Random thoughts on the reboot - I'm sorry, dear

(Inspired by a conversation with a friend)

The small cuts are the ones that hurt the worst. I've seen people with bones sticking out of their skin, people whose bones have been shattered, missing limbs and digits that only recently gone missing, and while some of them have screamed as we positioned them for x-rays, the ones who scream the loudest and most often have been the ones with lacerations, abrasions and hematomas.

I can't blame them. When I shattered my fibula, I thought it was the worst pain in the world. Until I had a 6mm kidney stone. Yea, you don't want one of those. Trust me.

But it's also true in the reverse.

And then there are those who think we're unfeeling bastards because we make them hold their ankle at a certain angle, or we don't react when they tell us the most horrible thing they've experienced. Probably something that happened in the past two hours. Because we will make you move that hand that hurts so much you're thinking of just cutting it off and being done with it. When a nurse or other professional uses endearment terms, understand we are not belittling you. We are identifying (and in some small way, trying to protect ourselves). I used to hate it when other techs would call the patients "honey". But two years in I find myself following their example and saying, "I'm sorry, dear. I'm so very sorry."

There are times we just accept we can't get a certain view. "DUE TO PAIN AND PT CONDITION, UNABLE TO OBTAIN VIEW. BEST POSSIBLE FILMS." Most often this is for the axillary (shoulder) view, which is only performed on those who have injured their shoulder (hold your arm straight out, or up at an angle, while turning your head opposite of the injured shoulder, lean out to the side you're holding up, now imagine doing this when the humeral head is +1" out of position).

I'm sorry, dear. I'm so very sorry you are in pain or that I have to cause this pain. I'll try to go fast/slow.

We know some positions aren't comfortable. We know our tables aren't comfortable. But we also know we need to get the correct views on the x-rays so the doctors can correctly diagnose you. We'll give you the encouragement you need, show you the confidence you need to see, give you as much energy as we can to lean forward as we lift you up by the sheet. We won't wince when you wince. And not give you any sign that yes, you do smell rancid (I know you apologized for that, but damn). No, I've seen fingers bleed worse than that.

Haven't showered for a week? No problem. Three inch long, crusty, yellow toe-nails? No problem. The auto-sphygmomanometer reads 200/120 and you ask me if that's high? No problem. Not in front of the patient. Never in front of the patient.

Back in the workroom? Oh, yea, we talk about it. We cuss, we exclaim, we wonder just WTF these people were thinking (3 days before you came to the ER, have you seen your ankle, did you notice the blood in your urine, just how many times have you fallen and hit your head?). And we cry as parts of us die because we can't help our patient.

Everybody's pain level is different. Everybody's life journey is different.

There's an exam called the osseous survey. It's about 14 images and we see almost everything from your knees and elbows up at least in one view (thoracic and lumbar spine we get a lateral view as well). There's a few things that will cause a doctor to order one. The most common, though, is checking metastatic cancer. Most patients I've done this on have been late sixties and older. Some have been in their 50s.

And then there was the teenager. Fourteen images is a lot of x-rays. These days we don't use very many actual x-rays to take an image (in fact, we're approaching the threshold where we could go lower in dosage, but the resulting film would be full of quantum mottle/noise and not very good for diagnosing anything). We measure our doses in the ones and tens of millirems/microsieverts (as a comparison, it takes 300 rem for your skin to redden, radiation sickness syndromes start above 600 rem). And an osseous survey (I think) is still less than most CT scans. But we're still giving a high chance (comparatively) for cancer. So as I'm positioning this teen for the left humerus, image number 11, I'm thinking, "Geez, I'm giving them cancer." But when we're done I wheel them down the hallway for their infusion. They already have it. And another part of you dies as you smile at them and mumble some encouragement when you leave.

A part of you dies when you see friends in the waiting room and they tell you their spouses are in nuclear medicine getting staged for lung cancer.

And a part of you dies when you hear the doctors mention the patients you just x-rayed probably won't last out the week.

And a part of you dies as you think the patient you just worked on will never have the opportunity to legally have a drink or the option of declining it.

Do you want to see that pain as I x-ray your wrist because it's sore after you twisted it falling into a chair? Do you deserve to see it as I move your leg which I can already tell isn't broken and you just have a bad bruise? Do you deserve to see it as I hold your elbow and wrist so your ulna and radius don't go further out of alignment as another tech positions the film below because I can already tell your arm is broken in two places? Do you need to see it as you tell me that I'll see some spots on your lungs from the TB you had as a kid and you're afraid it might be back?

No, no you really don't want to see that. So I put on a smile and say, "Thanks for telling me that, now take in a deep breath and hold it"; "I'm not a doctor, I'm not allowed to diagnose you"; "You need to ask the doctor if that bp reading is high."

There are patients who are so skin and bone it hurts them to lie on the table. There are patients who aren't all there and can't tell you why they are getting an x-ray. There are patients who are scared at what an x-ray might show but even more frightened by not knowing. There are patients who are so used to doctors appointments they'll start undressing right in front of you because they have no embarrassment left in them. There are the patients you're on a first name basis with because you've seen them so often. You ask how their kids are doing. I still have to ask you your full name and date of birth, though. There are patients who are in so much pain, even after morphine shots, they can only nod or shake their head. And there's the little girl lying broken on your table because some fucker couldn't wait or couldn't be bothered to watch where they were going and clipped her with their mirror.

I'm sorry, dear. I'm so very sorry.