Archive for the ‘Radiography’ Category

24 Hours: Episode 1

So on Thursday night at 9pm the first episode of 24 Hours in A&E (that was filmed at my hospital) was aired. It was something of a big deal for us; there was a big viewing party at work, and my colleagues were talking about it all over social media. I was out at the time of airing, but rushed home to see what made the cut. I was both impressed and disappointed with the final program, so here’s my review.

First things first; there’s a radiographer in the intro! In previous series us radfolk didn’t seem to be properly represented, in fact, the only time you ever saw a radiographer would be in CT because that’s a fancy bit of expensive kit. But now we have one of our own, briefly, in the intro to the program! Awesome.

Things got annoying immediately after that, however. As I said in a previous post, Kerry, the patient with the amputated leg, arrived minutes before I started work; as I walked along the high street at about 19:40 I saw the helicopter fly over and land. In the program, they claim to get the 25 minute warning phonecall at 15:56 meaning she’d have landed by 16:30. Why? Why change this from the truth? Even the patient’s mum says that it was tea time when she went out on her bike- who has tea at 3 in the afternoon? You can also see in the footage- it’s the end of June and the sun is beginning to set! So straight away that’s really bugged me as it seems completely unnecessary, and kind of destroys the integrity of the journalism (it is meant to be a documentary, after all). I appreciate that sometimes they juggle the footage slightly (you’ll occasionally see gloves on/off out of order, or other things that have been moved about slightly but that’s art I guess) but why mess about with it this much? Grrrrr. It also really annoys me when they show the x-ray being done, and then afterwards they cut to footage of the scoop being removed (it’s a big metal stretcher that they carry the patient on, would kinda show up on imaging) because that has no creative merit either.

Maybe it was to add some “perspective” to the patient who kept whining about losing her leg because she had a small needle embedded in her foot (she arrived at about midday). I dunno.

Aside from all that, it was incredible (and incredibly weird) seeing colleagues on telly. But it was awesome seeing the patients’ stories, as we never get to follow up on what happens after they leave the hospital, in fact we rarely find out what happens after they leave the x-ray room!

There was also a radiographer count of five, which is impressive! And only one of those was in CT!

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Two Weeks ’til 24 Hours!

The date and details of the first episode has been released by Channel 4!

This is hugely exciting for my colleagues and I as we finally get to see ourselves on telly, and we can stop guessing which patients made the final cut.

The first episode features a patient I remember very clearly. She arrived by helicopter just as I walked onto the hospital site; the helicopter flew over me as I was making my way along the high street, and I thought to myself: “Uh oh, this could be trouble”. Our helipad closes at 20:00 and it was about 19:40 so they were cutting it very fine, and as it turns out the patient had come all the way from Essex so they’d been in the air a while.

When I got into the department I discovered that my colleague (who I’ll call Sam) was already in Resus for the hand-over (or leg-over in this case) so I stayed in x-ray and started working through the list of patients in our waiting room. When Sam returned, I was told about how the patient, Kerry, was a young woman involved in a motorbike crash which amputated her leg at the scene. And that one of the heli-med doctors handed the aforementioned leg (in a splint, covered in frozen peas and hash browns) to Sam for safekeeping while in Resus.

I really hope her facial expression was caught on camera.

A short while later the inevitable visit from orthopaedics happened, and upon returning from doing a mobile x-ray on Paediatric ITU I was told that Kerry was being taken to theatre, and that they may or may not need x-ray during the case.

I left theatre shortly before 2am, having spent a couple of hours with one of my favourite orthopods while he battled to not only fix the fracture above the amputation site, but to tidy things up as much as possible to give Kerry the best possible chance for a comfortable prosthesis.

I don’t remember a huge amount of the rest of the shift, maybe it’ll come back to me as I watch it on telly. The new series airs every Thursday at 21:00 starting on the 30th of October.

