For the next three weeks I will be at a different clinical site than my beloved Good Samaritan Hospital. Keep in mind that I am going from a CR site to a site that still utilizes film/screen, but is of a comparable size and, I believe, treats a comparable number of patients in the radiology department.

I've spent three days there so far and I return again on Friday. My rotation this week has been in the "general" area where they currently only perform exams on in-patients and patients from the emergency room using film/screen. The outpatient stuff and fluoro has been moved to their beautiful new building right across the road, complete with DR rooms and fluoro rooms that utilize CR plates for the table bucky.

Anyway, back to film. My instructor pretty much annoyed me into submission as to the reasons I should choose this particular facility for my clinical swap, the two main reasons being a significantly shorter commute (25 minutes compared to 60 minutes) and the film/screen "experience."  Please note there are currently only two remaining hospitals (Shriners excluded) in the greater Portland metropolitan area that still utilize film. 

The commute is lovely and the film "experience"... well it sucks as much as I thought it would. 

Don't get me wrong, I'm enjoying my rotation IMMENSELY, but film is dying and I really wish it was already dead. There is no justifiable reason to keep it other than startup and implementation costs, which (in my non-bureaucratic mind) are probably going to be recouped in a couple of years just from the money saved on film, processing chemicals, repeats, library space and the manpower to staff 3 to 4 inefficient rooms versus 2 efficient CR/DR rooms, as well as the film library. Not to mention the dose saving benefits to the patient!

Have you ever had a patient who you thought spoke English but, come to find out, had an English vocabulary of, oh I don't know, lets say... at least three and likely no more than five (that sounds about right, but let's give the patient the benefit of the doubt and go with five) words?

This is a lesson I learned early in my clinical studies. I had a patient, Hispanic, who came through the Emergency Department's ambulatory care clinic for some X-rays on some part of his upper body. I believe it may have been an extremity. 

At the time, I was new at taking patient histories, and I ended up asking a bunch of "yes" and "no" questions. Apparently my interactions with the patient throughout the exam also consisted of only "yes" or "no" questions as well. Of course, the patient could enunciate both ‘yes' and ‘no' quite clearly and with absolutely---and I do mean ABSOLUTELY---no accent.

We finished up the exam, at which point my clinical instructor instructed me to accompany the patient back down to ambulatory care. Now, please be aware that this isn't the first time I've accompanied a walkie-talkie back down to the EDAU. Generally, what happens is I get the patient close to the clinic, and then I turn around and go on my way.

Well that's exactly what I did with this patient with whom, by the way, I had a lovely (apparently another "yes"/"no") conversation on the way back to the clinic. 

Unfortunately, when I said "... through the door and to your left," he must have thought I said something like "... through the door and keep going until you get outside at which point you can assume the magic pictures I took of you have cured you and you can feel free to go on about your day."

The patient responded with, "OK, thank you, goodbye!"

I don't remember exactly what was wrong with the patient, but I do remember a doctor calling up to find out where he was and I also remember that something showed up on the radiographs that required treatment for the patient.

They make me walk my patients to the room now...

Lesson learned, and it is this: Ask questions that require more interaction than "yes" or "no." Strike up a conversation with the patient and get personal. Make sure they understand the language you are speaking or get an interpreter!

This is probably only part one of my "Look How Stupid Alex Is" series. The lessons learned during experiences such as these will probably all fall under the subgenre of "natural consequences."

Fell free to mock me.

So, last weekend I was helping a buddy of mine move the world's heaviest 36" television set. This thing must have weighed in at 250 lbs plus. It's one of those Sony Trinitron flat screens, not plasma or liquid crystal display, no sir!  It was just a good ole' fashioned cathode ray tube (and what I can only assume is an additional 100 lbs of lead).

Things were going well. We had managed to get the television out of his sister's house without any major incidents, loaded it in to my minivan, and drove it to his place. 

All was well; there were only about 6 more stairs until we reached the front door.  Unfortunately my luck ran out about two stairs away from the porch. That's when I felt a "pop" in my lower back at about the level of L5. In my mind, all I could think about was how much clinical time I was going to have to make up.

On the ride home, which takes about 75 minutes, I felt the muscles in my back slowly begin to tighten, and I knew that I was going to be missing at least one day at the hospital.

I should make you aware that this is not the first time I've had problems with my back. About 12 years ago I strained it at work lifting a heavy rack in what was supposed to be a team lift effort "on the count of 3"...  Apparently I was the only one who knew how to count... I was out for eight weeks in PT and on workman's comp. There were no herniated discs, only strained ligaments and pulled muscles. 

My back has never been the same.

Anyway, I ended up missing three days of clinical and the fourth was pretty rough as my muscle relaxers and pain meds seemed to be slowing down after about five hours in to my eight hour shift.

Every little movement had to be carefully planned. Sliding help wasn't just an option, it was a requirement.  It seemed that the slightest twist of my torso would send my back in to a screaming conniption.

My techs have always told me, "Bring the patient and tube to your level whenever you can. Your shoulders and your back are your livelihood." 

Man if that ain't the truth!

