Diary of an On Call Radiologist 3 – cyber weekend!

Diary of an On Call Radiologist 3 - cyber weekend!

It's been a while since I last wrote a blog article. My sincere apologies to anyone that actually keeps up with me on any level. As you can imagine...exams might have had something to do with my relative online absence.

Anyway, I thought it would be fun for another diary update. This is what happened to radiology over cyberweekend, from my point of view:

I feel bad that I am turning up late. I think a lot of people have this problem with the alarm clock and general optimism with how long it will take to get into work. One seems to forget that traffic exists when you are in desperate need of more sleep. Today I had also forgotten about the potential 's' storm awaiting me thanks to the 'quest for bitcoin'. It's Saturday morning and the night reg is someone I know very well. I find her in the main department and my first and most obvious question is...do we have any milk in the fridge?

She did look at me funny, then took a minor dig at me for being late and then asked me if I have been living under a rock. Apparently there's been a virus that has hit all our computer systems. Everything is down. No previous imaging, no voice recognition, no PACS and worst of all no work wifi (aka youtube/amazon/netflix/bbci). All in all....radiology is ruined.

To that my answer went along the lines of...'Well then, I'm off home'. It turned out that even though radiology was heavily hit...we were still scanning!? But it was like something from the dark ages. I would now have to sit in the scanner room and report from the CT scanner itself. No images transferred anywhere and no previous imaging available. By report a scan they meant I have to either write by hand or write a word document and print/photocopy the reports. One copy goes to clinical team and the other stays with us. Any x-rays will need to be looked at at whichever machine it was done on...gotta love those NG Tube checks now.

Thankfully the hackers hadn't managed get to the nespresso machine, so all was not lost. It begs the question as to why no one has done that...note to self - 'figure out a way to hack coffee machines'

So having taken the handover from hell I headed down to the ED scanner only to be greeted by a whole load of clinicians not knowing what was happening either - which is not a huge change from usual.

Clinicians were actually shouting out -'Is the scanner still working?', 'My scan needs to be done first', 'I don't know where I am' and of course 'I don't know what we're yelling about!'.

Thankfully we had a few more hands on deck than usual as one of our consultants had volunteered to come in and help with the reporting. She also didn't know what was going on, but I wasn't that surprised by this. She has problems trying to find the on switch at the best of times. Since we had one screen and one mouse between us and the radiographers, our consultant decided that it would be best that instead of 'checking' my reports she would just report hot off the press. So all in all I was being promoted to being her VR (voice recognition). I have been a radiologist a long time now...and this is what it has come to. I am now someone else's VR.

Not long into the on call we were getting referrals for a few ultrasounds. The only way to do the ultrasounds is to go upstairs back to the main department and save the images onto the ultrasound machine. The images could only be reviewed on the machine itself. This was going to get tedious very quickly. We had a number of 'Murphy's sign positive ? gall stones' which were all for theatre (apparently) and the odd 'RIF pain ?appendicitis'. We said yes to all of them and told the radiology department assistants to tee them up for after lunch.

The morning was going well as I had managed to keep the consultant away from the off button. Another on call registrar was also on deck but upstairs ultrasounding whatever was coming in. They finish at 5pm and I would finish at 9pm.

Time honestly flew by. Handover from the short day registrar at 5pm was;
1. The coffee machine is still working.
2. All the ultrasounds are done except 1 that is a 'murphy's positive'.  A conversation had been had with the surgical SHO and it was agreed that the scan could wait till the next day.

So my consultant and the other registrar left to enjoy the rest of the evening away from work...and thus ended my voice recognition career.

I steadily worked through the scans and suddenly I got an angry phone call about that 'Murphy's positive' patient. It was the surgical registrar on the phone this time. I was taken aback by the general attitude of this surgeon. I understand that we are all under a lot of stress but this was getting a little out of hand. He was almost shouting down the phone demanding the scan. Often it is tempting to lose your temper when you encounter this kind of behaviour and end up having an argument. In my experience it's not worth it. There are a few possible causes for this kind of behaviour.

Here's an SBA (single best answer)for you:

The surgeon...
1. Is an absolute *****
2. Is inept and uses radiology to try and cover up their lack of ability/intelligence
3. Is genuinely worried about the patient.
4. Has had some kind of miscommunication with their SHO resulting in the true urgency of the scan being lost in translation.
5. Is stalling, hoping the scan gets done so late it ends up as someone else's problem.

I'll go with number 3

I run upstairs to do the scan, brushing passed a few clinicians who still look lost from the morning. The patient takes an age to arrive to the department. Standard portering issues.  Meanwhile I'm getting phone calls to my mobile for more referrals and the tannoy system keeps calling for me to return to the A and E scanner. Finally the patient arrives, the patient details are in and I do the scan and lo and behold...the ultrasound is normal! More importantly there is no way there is a positive Murphy's sign. I examined the patient myself and pushed quite hard with the ultrasound probe. Now the predicament...How do I phrase 'you have wasted everyone's time' politely in the report?

The report went along the lines of: graded pressure with ultrasound probe did not elicit any pain...basically I'm saying that I examined the patient myself and you are full of it.

The tannoy is really going crazy and there are number of missed calls on my phone now. I try to run back to the department but my knees get weak around the coffee shop so I have no choice but to replenish my caffeine supplies.

I finally get back to the A and E scanner, coffee in hand, and to my surprise the night reg has returned for duty! How time must have flown by. She's in a huff as there are a few scans that still haven't been reported and there are a number clinicians lurking outside looking to score some radiation.

I assure her that I have been working incredibly hard. I was a decent voice recognition service throughout the day and I got held up with an ultrasound. At that moment she gets a phone call to her mobile. First referral of the night and it turns out the same surgical registrar is now asking for a CT scan for the patient I literally just scanned! What...A...Joke

Looks like I may have got that SBA on that surgeon wrong...Now I'm thinking the answer could have a combination of 1,2 or 5...It's all so confusing...(Sigh) I've never been very good at SBAs...

 ***All jokes aside I cannot believe we got through that weekend. It is an absolute testament to every single person who works for the NHS who consistently step up in crisis situations. I couldn't be more proud to be a tiny cog in such a fantastic organisation***