De-Mystifying the Grey

“There’s no such thing as all or always, for everything there is an exception,” said Dr. Jerrold Teitcher, Director of Radiology at the Rockefeller Outpatient Pavilion, on the first day of my rotation with him.

The unnerving feeling that one year of Radiology within our Gross Anatomy course had not made me any more confident in reviewing scans inspired me to seek out a rotation in the field. I would be spending the summer between my first and second year of medical school at the cancer center where I’d first shadowed overnight. The timing was tricky – new residents and fellows began their time in the hospital within those summer months, and a medical student underfoot could potentially slow down teaching. Luckily for me, Dr. Teitcher was willing to add a student to his cohort.

My first thoughts, as we reviewed scan after scan, were of the terrifying capacity of cancer to displace organs from their natural positions within the human body. My second was of the impressive acuity with which the radiologist identified subtleties between normal and malignant tissue. It was a far cry from the classic presentations of disease which were drilled into us in class; here, instead, was a fine art, crafted over years of training and practice.

I gained many pearls of wisdom as the day progressed, from the evaluation protocol for surgical candidates to the differentials for non-enhancing cysts, and even the best places for coffee around the hospital. Throughout the day, there was a steady influx of consults on everything from infusion doses, to patient orders and  requests for “wet” radiology reads – the expression referring to a practice of the radiologists reviewing an x-ray film while still literally wet, one that dated back to a time when films needed to be dried following chemical soaking for development. He was  clearly a favorite with his team, and had commentary, for my benefit, on each person who came in.

Of course, I was completely won over when he brought up The Emperor of All Maladies by Siddhartha Mukherjee, and then launched into a concise review of choice medical literature to add to my book list, including his favorite, Tuesdays With Morrie. The week progressed in similar fashion, with reviews of dozens of scans, consults from every service and teaching tempered with humor. I was enthralled by week’s end, my time in radiology having surpassed my expectations. Before medical school, I had something of a stereotypical impression of radiology as a gloomy field , but now I didn’t find that to be true at all.

There were two fellows with Dr. Teitcher’s team, almost brand new, and the day alternated with each taking on a set of scans and presenting at midday. The endeavor reminded me of what rounds in the Medicine Service were like, with presentations punctuated by teaching. I saved my questions for quieter moments, often jotting down terms to look up later. Despite the many singularities in fields of medicine, there was something reassuring in seeing their similarities. And something remarkable in the shared goal of patient care. One of the last pearls the doctor shared with me illuminated the enormity of this shared purpose: “No matter how bad it is, you’re lucky to be on this side of the encounter.”

Every scan we read belonged to a patient whose life could be altered by the reading he gave, by oncologist’s presentation, and by the assessment from the surgeon. Nowhere I had shadowed had highlighted the shared responsibility of medicine so clearly as in radiology. Nowhere had I seen interdisciplinary efforts so cohesively managed as they were here where communication between physicians is so essential. It all starts with a scan; it all starts with a read. The grey of radiology, it seemed, had hidden to me how invaluable, how much of a foundation to medical decisions radiologic evaluation is.

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