Read more about the new series here: http://www.channel4.com/info/press/programme-information/24-hours-in-a-e-series-7

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Blog a Day – A&E (9am-5pm Weekday)

So the first “typical day blog” is from A&E. Our department here has two x-ray rooms and ceiling mounted x-ray equipment in Resus (which you’ll see on Channel 4 this Autumn, no doubt!). On a normal weekday we have (ideally) two radiographers and a receptionist, and we work from 8:45 until 17:15. The areas we cover are Resus, Majors, and the Urgent Care Centre.

The day starts relatively slowly; a few walking patients from urgent care with minor injuries to their arms and legs, a couple of chest x-rays from Majors. Things remain calm until 10:15 when the trauma bleep goes off “Adult trauma team to A&E Resus…” I go to Resus to find out the details. On paper it’s a 40ish year old cyclist who’s been knocked off his bike by a bus. Open tibia fracture, but other than that all other obs are fine (he’s breathing, his blood pressure’s ok, and he’s fully responsive and coherent). He arrives fairly quickly; sometimes we get loads of notice before a trauma physically arrives, at other time the bleep is sent out when the patient is already here. When he’s wheeled in, he’s assigned a Resus bay and the paramedics give us a handover. He’s had morphine and his leg’s in a vacuum splint but the injury is easy to spot. Once on the Resus trolley the team begin the primary survey and everyone rushes round doing their jobs. It turns out that the patient was cycling along a blue cycle lane when a bus decided to squeeze between him and a car turning right. The cyclist slammed his brakes on and probably saved his own life, but the car behind the bus hit him and sent him flying over the bonnet. I’m asked to do chest and pelvis x-rays straight away to make sure he has no other serious injuries which are being masked by the pain in his leg. His pelvis is ok, but there’s a small pneumothorax at the top of his right lung. He’s taken to CT to check the blood flow to his leg, as well as the nature of the open fracture.

Back round in X-ray a queue has formed. Two chest pain patients are outside on trolleys, and there are three patients in the waiting area who haven’t been seen yet. Before I’ve had a chance to pick up the form for the next patient I hear the red phone ringing over in Resus. We get through the queue of patients just as the bleep goes off in response. “Adult trauma team to A&E Resus…” My colleague (who I’ll call Mark) goes round this time; similar story to the previous one, cyclist vs large vehicle, only this one’s much worse. The van that hit him went right over him, so he’s taken straight to CT after the handover and has extensive internal injuries including a spinal fracture (C4/5) and multiple pelvic fractures.

Meanwhile in X-ray a very unhappy paediatric patient has arrived with a very bent forearm. You can always tell it’s sunny outside when the trampolining injuries start arriving. She’s in agony, but is very cooperative (the seriously hurt ones usually are) and we get some perfect x-rays showing the greenstick fractures of her radius and ulna.

Then we get four stroke patients in a row (we “routinely” do chest X-rays for stroke patients in case of underlying chest pathology, or in case they aspirated fluid during the stroke, the usefulness of the X-rays is debatable, however).

The 5 year old with the broken arm comes back, this time in plaster, and lot less upset. She proudly tells me that she knows exactly what to do this time, and she definitely won’t cry. True to her word, we get perfect x-rays without me even touching her arm, and dad takes a photo of her giving the thumbs-up next to the x-ray machine.

The next child to come in is a bit different- “Paediatric trauma team to A&E Resus…” a two year old who was found, unresponsive and not breathing in his cot. Mum was absolutely inconsolable, screaming and crying (understandable, really) while the team attempted to resuscitate her child. He had a pulse, but his breathing was infrequent and shallow, so I did a chest x-ray, after he was intubated and it looked like he’d inhaled fluid (possibly vomit).

Things went quiet over lunchtime, with only a few chest x-rays coming in from Majors, and a psychiatric patient who had told her carer that she’d swallowed razorblades. It turns out from the abdomen x-ray that she’d actually swallowed parts from a pen, which was a relief.

As I escorted her back to her cubicle in Majors, a mortuary box was wheeled past me towards Resus for the second cyclist. Another unsurprising and unnecessary death on London’s roads.

