Thursday, December 30, 2010

Image This!

I think it was a mistake when I requested to work on that assignment.  I survived cancer, I was (and am) doing well so I thought working on a project at a cancer hospital would give me a real sense of fulfillment.  It only managed to piss me off.

This cancer hospital in Florida was revamping its entire radiology department by converting from film to digital imaging.  I was there to help make that happen and to teach the radiologists to do their jobs by viewing images on a computer, instead of looking at a piece of film on a light box. We worked closely at the viewing stations, pulling up patient exams on the monitors, one after the other, configuring their settings and tools for maximum efficiency. “Throughput” it's called, in the “healthcare biz”.  The number of patients you can put-through the system in a given period of time-that's it, exactly.  My mind conjured up images of a train of endless patients sliding through narrow CT and MRI scanner rings. Yep, that's throughput. 

There were a lot of us cancer survivors in that place, which for me, includes everyone from the minute they are diagnosed.  Business was too good. 

Working with radiologists can be challenging.  They are a strange breed. Their work is vital but unlike other specialties, many of them do not actually see or touch their patients. They spend hours, in darkened reading rooms, quiet music playing, removed and insulated from the hospital's drama and chaos, manipulating images, measuring tumors or reconstructing damaged body parts in 3D.
Unlike standard hospitals where I spend most of my time, that place was a comprehensive cancer center, which means that nearly all of the exams we encounter have some sort of cancerous pathology, either newly diagnosed, or metastatic (cancer that has spread from its point of origin to somewhere else in the body).  I try not to visibly cringe or my credibility as a health care professional might be called into question, but it's tough not to react to the malignant images.  Occasionally the radiologist or I will remark with considerable understatement about something particularly gruesome we see- “Oh, that's not good” or “Oh, I bet that hurts”, but not much else.  I really have to struggle to keep from running out of the room when I see someone close to my age, whose breast cancer went wild and has spread to other vital organs of their body.  I am not sure which I dread more, the idea of it spreading to my brain, liver or my bones.  They say the best way to die is when it spreads to your liver because you are pretty out of it at that point and quietly slip away into a coma.  I know I fear the pain from metastatic bone cancer.  As for brain tumors and losing my mind, I can’t even go there.

Old medical joke:

Q. How do you hide a 100 dollar bill from a radiologist?

A. Put it on the patient.    Funny.  Sorta. 

It is said that most doctors see the patient and have to imagine the disease. On the contrary, radiologists mostly see the disease and have to imagine the patient.   For anyone living as a cancer survivor, and for me at that time in my life, it was hard to imagine a day that didn’t involve thoughts wildly ranging between hope and despair.
Constantly observing one cancer filled image after another did not help the healing process.  CT images of bodies waging futile campaigns against an indiscriminate killer, kept my life's imaginary hourglass clearly visible. 

And then there was guilt. 

Over the years I’ve been able to accomplish what might be considered some fantastic feats of physical endurance for anyone, much less a cancer survivor. 
A few years ago I climbed a mountain many of them will not live to ever visit.
I WAS one of them but they couldn’t know that by looking at me.  Making eye contact as I passed patients in the various departments was close to impossible.   I was and still am the picture of health.  My scans clear, my health good.  I was an intruder there. Worse, I managed to escape and left my buddies behind.


I've been tossed out of a club I didn't want to join in the first place.
I wasn’t insulted, but somehow I felt strangely set adrift.   I sensed or maybe I just imagined that they looked at me with envy and desperately wish to trade places (or bodies?). They couldn’t see the damage I live with and overcome every day.  I am familiar with the desperation that would drive those thoughts.  I've had them.  When I'm caught up in a fit of panic that the cancer has returned because of some unexplained pain or illness I'm having I get scared and mad all at once.

What really gets me especially worked up is when I see people deliberately pissing away their health in various ways.  I had to quit working directly with patients because it made me angry all the time.  When a 400lb. patient would come to the radiology department complaining of back pain, it become increasingly more difficult for me to keep my tongue in check.  What they needed was a damned diet and some exercise, not an x-ray.  I love to help people, but I have a really hard time helping people that are bent on self- destruction.  Not very politically correct of me, but so what? Call it judgmental, call it whatever you want but that's my reality.  It’s tough to exercise good judgment in this life, without being judgmental. 

It was hard as hell to be there.  I began to realize that my mission to help cancer patients had rapidly turned into an exercise in futility.     
I got so flustered one day I had to take a break from the dark reading room.  I stepped outside the hospital to take in the soft, gulf coast sunshine.  It was warm, bright and beautiful.  Then, I saw bald people also outside, in hospital gowns and wheelchairs enjoying the sunshine too.   Many were smoking.
The rising cigarette smoke would curl around and practically caresses the IV bags hanging on the poles attached to their wheelchairs. Some were so weak that they had to have someone push them outside so they could have their cigarettes.  I became so enraged that I all I could think of was that I wanted to kick them all in the chest and knock them over backwards on their asses.  I knew it wouldn’t help but I couldn’t keep myself from thinking about it.

  Nothing helped. 

Disgusted by what I saw, I stood up and went back inside.  

Perhaps by getting out of the sunshine, I managed to avoid skin cancer.   

1 comment:

Dogwood said...

Gosh, you cover so much turf. First, the connection between the abstraction of the X-rays and the reality of broken bodies. Just like you look at the Twin Towers wreckage and immediately visualize the human trauma attached to this magnificent wreck. Seems like you can't escape the real world, which is a troubling place to be. Those of us that can't shut our eyes are in for a rough time of it now and then.

I've got mixed feelings about the self-destructive vices, such as the smoking and obesity you mention. We've all got our demons and our little manners of escape, and I fear we're becoming a world of tongue-clicking nannies and killjoys, backed up more and more by force of law. Partly this is driven by the human need to meddle in other people's lives. And of course, partly it's because our dynamic is changing in ways that make us pay for the other guy's indulgence. If I have to pay for your cancer, then I get to tell you not to smoke. This is a problem inherent with the "caring" society. As we are compelled by law to "help" each other, it becomes a matter of financial necessity to beat each other into submission. Carried too far, this "help" becomes smothering and dehumanizing.

When did "judgmental" become a swear word? This is a recent phenomenon. Of course you've got judgment! In the world I want to live in, the fat slob can eat himself to death, and you can refuse to treat the fat slob because you'd rather spend your time helping people that aren't suffering from self-inflicted wounds. That's the "liberty" thing that we're losing sight of. I want us to be good people, charitable people. But if our personal judgment becomes null and void, and a shameful thing to express or act upon because we've yielded authority to bureaucrats, then again, we're losing our humanity. (This seems to be my theme for the day.)