Diary of an On Call Radiologist
So here I am. Another night in this place as the Radiology registrar on call. As always I’m anticipating the worst.
What is going to come in tonight? A leaking abdominal aortic aneurysm? Perforated bowel? Ischaemic bowel? The list is endless. Like any other specialty, anything could walk in. The stakes are high though and it’s something I didn’t consider when I came into this job; surgeons depend on what I say in my report. If I say everything is normal; they go back to sleep. If I say I see something abnormal; they could be up through the night in theatres.
My shift starts at 1700 hours and finishes at 0900. That’s a 16 hour shift and on top of that it is a resident on call. That’s something that is quite different to other training schemes. Some training schemes are non-resident on-calls, so they can take a laptop and do reports from home. Sigh, sounds like a nice existence.
Anyway, I’ve written this up for those of you who are thinking of applying and have not had the chance to shadow an on call. I hope it helps and give you an insight as to what it can be like…
1700– I’ve arrived in to work. There are three scans from the day that still needs to be reported. They are all heads and all trying to find a reason for confusion. Phew, those should be easy.
1740– One of those scans were quite difficult. There was some kind of weird mass that I couldn’t really describe. There was so much oedema that it was difficult to decipher the normal anatomy. Poor patient wasn’t even that old. Either way the images are going to sent to a neuro centre for the neurosurgeons to look at. No one will do anything over night. Knowing the neurosurgeons, they’ll want an MRI head, followed by a full staging CT before doing anything…none of which will happen till normal working hours…how convenient.
1800– A phone call comes in. First referral in the last hour, not bad. It was a referral for a possible ruptured abdominal aortic aneurysm from an ‘SHO’. On further questioning it was not an SHO, it was an FY2 and he was asking for a CT scan on a patient who had an episode of chest pain, known angina, stable BP, normal bloods. The patient is pain free after GTN spray. I politely told him that the scan is not indicated. He argued a bit and then promised me I’d be hearing from his consultant. I eagerly await that phone call.
1810– CT Abdomen/Pelvis requested on an elderly man who has had a colonoscopy earlier today. Since then he has been suffering with an acute abdomen. The Surgical registrar has seen the patient and is worried the patient may have perforated. I’m now waiting for the scan to happen.
1815– An orthopaedic SHO has called asking for a CT pelvis on for an elderly lady who has fallen over and broken her hip (#NOF). They want it to be done in time for the ward round tomorrow morning. It’s an attempted abuse of the our on call system since no-one is going to take the patient to theatres tonight. I told them politely to get it done in the morning.
1830 – The colonoscopy patient is finally here. The surgical team are in the scanning room and the family of the patient are waiting outside. The radiographers call me through to check the images are ok. I have to walk past the family who are eagerly anticipating the results. They look at me wondering if I’m about to tell them what is happening. I avoid eye contact like a good radiologist!
1831 – The colonsocopy patient has ischaemaic bowel. The surgical registrar is on the phone talking to his consultant and is discussing what the plan should be. I flick through the rest of the scan to make sure we have decent images. I look through the glass window into the CT scanner to see the poor patient lying there, and he looks surprisingly well considering. The surgical registrar puts his phone down and tells me the consultant feels the patient is not a candidate for surgery. Too many co-morbidities such as congestive heart failure, chronic obstructive pulmonary disease and chronic kidney disease. The poor man wouldn’t make it through the surgery. I’m a bit annoyed though, because they could have decided this before asking for the scan in the first place. Anyway, I’ve got to now work through the rest of the images and see what else I can find.
1832 – I walk out the scanner control room and the family look at me as though I’m going to tell them what is going on. I do the radiology thing again and keep my eyes down and walk back into my reporting room. I feel bad for them, and am glad I don’t have to be the one to tell them the terrible news…
1900 – I’ve accepted CT abdomen and pelvis on an obstructed patient. We were all ready to go and then we realised the creatinine was not done! The team had conveniently forgotten to add this to the request card. The radiographers quite rightly called up the surgical SHO and asked them about the renal function and were instead met with general rudeness and a ‘just do the scan’ attitude…a misconception of their own superiority in a make believe hierarchy it seems. The radiographers told me this so I decided to put the ‘scary radiologist voice’ on and call the SHO myself. Unsurprisingly the SHO backed down immediately and told us he’d call us once the blood results were back…I’m glad we sorted that out.
