Wow. Three parts in three days. Lets go!
You can read Part One here.
You can read Part Two here.
Thus begins part three:
I started my first day of my clinical trial, nervous and desperately afraid of failure. I met the co-workers that would be my “instructors” at the hospital for the next seven months. I would love to tell you that I connected with each of them deeply, and remember every single one of them individually… but I don’t. There were four other techs besides me and the only one I can recall was a wonderful woman named Ling.
She was an older (than me!) Chinese woman that had moved to the United States with her family. When she lived in China, she was an OB/GYN that practiced, worked with women, and delivered babies. After moving to the USA, she found that the path to practicing medicine in our country was more than she was willing or able to complete – so she decided to become an ultrasound tech instead.
I want you to imagine, just for a moment, the gift it was to have a preceptor as the main tech in charge of my training that was ALSO actually a physician. She was an absolute wealth of knowledge… not just in ultrasound and medicine, but in life. To this day, I am still thankful to have spent those seven months under her tutelage. I wasn’t well aware of it then, but she began the process of shaping the woman I would become.
So! I was Arkansas. By myself. In a teeny-tiny, lonely apartment. I was working at a hospital where I don’t really know anyone. I had no friends. I was incredibly scared. And desperately lonely. I kept reaching out to Steve, but he was always too busy to talk… which I didn’t understand at all.
Finally, after an entire week of feeling isolated beyond my imagining, I asked Steve what was going on. Why haven’t I heard from you? I feel like I’m DYING here, and you are just absent.
Steve responded with a very well written and beautifully composed email about how being married was different than he’d expected. He told me that he regrets having never dated anyone else, and that (in the week that I’d been gone) he realized that he’s been missing out on a lot. The very gist of the message is that he doesn’t want to be married anymore – but he also doesn’t want a divorce. He just wants some time to figure it out.
I was utterly devastated. I spent so much time crying I thought it was possible to die from exhaustion. I was entirely sure that I had done something wrong, failed in someway or otherwise been wholly inadequate. I was also determined from there forward to be exactly perfect, and do everything right in order to fix my marriage.
I spent the next weeks in a blur. I worked with patients and learned protocols and kept my head above water. I didn’t contact Steve unless he contacted me first. I cried all the time. I lost an incredible amount of weight, and the people around me became concerned.
One afternoon, a few short weeks into my internship, there was an exam ordered in the emergency department. In this particular hospital, we would take one of our machines “portable” for all ED exams, and travel to the department for the study. We were busy with outpatients, so Ling told me to go ahead and take a machine to the ED, get started, and she would be along shortly to scan behind me.
I rolled my machine into the room and introduced myself to my patient. She was a lovely woman with chestnut hair in her early forties. She was soft spoken and clearly in a large amount of pain. I took a brief medical history from her, and found that this was her fourth emergency room visit in the past week – all for the same symptoms.
Now, there is a thing that happens in the minds of medical professionals, and it isn’t very beautiful. It’s very easy, even early in your career, to allow empathy to fade and find yourself jaded to the state of human beings. My mind immediately assumed that this woman wasn’t in actual, physical pain – she was just looking for pain medication. BUT, I hadn’t done any of her previous ultrasounds, so I was going to do the best job I possibly could. I was hoping to be off of “scan behinds” shortly – where I’d earned enough medical respect to stand on my own as a tech.
It also bears mentioning that each hospital has their own different set of ‘protocols’ for each exam. What had been ordered on this particular woman was a “gallbladder” ultrasound which – by THIS hospital protocol – only contained images of the liver, gallbladder, pancreas and right kidney. Since I was still a student, and all of my practice scanning included our SCHOOL’s protocol, I started out my exam with images of the Aorta and the IVC. These are the two great vessels that both bring blood to and send blood away from the heart. I was scanning the aorta of my patient while simultaneously trying to hold a conversation and not act like this was the first time I’d ever scanned on my own. I listened to her tell me of her kids, and her husband. I tried to nod understandingly as she shared how scared she was that they couldn’t find something wrong with her, and she knew there was VERY CLEARLY something wrong with her. She was writhing in pain, breathing sharply and unable to take a full breath.
I kept stopping and staring at the screen. My images didn’t make sense. I couldn’t make my brain understand why there looked like blood flowing in BOTH directions in her aorta. The aorta is an artery. The blood flow leaving the heart and spreading to every part of the lower body is HIGH pressure, and very direct. It CAN’T flow in both directions. I scanned every way I possibly could, convinced that I was making a massive mistake. I’m not ready to scan alone. I can hardly make the machine work correctly. WHAT IS WRONG WITH ME??
I took the rest of the images required for the study and found, no surprise, her gallbladder and pancreas to be completely normal. I called Ling on the hospital phone and she told me to leave the machine in the ER and go ahead and present my images to the Radiologist – she would go scan behind me as soon as she was free.
The radiologist was a kind, tall, spindly older man with wire glasses. He was incredibly respectful of everyone he met. He loved to ask me questions and was always impressed with my answers. In this particular instance, I showed him my images, and told him I thought it was possible that she had a dissection in her aorta… but I was really not sure. I had no clinical confidence in myself. He looked at me for a long moment, and then asked me, “What possessed you to check her aorta on a gallbladder ultrasound?” I shrugged, worried that I had done something wrong, and told him that it was just habit… ultrasound school protocol and such.
He didn’t say much else but thanked me for my hard work.
A few hours later, near the end of my shift, the radiologist found me in the ultrasound department. He pulled up a CT scan on the same woman I had scanned earlier that day. He told me that, because of my ultrasound findings, the emergency room physician ordered a CT scan that showed my patient not only had an aortic dissection that spanned the entire length of her great vessel, but she also had an 8cm aortic aneurysm near her heart. I know these are medical terms, but try to follow me… an aneurysm is a swelling or bulge in a vessel that gets so thin the walls become weak. A dissection occurs when the blood stops flowing IN a vessel, but flows BETWEEN the walls of the vessel instead. Both of these medical diagnoses are life threatening. An aneurysm is significant at 4cm, dangerous at 6cm and deadly at 8cm.
The radiologist told me, because of the CT findings, this woman was rushed into emergency surgery to repair the aneurysm and dissection of her aorta. Her heart stopped beating twice on the table. They were able to revive her, and she was doing well in recovery. He looked me straight in the eyes and told me that MY ultrasound findings, my protocol, saved the life of a woman that had been in the emergency room three other times before she saw me. He thanked me for saving her life. I had never experienced anything like it before – that feeling of elation. I wanted to call Steve and tell him… but I wasn’t allowed.
A few weeks later, after some more brilliant highs and lows, one of my husband’s friends sent me a message out of the blue.
“I know this is going to hurt, and I’m sorry. I can’t watch him lie to you any longer. Steve is dating someone else.”
To be continued…