My week of suffering also helped to cement in my mind the fact that we need to be aware of the mobility limitations of patients and how we manipulate them in our attempt to achieve the "textbook" image.

Let the patient do what they can. Don't force them to do more than they can handle.  The same goes for us. Do what you can, but don't do more than you can handle, at work as well as at play. This is your career on the line. And if you're a student, don't end your career before it's even started.

Fortunately my back was only strained and in spasm... this time.  As I'm writing this my back is only slightly sore and I'm functioning at roughly 98 percent, but it was a scary experience for me nonetheless.

For those of you who are deciding whether or not to pursue an education in the "imaging arts" I would urge you to keep in mind the following things:

• You probably will not be the person choosing your clinical site.
• The impression that you receive from whatever interview/job shadow process you will go through will most likely not give you an accurate impression of the personalities of the technologists you encounter---regardless of whether the impression is positive or negative.
• Every technologist you encounter will have different methods for achieving comparable images.
• Some technologists will want you to do things their way, and only their way.

Please note that this isn't necessarily my personal point of view, but rather a consensus of cohorts polled. I'm fortunate enough to have squeaked my way in to the program as an alternate at a clinical site that was #3 on my list, but I never had the opportunity to interview there.

Luckily, my interviews were pleasant and informative at both of the clinical sites I interviewed at and I was actually fortunate enough to have a one day rotation for tomography at one of the sites.  In my experience there, the clinical instructor was as pleasant during the second interaction as she was during the first. 

The other clinical site I interviewed at is the site I will be going to for a three week rotation this term. I'm sure you'll be hearing more about that since it's a film/screen facility, and all my clinical experience so far has been at a CR facility. By the way, I'm exceptionally nervous about shooting on film.

Just keep this in mind, if you you're flexible, resilient, compassionate, and have the hide thickness of a rhinoceros this may very well be the career for you! 

I've had jobs where I was required to adapt to the various personalities I encountered on a daily basis, and, prior to my clinical time in the hospital, end-user support was the most difficult to cope with.

It was actually comparable to the patients I interact with the hospital, only with less physical pain (although only Heaven knows how some of the users I supported managed to walk away from our encounters unscathed).  Here's an example.

Me: "OK, so what were you doing when it stopped working?"

User: "Nothing, I was just sitting here (most likely playing solitaire) and things went wacko."

Me: "Nothing? Are you sure?"

User: "Yep."

Me: "Really?"

User: "Yep."

Me: My mind is screaming Riiiiight... Suuuure... but today the brain-mouth filter is working and I say, "OK, let's see if we can figure this out..."

In the above scenario the User is the equivalent to the patient.  Below is an interaction for comparison.

Me: "So, are you able to shift over to the table for me?"

Patient:  "Yeah, I think so..."

Me: "Take your time, don't do any more than you're capable of."

Patient:  "I think my shoulder may be dislocated."

Me: "Well don't try to move it, we can slide you over and do all the work for you."

Patient:  "I can do it... My shoulder hurts a lot; I REALLY think it's dislocated..." (at this point the patient is moving his arm around in a grand, repetitive, circular motion)

Me: My mind is screaming Riiiiight... Suuuure... but today the brain-mouth filter is working and I say, "OK, let's see if we can get some pictures so the doctor can figure this out..."

Do you see the similarities?

The lesson learned is this... The brain-mouth filter should always be connected and in the ON position and, most patients (similar to their end-user equivalents) don't usually have a clue as to what their problem is, so it's up to us to be part of the team and help solve that problem.

I managed to bumble my way through yet another term in Portland Community College's Radiography program.

To be honest though it's not the class work that gets to me, it's the clinical stuff.

The clinical site is fine; the techs are fine. It's the self doubt that gnaws away at me from the inside out. It's the "mind-of-the-thirty-six-year-old-that-isn't-quite-what-it-was-ten-years-ago" that's the real problem. I worry about such things as, "Hmmm... I'm three quarters of the way through my education and I still haven't shot (let alone "comped") a humerus."  Do I still remember how to do a humerus?  Can I wing it?  What about trauma?  I don't have any trauma comps!  Uh-oh, how am I going to get my trauma comps?!

Breathe...

I keep telling myself, "We're coming down to the wire here Alex, it's time to get on the ball and finish up the competencies!"

Breathe again...

Man, if I don't make it through this my wife is going to KILL me!

Hmmm... I'm feeling the hyperventilation setting in...

Every clinical site is different-some see trauma and some don't. Some see a lot of heart patients. Some see tomos and IVPs. Others will see a lot of fluoro and bizarre exams such as defacography. I see a lot of two view chests.

I take solace in the fact that most people make it through the program just fine and manage to collect the required competencies within the appropriate time frame. I also take solace in the fact that whatever I'm going through now my techs have all gone through at some point as well. I still feel incompetent though.

A lot of techs tell me that it's actually the first year after you graduate that you learn the most. That's when you're out there doing it all on your own and that's when you fine tune everything you've learned up to that point. Hopefully, once I somehow pass the clinical portion of my education, I won't look like an idiot to my employer (if I can find an employer in this oversaturated market...).

That's another story for another day...