Just as Mark made a comment about how calm things had been for the past couple of hours, the helipad response team sprinted past; the helipad had only recently opened and we were still in early double figures for patients visiting us via the roof so it was still very much a novelty. I dashed outside to see if I could watch it land, but it had already touched down by the time I got to a vantage point.

This was a straight-to-CT trauma patient who had fallen from a height of about 20 feet onto concrete. After his CT scan and on his way up to ITU we did some x-rays of his arms as it turned out that on top of the extensive lower leg injuries he’d sustained, he’d also broken his thumb…

We had a few more weather-related injuries (mostly sports, but two more trampolines), and a motorbike rider who broke his wrist in an altercation with a pothole. And then to finish the shift off, a woman came in who had sat on a wine glass and had shards embedded in her buttock- an accident which happens more often than you’d think, often enough for me to have perfected the tangential buttock projection

At 17:15 the long day people (who work until 20:00) arrive to take over for the evening. Looking at the worklist at the end of the day, I’d say we’d had at least 60 patients during the shift, fairly unremarkable for our usual workload.

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Blog a Day

A while ago I was asked by a prospective radiography student what an average day is like for a radiographer. I answered that there was no such thing as an average day as we cover so many different modalities and areas, but within those areas it’s entirely possible to have an average day, so here goes!

I wrote these blogs over the summer but have waited to publish them to avoid any chance of patients recognising themselves (in the extremely unlikely event of them reading this). Also, as I was writing the notes throughout the day, the posts themselves required quite a lot of editing and proof reading! Please bear in mind that these posts relate to a typical day in my hospital only, others may be quieter / busier or have a completely different structure.

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Industrial Inaction

It’s been ages since I last blogged, and there’s a reason for that. In the past, something would come to mind while I was at work, and I’d jot down a few points or occasionally even a full post if there wasn’t much going on. However, the days of “not much going on” seem to have passed. Since the opening of the helipad, and the major trauma network policy being that all trauma patients come to us rather than to a DGH, the workload at the hospital has drastically increased.

Other than that, there have been a few other developments; 24 Hours in A&E have been and gone, the cameras have been taken down, the fixings painted over, and the program will be aired sometime before Christmas apparently. All very exciting. We don’t yet know which particular time periods have been covered on the program, but the final weekend of filming was incredibly dramatic so I’d be very surprised if at least some of it doesn’t make the cut.

We’ve also had a load of brand new Band 5 radiographers start in the department so that’s been interesting, it’s a busy London department, so plenty of people come and go, but it’s been a while since so many newbies showed up in one go. One thing that’s quite remarkable about this graduating year group (if our newbies are a representative sample) is how many of them went on elective placements abroad; Sweden, Argentina, Singapore… all over the place. It’s very encouraging to see, because (while I appreciate not everyone is able to) it gives them the opportunity to experience healthcare provision from a very different perspective. Some countries are very similar to the UK in the way they provide radiology services, others are completely different. Radiation protection is a subject which varies greatly, and as I saw in Nepal, in some places the concept does not exist, and from chatting to some of our new staff they also saw that elsewhere in the world. Also, while the UK tends to be very modern generally, because our healthcare is provided through taxation, funding is limited, so we don’t always have the more cutting edge equipment available to us. In countries like Singapore, you get to play with the really fun toys.

And on the subject of funding…

The current pressing matter is that of industrial action; several unions have balloted their members, including the Society of Radiographers, and a vote to strike has been made. It wasn’t an easy decision, withdrawing labour is usually a last resort, especially when it is going to have an effect on patients, but since the Tories have been in power, NHS staff have effectively endured continuous pay cuts, and it’s got to a point where something must be done. Personally, I feel hugely uncomfortable- I’ve attended many protests and handed out leaflets to the public, but I have never participated in strike action before, in fact until the two ballot papers arrived at my home last month, I’d never even seen such paperwork before. I was even more conflicted when the ballot result was returned- a turnout of 41% with only 53.3% voting for strike action, and 78.9% voting for action short of a strike. So in reality, a fifth of radiographers voted to strike. Luckily there is currently no minimum turnout to validate a strike, and in my opinion if there was to be one implemented, the same should apply to a general election.

