Well, I gotta be honest, I’m really enjoying Rads at this point. Maybe not enough to actually do Radiology, but it’s certainly one of the more interesting fields I’ve seen so far. There are a couple things so far that have made me reconsider my last post.

I thought radiologists never saw patients. While this is mostly true, there are a lot of procedures you can do, especially in the field of interventional radiology. On top of that, on chest Xray (which I’m on this week), the radiologists review all the ICU radiographs from the previous day, so they are very familiar with every patient in the ICU. There is also a lot of cross-talk between the radiologists and the other docs (pull this tube out, decrease the fluids because he’s getting edematous, we suggest getting a CT scan, you gave him a pnemothorax, etc).

The field is also INCREDIBLY broad. Even a simple chest x-ray holds a massive amount of information, so you never see the same thing twice. You go at your own pace†, and they get really, really good at this stuff. The difference between a radiologist looking at a film and an internist is crazy.

So here’s the other thing: the geek factor. Listen, I grew up playing video games, tweaking computers, and spending inordinate amounts of time on the internet. Oh, wait, I still do that. Radiology is one of those fields where technology is growing at an exponential rate, and that suits me just fine.

Obviously there’s a few problems, like the fact that it’s a fairly solitary field and you become a vampire. We’ll see once I get on Emergency if the bright lights and the pandemonium are what do it for me… I have an overdeveloped sense of schadenfreude which fits in just delightfully with the ER. So, we’ll see. I’m keeping my options open.

†bonus for me, who hates the structured 8-5 workday of clinic.

Well, I started my radiology rotation today, and much like my immediate, vehement feelings about ophthalmology, I can quite honestly say that I’ll never, ever be a radiologist†.

It’s really interesting, and really, really cool, and I know I’m going to learn a lot… but I swear to god, if I sit in a dark room for one more day staring at a black and white screen (with infinite shades of gray, of course) I might just go postal. Oh, wait. It’s only my first day of the rotation.

By the end of the month I swear I’ll be feeding off unsuspecting humans, cackling with my paper-white skin, slicked back hair, and long, well-groomed fingernails. Bonus: if Interview With The Vampire has anything to say about it, maybe I’ll end up looking badass like Brad Pitt.

Aside from sitting in a dark room the other thing that gets to me is that all these guys are really low-key. And not in a “laid-back” sort of way. More a “I talk very quietly into my dictaphone for 8 hours every day” sort of way.

I’m going to lose it.

†Sorry Uncle John, it’s just not in the cards.

I read an article on CNN today about a woman who was shockingly left to die on the floor of a hospital waiting room. She was waiting for admission to the inpatient psych ward.

There are several things I find wrong with this story.

1) Inpatient psych patients are not typically ill, so psych nurses/docs don’t expect people to die on their floor.

2) She had been waiting for 24 hours. They probably thought she was sleeping.

3) A security guard rolled his chair over and looked at her, then left. I find it hard to believe he’s cold hearted enough to leave a dead woman on the floor, so I’ll bet he thought she was sleeping.

4) Other patients “didn’t react”… so they probably didn’t think she was dead either. They probably thought she was sleeping. Or crazy. Or both. But if they thought she was dead, I’ll bet someone would have called for help.

5) She was being committed, which means she’s crazy. Crazy people do wierd things, like lie prone on the floor. I’d like to see how she was acting before she died, but we don’t have that footage.

6) It is the fault of how we currently treat psychiatric disorders - not the individual hospital - that there are never any inpatient psych beds.

7) Mis-documentation usually means “lazy” or “didn’t check”. Doesn’t mean it’s acceptable, but it doesn’t necessarily mean it’s a coverup. See (1).

Now, I’m not trying to say that it’s not a travesty that this poor woman died waiting for a hospital bed, but there are a few points to make. Most importantly, an inpatient psych bed is a very, very different beast from an inpatient hospital bed. In fact, psychiatrists as a general rule are terrified of “sick people” and will call in consults from other doctors simply to see if it’s ok to give tylenol. Patients are not treated for medical conditions on a psych ward.

For that matter, patients are often left alone on a psych ward… because the purpose of being a psych inpatient is simply to do behavioral therapy and give antipsychotic drugs on a scheduled basis and wait for them to take effect… which can take months. If someone ever gets sick, they are shipped as fast as possible off to the Medicine ward, because (again) shrinks don’t take care of medical conditions.

Because of the way we currently treat psych disorders, it’s also not the fault of the hospital that there are never any beds on the psych ward. The ER would have called around every hospital in town to find out who had the shortest waiting list, and then sent her to wherever could fit her in.

Also, only certain hospitals accept the responsibility of “involuntary committment”… the VA, for example, is voluntary stay only. They can only fit so many patients into a psych ward, and they are always at capacity. You wait to be admitted until someone else is discharged, which is wholly dependant on how long it takes their drugs to kick in.

I find it frustrating, because the easy thing to do is to point the finger, especially because this woman was only 49. But without more information, I’m just not sure there is blame to be placed, aside from the misplaced, abject anger at the system itself.