Week 4: Varied Perspectives

I was so absorbed in what I was doing I didn’t notice the blood at first.  My hands were gloved in red. Well, more precisely my hands were encased in surgical gloves, which were stained red by the blood dripping from quivering guide-wire pulled from a patient’s femoral vein.  I carefully slid an IVUS catheter along the wire toward the physician’s waiting hands.   Taking the IntraVascular UltraSound from me, the physician extended it into the patient’s vein, searching for the presence of a clot.  I have seen this procedure numerous times during the last few weeks, but this time I was “scrubbed in”, standing next to the physicians and gaining a new perspective from within the sterile field. 

            During the past week, I scrubbed in to several procedures.  With no medical training, my participation was limited to removing trash, coiling wires, and sliding the occasional catheter onto the guide wire, but the experience provided me with a deeper insight into what was happening.  I felt the friction between the wire and catheter as guided the catheter forward, understanding at a more physical level what it meant for IR physicians to precisely maneuver the catheter into a target vein. I learned to pin the wire in place while avoiding any kinks, how to straighten the curled tip of a pig-tailed catheter and thread it gently onto the guide-wire tip without ripping it. 

Being scrubbed in also allowed me to handle the medical implants and devices.  Although I had seen several IVC (inferior vena cava) filter placements and removals in the past, this was the first time, I was able to pick up the filters, examine clots that had been caught by its basket and feel the tiny hook at the end which allowed the physicians to capture the filter with a snare.  In one instance, a collagen plug that the physician had intended to sue to close a vein after completing a procedure came out with the catheter, and I was able to hold the plug between my fingers.  Although I knew the plug was made of protein, it felt and looked more like it was made of paper.

            As I experienced my own lessons in interventional radiology 101, I observed the education of individuals a bit farther along in their IR studies: radiology residents.  For the most part, I have watched only attending physicians and interventional radiology fellows up to this point.  However, at the end of last week, the fellows graduated.  Before the new class of fellows started, two radiology residents joined the division as part of their compulsory rotations in IR.  The residents provided me with a new view of the clinical area of radiology.  I listened to their conversations as they compared their experience in diagnostic radiology, their main area of interest, to interventional radiology.  Despite the fact that the two areas are within one department, the overall focus and goal seems fundamentally different.  While in interventional radiology, imaging is seen as a tool, used to guide various therapies, in diagnostic radiology, imaging is the goal.  The residents compared marathons of standing for hours in the angio suites of IR to 10 hours of staring at a screen reading scans.  It struck me that the reading room in diagnostic radiology must be constantly busy, contrasting sharply with the reading room in IR, which except for the occasional fellow dictating notes, tends to be a place of relative quiet and solitude during most of the day.

            A scheduling difficulty opened up yet another perspective for me on clinical treatment.  Although patients are held to a strict schedule, told to arrive at the hospital sometimes two hours before their procedure, an emergency procedure caused one outpatient to be held waiting for an extra four hours past the time the procedure was supposed to begin.  Naturally, the patient was upset.  Nurses and techs repeatedly came into the procedure room bearing the same message from the outpatient: “when will you be ready?” I am certain that if I were in the patient’s position (i.e. kept waiting for hours for a procedure) I would also have been restless and at least a little annoyed.  However, from inside the angio suite, I saw the dilemma in a new light. To keep things semi-organized, the patient’s must be kept on a strict schedule.  If one patient is late, the entire schedule for the day is delayed.  However, in many cases, especially in interventional radiology, the physicians do not know exactly what they will need to do until the procedure has begun.  IR doctors frequently must diagnose and treat a condition in one procedure.  In the case of the 4-hour delay, the inpatient was transferred to IR to embolize a potential gastric bleed.  It took over an hour of performing angiograms to identify the precise site of the problem, before the embolization itself could even begin.   The individuals creating the schedule for the day must allocate enough time for each procedure without knowing how long the procedure will take.  Most of the time, enough leeway is built into the schedule to keep everything running on time, but occasionally, an unexpectedly long procedure causes delays.  I would like to think that after this experience I would be a bit more understanding of doctors and more patient if my appointment were ever delayed to this extent.