But nevertheless, a strike has been called. so next Monday radiographers across the UK will walk out at 9am and not return to work until 1pm, and I shall be one of them. I’m quite disgusted with the way that the NHS has been treated by the government, with large chunks being sold off to politicians’ friends for a hefty profit, cuts to funding, and disparaging comments being made by those in a position of immense priviledge. Yesterday a significantly larger strike took place, with Unison members on the picket line from 7am. I joined the picket for an hour before work yesterday, and it was lovely to bump into June Hautot again, a local “trouble maker” as she has been described. I doubt we’ll have as much support on the 20th, but I’ll certainly be there regardless of the weather!

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Work Experience

Recently the SoR tabled a motion about whether to make work experience mandatory prior to commencing a radiography degree in the UK. Surprisingly, it failed to pass, even more surprisingly for the reason that apparently some students find it difficult to get work experience as their local hospital may not allow it.

I feel that this raises a few issues which need to be addressed:

1) Radiography degrees in the UK are funded by the NHS for domestic students. This means that upon graduation, you end up with an internationally accepted degree, with good job prospects, and nowhere near the £27k debt that your flatmates were lumped with. It also means that a lot of money is wasted when students drop out of the course, which happens, a lot. Attrition rates are around 40% nationally, which is shocking, and surely must be at least in part due to students not being prepared for what they’re expected to do.

In my year group, 53 started the course in September 2009, but only 39 graduated in 2012, and I know from talking to some prior to their departure that it was because they were not expecting it to be what it was. Our first placement was within 10 weeks of the course starting, and this was the point of the first exodus. Obviously the academic workload was a major factor for some people, but other reasons I’ve heard range from “I didn’t know I’d get vomited on” to “I can’t stand the sight of blood!”. Even a day’s shadowing would give enough insight into our exposure to bodies and their fluids. One student I spoke to recently asked me how long it takes to become a radiologist once you begin radiography training. I explained the difference, and she seemed genuinely surprised that one didn’t lead to the other.

Personally, I find this level of ignorance unacceptable; in the internet age where information is a few clicks away, and emails can be sent with minimal effort, it really isn’t difficult for people to show an interest in the career they’ve decided to pursue. Which brings me to:

2) Apparently some hospitals don’t accept work experience students. This is an issue which needs to be fixed but it can also be avoided; if a hospital isn’t interested in teaching the next generation of healthcare workers then quite frankly, it’s not somewhere a student should be interested in visiting anyway, because that’s a crappy attitude. I’d be interested to hear the reasons a department could give, so please, if you’re aware of any, leave a comment or two below.

So then it’s up to the student- if your local hospital won’t let you visit, go somewhere else! You’ll have to travel to your placement sites once you’re enrolled anyway, so this really can’t be regarded as extraordinary effort. I appreciate that people have jobs and kids and other commitments, but this is your future career we’re talking about. Is it really too much to ask?

 

As everyone is probably aware, the NHS is under constant pressure to cut costs, and like most huge organisations is quite wasteful in places. Stupid things like paying over the odds for toner cartridges, or allowing boxes of sterilised orthopaedic equipment to expire, unused, in store rooms, spring immediately to mind as things that I’ve personally encountered. On the subject of NHS funded education, one idea I’ve heard thrown around is to make drop-outs to pay the NHS for the tuition that they received, but I fail to see how that’s enforceable. Especially from students who drop out of further education entirely.

Another way of ensuring value for money could be to make it so that NHS funded students must work for the NHS for n years post graduation, something I assumed was already in place prior to fully researching the degree. This wasn’t an issue for me before signing up as I wanted to work within the NHS anyway*, but I was genuinely surprised to discover that the NHS would pay for your education and then you could bugger off to a private practice as soon as you graduate. Interestingly, in my research for this post I discovered from a UoP lecturer (thanks Mark) that of my year group only two graduates went into the private sector immediately, which isn’t terrible. Also, one went into the priesthood, so that’s… different. And apart from another graduate who left healthcare entirely, and one who has successfully avoided the Alumni’s radar, the rest went into the NHS for their first posts.