1940 -There’s a lot going on this scan and I’m finding it difficult. There are multiple loops of dilated bowel and I’m trying to find the transition point. During this I’ve had 3 thrombolysis head referrals come through. It’s annoying because its disturbed my flow and I have to now re-look at this obstructed patient’s scan to make sure I haven’t missed anything.
2000– I have finally finished reporting the obstructed patient’s scan. I’ve read and re-read the report to try and make sure it made sense. I was disturbed during this to review the thrombolysis scans as they came through. One showed a hypertensive bleed, one showed no contraindication to thrombolysis and the other was a definite stroke needing thrombolysis.
2005 – Oh my God! I’m panicking as I’ve gone and said one of the thrombolysis heads had no contraindication to thrombolysis and it turns out that they do on further inspection! They actually have what looks like a tiny bleed in the right cerebellar hemisphere!
2007– I’ve called up the team and they have subsequently stopped thrombolysis. No harm done..hopefully.
2107– I’ve spent the last hour reporting the X-ray plain films.
2200 – CT head request for another possible thrombolysis patient.
2300 – I’ve been called to theatres because an ENT consultant wants me to do an Ultrasound neck on a patient who has had sudden onset neck swelling and he was wants me to rule out a collection. Best not argue with a consultant eh?
0000 – 4 CT head scans have come in the last hour.
0100– I’m getting pretty tired and it took me longer to get through those last few scans. I had a phone call during it from a House officer trying to interpret an X-ray facial bones. I felt bad for them so we went through it together…I’m such a nice person.
0200– Another two CT heads for possible thrombolysis.
0300 – Strange request from an FY2 asking for a CT chest to assess the position of a chest drain. I asked her why she does not get a chest X ray and she demanded that I do the CT because it will show her more! I politely explained that this is not an indication for a CT chest and she should talk to her senior before calling me. She got very angry and proceeded to tell me that I was being rude by questioning her clinical acumen. She then hung up on me. Charming.
0500– Same FY2 has called me again now claiming that the same patient needs a CT chest because they are breathless. She still refuses a plain Chest X ray because a CT scan will show her more. No ABG, sats are actually normal and the patient is stable. The patient is just breathless. I asked her politely if she has asked her seniors to review the patient and if not she should do it quickly. A CT chest is not warranted in this patient as the patient is stable and this ‘doctor’ still has no idea what she is really looking for. She hung up on me again. I’m worried about this doctor’s general ability/intelligence so I call up the medical registrar and explain the situation to her.
0600 – There’s been a road traffic collision involving two brothers on a motorcycle. The younger of the two was on the back and went flying over and hit a car bonnet. He’s complaining of back pain and the X-rays look suspicious.
0620 – I’m worried about the kid’s lumbar spine. I’m not sure what I’m seeing. Theres some kind of lucent line going through the T12 vertebra. It doesn’t really look like a fracture but I can’t ignore it.
0640 – The doctor looking after the kid has come to ask me why it’s taking so long to get a report out. He seemed quite annoyed at which I am surprised at. What does he think I’ve been doing all this time? I show him my concerns and I’ve pulled up some images off Google showing that this is most likely a normal vessel and not a fracture. He’s asks me if I’m sure because he’ll take the patient off the back slab if I say everything is normal…
0650 – I’ve called my consultant and discussed this case with them .She was really helpful and explained that the lucent line is a Basivertebral vein. That’s what I thought. Phew. Thank you Google!
0800 – I get a phone call from an A and E consultant asking for a CT Aorta on the patient I discussed late last night! I refuse the scan again because the patient has remained completely stable and has been pain free all night. He says he’s going to come to the department and talk to me face to face as this patient is known to have a 3 cm aneurysm on a CT scan earlier this year and that I’m being obstructive. 3cm isn’t even that big, I’ve never heard of this consultant before…either he is a junior lying about his level…or a locum.
0930 – My radiology consultant and I have gone through the scans I did last night and all seems well. The A and E consultant didn’t come to the department or call my consultant and I’m a little disappointed. I was looking forward to a showdown.
1000– I’ve left the hospital and feel great. No mistakes from last night and only the occasional bust up… I think I’ll go celebrate with some McD for breakfast!