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Signs of Obsolescence

Mon, 03/25/2013 - 9:37am
Bruce Campbell, MD, Medical College of Wisconsin Otolaryngologist

Tell me to what you pay attention and I will tell you who you are.
-Jose Ortega y Gasset   

The senior resident hauled our little band of medical students down to the radiology file room. As he dug through the heavy manila x-ray jacket searching for films, he told us the patient’s story. “This 63-year-old lady was really sick when she came in. Heart attack a couple of years ago. New trouble breathing. Swollen ankles. She was miserable. She was in the ICU for over a week.” 

He slid one x-ray after another from the jacket, searching for the chest x-rays that had been taken with a machine rolled to her bedside in the intensive care unit each morning.

“Aha! Here they are!” He snapped the films up onto a series of light boxes and pointed to the one on the left. “Okay, students. This is the chest x-ray from the emergency room the day she was admitted. What do you see?” 

We were on our first hospital rotations. We had a pretty decent understanding of anatomy, biochemistry, and pathology, but knew little about clinical medicine. We stared at the x-ray and said nothing. 

“Okay, people. Look closely. Describe what you see.” 

“Well,” said the bravest among us, “the lungs are here. Here are the ribs and the spine. Here is the heart and the blood vessels. Oh, the diaphragm is down here.” 

“Good, good. That’s a start. So what do you see that is different from a normal x-ray?” 

This was tougher because we had so little experience with either normal or abnormal images. We stared blankly. 

“C’mon. The radiologist has left you some clues. What do you see?” 

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