*There was a short period of time where after meeting Noel Fitzpatrick (the Supervet) at the UK Radiological Congress in 2012 and talking to his chief radiographer when I desperately wanted to work at a veterinary practice, but after composing an email to them with my (not exactly huge) CV attached, I let it sit in my drafts for a while before deciding to get some experience in the human world first.

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Smile for the cameras!

When I first began looking at a career in health care, I spent some time thinking about what it was that attracted me to the idea, and whether the areas I was looking at would satisfy my interests. One of the things which drew me to radiography was the variety within the job, covering all of the different modalities (CT, ultrasound, theatre imaging, plain film, dentals, mobiles, interventional, fluoroscopy…) and then within even the most “vanilla” modality it can take some quick thinking and improvisation to get a decent image. Our patients vary in condition, regardless of what we’re x-raying; sometimes due to disability, disease, injury, cognitive state, fear, language barriers etc, and these can all affect how we have to interact with them, and can mean deviating quite considerably from the textbook methods of radiography.

An area which can really challenge a radiographer is Accident and Emergency, for the reasons listed above, but also throw in a very real sense of urgency, a suffering patient (who may be terrified and confused), anxious relatives, inpatient doctors (probably an unhelpful orthopod too for good measure) and it can feel like everything is against you.

Often we get called to resus to attend a trauma call (when a patient is handed over from the paramedics following serious accident or injury) and we have to take x-rays while the team are still working hard assessing and stabilising the patient. This requires a certain amount of assertiveness from the radiographer, as you need to be able to judge exactly which moment you will be able to take the exposure, as well as warning the team not to get in the way.

If you have watched the excellent Channel 4 series 24 Hours In A&E you’ll be somewhat familiar with this process. If you haven’t watched it, the program is one of the few reality TV shows worth your time; 90 static cameras were installed around the A&E department at King’s College Hospital and controlled from a separate location, allowing the medical staff to carry on with their work without interruption. The show typically follows 4 or 5 patients from their arrival at A&E, all the way through to a follow up a few months later. Obviously this is all done with the full consent of the patients and their relatives, as well as the staff involved in their care.

The series first aired when I was a radiography student and I was instantly hooked. As diagnostic radiographers it’s not often that we get to follow a patient’s story outside of the brief snapshot that we get to see, so it was interesting to watch what else a patient experiences during an A&E visit.

So you can imagine my surprise when I heard that Channel 4 were moving out of King’s and into my hospital! The cameras are being installed over the next few weeks and filming begins in May. Naturally some of my colleagues are dubious, but personally I think it’s brilliant news, and a clever move for Channel 4 as our helipad opens next week, meaning that the A&E department will be significantly busier by the time the cameras are switched on. I don’t know when it will be aired, but I imagine it’ll be late Autumn at the earliest, so keep an eye out for the trailers!

Incidentally this means that my place of work will no longer be a secret, but I still won’t name it openly so please don’t ask!

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Out in the Open

So some exciting things are happening at work this summer, and in order to blog about them (which I really want to) I will have to indirectly out myself and my employer. This shouldn’t have a drastic effect on this blog but I will definitely be seeking advice on how to continue without jeopardising my career or my patients’ and colleagues’ privacy.
Watch this space.

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Differing Opinions

Uh oh,  it’s February and this is my first post of the year… Oops! I have a couple in my drafts but I need to let some time pass before publishing.

I just wanted to throw a quick question out there to my fellow health professionals as it’s an issue I’ve encountered a few times recently. What do you do when a patient says something you really disagree with, expecting a reply, and you know you’re going to be stuck in the examination room with them for an awkward few minutes?

I had to endure a patient’s hateful anti-cyclist diatribe shortly after attending a nasty cycling related trauma call. He even trotted out the ridiculous “they don’t even pay road tax” nonsense. I kept my mouth shut and refrained from providing my opinion because it wouldn’t have been appropriate, but it was a very uncomfortable experience for me.

