Alpha Docs by DANIEL MUÑOZ

Author:DANIEL MUÑOZ
Language: eng
Format: epub
Publisher: Random House Publishing Group
Published: 2015-08-10T16:00:00+00:00

10

ROTATION: NUCLEAR MEDICINE, PART II

A Christmas Present

The next rotation is the second round of nuclear. This one, like the first, runs two weeks, which is more than enough for anyone except those who want a career in nuclear stress testing. The first nuclear rotation, I knew almost nothing. I’d never read a scan, and never written a nuclear stress report. This time, I know the drill. As in the first nuclear rotation, I’ll read the tests with whichever attending is on, sometimes together, but often not. When we meet, he or she will point out details, comment on my interpretation, add some insight, and ask questions to make sure I get it. No pressure.

Still, I reflexively show up at 8:30 on Monday morning, even though the other Fellows have told me that there’s no reason to be there that early. But it’s day one, and I’m compulsive. Two idle hours later, I realize the other Fellows were right; there are no scans to read and won’t be until they’re fed to us by the clinics in the afternoon. The attending isn’t here. The door to the nuclear reading room is closed. I drink coffee and read newspapers, have lunch, and return emails. Then, in the afternoon, I go to the lab to meet the attending and get started.

The nuclear reading room is dim, illuminated only by the computer screens surrounding the console where readers—Fellows and attendings—sit in rolling chairs. Today I’m working with Dr. Ulysses, the uncrowned Hopkins king of reading nuclear scans. Dr. Ulysses started in nuclear before the training became formalized, and he has taken every exam and update since. He’s also a practicing cardiologist four days a week, not a full-time nuclear reader like some, and to me, that gives him added credibility. In clinic, he sees patients with heart issues, some of whom end up requiring a nuclear stress test. And since he reads scans (maybe not the ones for his own patients but for patients like his), he sees if there is a correlation between the suspected diagnosis and the scans.

When Dr. Ulysses reads the scans, he has an incredible eye for small detail, like an astronomer at a telescope who says, “There’s one of Jupiter’s moons,” but when you look, all you see are fuzzy white dots. Just when you think he’s not paying attention, he leans slightly forward, zooms in on one tile, and stares at it with his Superman X-ray vision. He quietly says, “See this?” and honestly, I rarely do. He points to the “before” tile of the same view, then back to the “after,” and says, “Right here.” Now I see it. His approach as an attending is, he watches you, and if you don’t screw up, he just keeps watching. Here and there, he makes a comment: “The anterior wall isn’t getting blood.” Otherwise, he weighs in only if he thinks you’re off. His silence or head nods are his way of giving the okay.

The second day, my attending is Dr.

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