Wednesday, February 4, 2009

The Art of Being Invisible

I walked down the long bright white bridge linking the main hospital to the cancer center.  I stopped midway at an elevator - a small sign next to it said "MRI."  Although I had passed this elevator many times, I had never been to MRI.  I walked in, pressing the down button that initiated the journey to a subterranean level.  It was my first day on my radiology rotation, a subspecialty that was on my short list.  It appealed to me much in the same way that pathology did:  It was visual.

I had called the previous Friday to ask what time to show up.  Someone told me to be there at 7:30 a.m.  I arrived at 7:25, and the frosted glass door was locked.  I waited five, ten, fifteen minutes, and then slumped to the floor, opening a book.  Finally, at 8:10, a tech showed up.  She glanced at me wordlessly and proceeded to unlock the door and walk in.  I jumped up and introduced myself, following her.

She was in her mid-forties, and her green scrubs fit loosely on her thin frame.  Her hair was dyed black and hung limp on her shoulders.  She looked tired and bored.  

"So how long have you been here?" 

I answered, "They told me to be here at 7:30."

She laughed, the largest display of emotion I would see from her all morning.  "No one gets here until 8:30 at least.  You can wait over there."  She pointed to a large wall of fluorescent light boxes, empty of films.   Then she walked over to a large circular desk with enough lights, screens, and gadgets to evoke the control center for the Starship Enterprise.  She began fumbling around with schedules and paperwork, and I studied her actions while I waited.

Eventually, a resident walked in the room.  He was of average height and build with brown short hair.  He was strikingly pale, with small pointed facial features, except for his eyes.  They stuck out disproportionately wide, as if he was used to being in a dark room.  The juxtaposition reminded me simultaneously of a rat and a mole.

I walked over and introduced myself.  He stared at me warily, not returning the introduction.  Ignoring his rudeness, I proceeded to ask a couple of questions, subtly declaring my interest in his chosen field.  He discouraged my questions with short answers and lack of eye contact, as if he had already pegged me as a pesky medical student that didn't know how to take a hint.

Frustratedly, I resolved not to be the med student he had decided I was without even engaging with me.  I was already a pro on the wards and clinical rotations - I could read people relatively easily and had navigated my third year quite well.  I was a little put out, but as the med student, it was not my place to let that show.  I had also encountered this behavior many times, most prominently in surgery, where masks and goggles make it easy for residents and support staff to treat med students as a non-entity.  I was a little surprised it was happening on radiology, where my face was in full view, and there was not so much formality and ritual, like in surgery, to foster such easy contempt.

Eventually, an attending walked into the room.  He was casually dressed in a sweater, jeans, and hiking boots.  He was overweight and had a long ponytail.  He looked like someone who might be interesting to talk to, but I wouldn't know.  I was never introduced.  He walked over to rat/mole and started small talk about sports and office politics.  I tuned out until they began to put some films on the light boxes.  I walked over and sat near them; to someone standing across the room, I might have appeared to be a part of the conversation.  But certainly not from my vantage point.

Rat/mole asked the attending, "Do you think there is a tear in her lateral meniscus?" 

"I'm not sure.  If it's there, it's pretty subtle.  But you may be right."

They continued on, and eventually a third radiologist walked in the room.  From her age, I guessed that she was a resident.  Early thirties, pleasant features.  I hoped her personality matched her face; I wasn't getting anywhere with these other two.

Suddenly, rat/mole turned to me.  I was surprised that he was making eye contact, and allowed myself to imagine that I might actually become recognized as a person, in the room.  I wondered what he might say.  Would he pimp me?  Maybe a little nerve wracking, but negative attention was better than no attention at all.  I remembered from studying psychology in college that even kids raised in families with physical and/or verbal abuse turned out better than the ones that were totally neglected.  I allowed myself a glimmer of hope.  I'm such an idiot.

Rat/mole sneered down and asked me, "How many chairs do you see in this room?" 

I looked around.  There were three.  I was in one of them.

He continued meanly without waiting for an answer, "And how many radiologists do you see in this room?"

Well, there were now three with our new addition.  I wasn't dense.  I excused myself, stood up, and offered her the chair.  She snickered at rat/mole, sat down, and they proceeded to discuss the films, continuing to ignore my existence.

When I left for lunch, I never returned.  

The next day, I requested to be moved upstairs to CT, where I met a lovely resident who I work with today.  Sometimes we bump into each other at the park, and talk shop while our kids play.  I also work intimately with radiology at work, and they are some of my favorite people.  I just happened to start off on the wrong foot.  Crossed it off of my short list.

I bumped into my sister-in-law at Kroger last Saturday, and she stopped to vent about her miserable rotation while her boyfriend ran around and shopped for their dinner guests.  Talking with her reminded me of how demeaning being a third year med student could be.  Also of how the people you work with can make or break your rotation.  It is a difficult task, to separate the personalities from the specialty - after all, the personalities will disappear but you will be working in your chosen field for the rest of your life. 


John Hornor Jacobs said...

Those radiologists can suck it. Bastards.

You ever see those people again? God, I wouldn't be able to not say something to them.

Michael said...

Two or three weeks ago:

So I was waiting for barium to make its way down to the small bowel. I had been getting xrays every 30 minutes, handled by a med student. She was chipper and positive and enjoyed what she was doing, if overly descriptive. She even let me know how thoroughly she had read my chart, and repeated herself when the radiologist walked in the room a minute later as if I hadn't heard her the first time.

I'm sure Liz remembers - small bowel followthroughs back when I had a colon lasted some 6-8 hours waiting for stuff to move. It was painfully boring, but I was prepare for the long wait.

The third xray was handled by a tech. He went to get the films developed, and I laid there wondering how often they wiped down the machine with sanitizer, trying not to breathe too deeply. All of the sudden the med student rushes in.

"Do you feel OK?"

"yes...?" I both answered and questioned at the same time.

"Do you feel anything weird?"

"Other than the fact I'm starving and I just drank 5 pounds of barium, no."

"You don't feel like anything is wrong? It looks like something is broken in there."

So I imagine what followed next. She takes the film back and finds the radiologist. He takes one look at it and knows instantly that the barium had spilled into the ostomy bag and looked like a big puddle, but I believe he didn't tell her this, because both the student, tech, and radiologist came in.

Student: Dr. Soandso is the best he's just going to find out exactly what's going on don't you worry its going to be fine he's so good and this sort of thing.

He pulled up the "live" xray machine, showed her the ostomy bag, and said "you're done." to me.

Gizabeth Shyder said...

Ya know, the next time I saw that guy he acted like he had never met me. He unleashed volumes of bitterness over the politics of getting a job, clearly frustrated that he had no offers. That was justice in and of itself.

Michael, maybe my guy was such an asshole b/c he was confusing me for YOUR med student:) - not that even her ignorance deserves that kind of treatment. But her ignorance is quite humorous.

christie said...

What nasty people! They would get along really well with Peppy Pulmonologist. I guess there are those people in every field. I just read this from one of my favorite bloggers. She describes some really disgusting academics...