How do you deal with these situations?

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“Superstition Ain’t The Way”

Medicine in this country is fairly evidence based, with a few exceptions usually presented in the name of “patient choice” (such as homoeopathy, chiropractic, and acupuncture being offered on the NHS). Healthcare professionals are expected as part of our ongoing clinical and academic development to keep informed on the best current practices within our field. Despite this general approach, hospitals (specifically A&E departments) can be incredibly superstitious places. In this post I’d like to cover (and maybe debunk) some of the superstitious behaviour that I have noticed.

Bark at the Moon
There’s a widely held belief that a full moon affects human behaviour, more specifically that it causes people to go crazy, thus making A&E departments (and police stations) busier than they would normally be at any other time of the month. People give various reasons for this, everything from the vaguely believeable (full moon = more light at night, therefore people stay out later and get up to mischief) to the completely bizarre (our bodies are made of 70% water, therefore if the moon has an effect on the seas, it must have an effect on us). This myth is so prevalent that it has been studied by academics to discover if there is any truth to it, and repeatedly it has been disproven. Nevertheless, once a month, a chaotic resus department will be blamed on the moon.

The “Q” Word
If they’re not pointing the finger at celestial bodies, A&E staff like to blame a sudden influx of patients on someone, somewhere uttering (or thinking about) the “Q word”. This one has got me in trouble a few times, as until recently I was wilfully ignorant of such superstition, so I once merrily wandered into majors and declared “corr it’s quiet in here tonight!” only to be practically mobbed by the nurses who were happily enjoying their rare minutes of downtime. On a recent night there were about four very drunk, quite rowdy patients in resus, and by 1am they had all either been discharged or fallen asleep; I went round to do a chest x-ray on a stroke patient and remarked to the doctor in charge that “it’s a lot quieter in here now!” referring to the volume rather than the workload. He shot me a look that pierced my soul and walked away. I was suitably embarassed.

The funny thing with this particular superstition is that it is a self-fulfilling prophecy; if it’s got to the point that it is so quiet that it’s worth remarking on, regression to the mean dictates that the situation will probably change soon, regardless of the language used in the department. I’m desperate to ask one of the A&E consultants if they genuinely believe that words uttered in resus can cause a major trauma 4 miles away… I’m not that brave though.

Lucky Number 12b
This isn’t a universal thing by any means, not every hospital adheres to this superstition, in fact, not every ward within a hospital observes it, but in Trogdor’s Majors A&E there is no cubicle 13. There’s 11, 12, 12b, and 14. However most of the actual inpatient wards do have a bed 13, so maybe it’s just an A&E thing. On a related but separate note, clinicians have been known to close an A&E bay if it appears particularly unlucky; on a recent night shift, 4 consecutive patients who were admitted to resus bay 2 died. The first was a cardiac arrest (who was unlikely to have survived as they had had multiple arrests before the paramedics arrived), one was a major trauma who had severe blood loss, another was a stroke, and the last was admitted with sepsis and neurological instability. Plainly, there was nothing wrong with the bay itself to cause these deaths (that would trigger a profoundly serious investigation) but such was the bad feeling about it that it went unused for a couple of hours until the other bays were all full. I don’t think anyone else passed away for the rest of that shift- maybe the trauma gods were satisfied? Who knows.

“Bad Nights” and “Good Nights”
I think that in the US these are called “black clouds” and “white clouds”, but they mean the same thing; certain people get branded as having “bad” night shifts, or “good” night shifts. I’ll be looking at the rota, and someone will say something like “oooh, you’re with Dave, he has really bad night shifts”, which is always helpful. Some people will even go to the extremes of swapping shifts to avoid working with certain people (although they might be using it as an excuse!). I can’t help thinking that this has more to do with how much the person moans about how horrible their shift was, as the people I know that have a reputation for “good” shifts have actually had some hideous ones, they just keep their mouths shut about it.

That’s all I can think of for now, but if you’ve encountered any peculiar superstitions within the medical field, feel free to share them in the comments!

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