iRADiX

The summer heat had set in and the sun was high in the sky. The clock had just struck noon when the idea to take a quick break flashed across my mind.

I had just finished the morning rush of patients for ultrasound.

Standing up from my chair, I told my secretary of my intention.

Receptionist entered to announce another patient from Germany with renal colic.

Considering his acute problem, I did not deem fit to delay the scan.

As the patient entered ultrasound suite, he glanced at me with a puzzled look.

The nurse draped a sheet on him and I started to take up the transducer when he suddenly sat up.

“Can you do an ultrasound examination?”

I was startled at his question and completely taken aback. Neither did I comprehend the reason for such a question nor could I justify it.

Here I was, having done more than 60,000 scans of all kinds in my career, faced with such a question.

It was as if my profession was laughing at me. I could very clearly visualize Mr. Rumack with a grim smile on his face and Mr. Cosgrove having a hearty laugh!

My mind was clouded with so many thoughts ‘criss-crossing’ all over as I fumbled for words.

Seeing my confusion, the patient apologetically remarked –

“I didn’t mean to upset you.”

But the harm had already been done.

What could salvage me now?

I gathered some courage and politely replied – “It’s not about whether I can do something or not, but how well can I do it?”

Speaking in the same vein I said “I can assure you that I can do a ‘good’ ultrasound scan for you.”

Confused by my answer, he asked –“What do you mean by a ‘good’ ultrasound?”

I was bewildered by his inquisitiveness and as if his argumentative abilities were having an overbearing effect on me.

I myself had never pondered on what constitutes a ‘good’ scan? Does it mean getting the right diagnosis or getting clear images or both?

Or is it just ‘ironing-with-the-probe’ to satisfy the patient!!

I reflected on those patients in the past who had returned back to me carrying box of sweets or some gifts because I had done a ‘good’ scan for them. In those moments, I had just felt happy with myself and had enjoyed the transient glory then, without thinking as to what I had done to deserve all this. I had just done my job, and that’s it.

And as if I had ever done a ‘bad’ scan on any patient?

Often the correct diagnosis is elusive, and we end up jotting down a whole list of probable differential diagnosis. Does that constitute a ‘bad’ scan?  I don’t know.

Ultrasound has always been a tool for me to establish a ‘cause-and-effect’ relationship. I have always tried to look beyond what is apparent as often we would find the real problem there.

Lost in my thoughts, I didn’t realize that the patient was addressing me again. He told me of an earlier scan that he had done a few days back where the radiologist had detected the sequelae of urinary obstruction but had failed to detect the ‘cause’.

Alright, so the challenge for me was to detect the ‘cause’ of his urinary obstruction.

I assured him that I will do my best.

As I began to scan him, I realized that he indeed had unilateral hydronephrosis. Looking through his urinary bladder, I could see a normal distal third part of ureter. However, I didn’t see a normal ureteral jet on color flow. So I suspected a mechanical obstruction in the mid-third part of the ureter.

I was coming to the most difficult part of the scan now, that to trace the mid-third part of ureter. I was quite unsure whether I would be able to solve this mystery!

Maybe I would not have tried so hard in the first place, had my capabilities not been challenged!

I told him that I will have to press the transducer deep into his abdomen and he may feel slight discomfort.

“Why do you want to do that?” he questioned with a frown on his face. .

Now was the time to explain to him the finer nuances of ultrasound technique. On explaining to him what I had already done and where I had reached till then, he decided to cooperate with me.

I began to trace the ureter from its proximal end and applied pressure on his abdomen. And then I saw that calculus in the lumen of ureter and causing luminal obstruction.

I was so relieved with my discovery.

With a satisfied smile on my face, I began to tell the patient of my ‘complete’ scan and his ‘cause-and-effect’ problem.

I was sure that he would compliment me on my work and expected few nice words from him.

Strange thought crossed my mind that maybe in some way I had upheld the prestige of Indian radiologist!

As I finished explaining to him my results and handed over the film and report to him, he nonchalantly bid good bye, to my utter surprise.

Curiously, I initiated to ask him about what he felt about the scan with me now, knowing very well the ‘state of mind’ he had entered my examination room.

“I knew it was a stone. No big deal !!”