personally by the events of September 11 after losing a loved one to the tragedy. I'm sure the hospitals and medical centers in the New Yorkarea experienced a dramatic rise in patients requiring medical imaging due to the physical symptoms created by emotional stress and anxiety. I'm proud to be a part of the medical imaging community that has helped so many people over the years.

At this time of the year in Arizona, we are ready to welcome the “Invasion of the Snowbirds.” The term Snowbirds is lovingly used to describe the elderly population that migrates here for the winter. For the medical imaging community and for medical practices in general, the snowbirds bring much needed and welcomed business to practices suffering from a summer hangover.

Since the Phoenix summers are known for their onslaught of 110 plus degrees of heat, many of the area’s elderly population migrate to other states for a more livable summer experience. When the elderly residents make their trek to different states for those summer months, they tend to take their business away from the different medical practices here. As a result, the medical practices that have been thriving during the winter now seem more like a town vacated due to an evacuation. An evacuation that seems to last for months.

I noticed something quite interesting this past summer. The lull in business never seemed to materialize this summer. The practices I work for actually stayed busy during the summer months. It seems the down economy has influenced the travel habits of many of our elderly population. Many of our elderly residents are traveling every other year, while a majority of them are patiently waiting for the economy to become strong again before they gas up their Winnebagos and hit the highways at all.

Whatever the case may be, the tempered travel habits of our elderly population has meant that the medical imaging community and medical practices in general are the benefactors of their decisions to stay home. I wonder how other states with harsh winters are being affected by the economy. Are they experiencing an upswing in business as well in the winter, just as we have here in the summer? I would be very interested to learn more about this.

Two years seems to pass very quickly when you’re not looking. After a couple of Nuclear Medicine Conferences where one may earn a handful of Continuing Education Credits, a person tends to become busy with every day life. Sure, you make a note to yourself that you still have a number of credits needed to maintain your Nuclear Medicine License, but you assure yourself that you have plenty of time to fulfill those credits. So why is it such a surprise when you discover that all that time you thought you had, is actually about to run out? Thankfully, there are a number of resources at our disposal from which to draw upon when the end of your license renewal approaches.

Of course, there is a mountain of websites that will charge you for each credit you earn, and if you are truly in a bind, you may just decide to pay for each one. However, there are also several websites that offer free CMEs to those of us who are willing to do some research.

If you are a member of the Society of Nuclear Medicine, you can certainly access their website at www. Snm.org to pick up some needed credits. Here is a list of free websites that may prove useful if you are in need of some quick continuing education credits.

1). Cardinalhealth.com (It helps if you actually have an account with them)

2). Echeloned.com (A GE sponsored site for credits)

3). http://isotope.criticalpoint-lms.com (this site has several free tests you may take)

4). The University of Mexico also has a free credit catalog you can try. You will simply be asked to create a login and password to access their site.  https://hsc-moodle.health.unm.edu. The site may be a bit tricky, because once you sign on and take a test for nuclear medicine, your certificate may be located within the pharmacy section of the site (this happened to me after trying to locate my cme certificate).

I hope this helps those in need of some cme resources. Feel free to add to the list if you would like. It would be greatly appreciated.