The Shadow Doctors

Dr. Cranky must deal with an interesting medley of personalities as he carries out his daily duties, and one of the most interesting of these involves the shadow doctors. A shadow doctor, in the medical lexicon, is also known as a Radiologist. These men and women live in dark cubbyholes deep within the bowels of every hospital across America and practice a strange, occult combination of clinical medicine and physical science.

They are quite clever and make their livelihoods by bouncing energy either through (in the form of ionizing radiation) or off of (in the form of ultrasonic sound waves) actual human beings and interpret the pretty pictures which result. Sometimes even this is not enough for their tastes and they have been known to play with a patient’s very molecular structure by exposing them to extreme magnetism (via Magnetic Resonance Imaging) or by having them consume various radioactive substances (referred to as Nuclear Medicine) to see what “lights up.” These are physicians with whom Dr. Cranky has a love/hate relationship. How can this be, you may ask? After all, Dr. Cranky seems to be such an amicable chap. How could he not greet each of his compatriots with a hearty “hail good fellow, well met!”

On the one hand, Dr. Cranky loves radiologists because they often give him the answer to some vexing problem he has been unable to solve on clinical grounds alone. A patient with chest pain, for example, might only have sore chest wall muscles. On the other hand, he might have a pneumothorax (collapsed lung), a malignancy (cancer), an infiltrate (an abnormal accumulation of something, usually infection) or any of a whole host of nasty suprises lurking within. In a lot of these cases a quick X-ray will provide the diagnosis posthaste. Although Dr. Cranky has been reading his own X-rays for some time (and believes he is reasonably competent to do so) there comes a time when the shadows on the film are not at all clear and help is required. This is where the trained eyes of the shadow doctor come into play. They can often provide Dr. Cranky with the information he seeks, and good patient care is the result. The second reason Dr. Cranky has a fondness for radiologists is more personal. His direct antecedent, the Cranky Father, is a retired shadow man himself. Dr. Cranky would not be where he is today had it not been for his dear old dad toiling away in the godforsaken darkness.

On the other hand, the hate part of the love/hate relationship comes from the radiologist’s frustrating and often infuriating tendency to equivocate and hedge when it comes to their interpretions of the pretty pictures. For example, if Dr. Cranky should have a patient’s electrocardiogram (a tracing of the electrical activity of the heart) and was not sure of the patient’s underlying rhythm, he would take it to a cardiologist for his opinion. The cardiologist would look at the tracing and quickly give Dr. Cranky his thoughts as to what it showed. He would say something along the lines of, “oh, it’s obviously multifocal atrial tachycardia because of the multiform p-waves.” Or, he might say, “no, it’s definately not multifocal atrial tachycardia because of the absence of p-waves. I think this rhythm is atrial fibrillation.” The cardiologist would not say something like, “hmmm, irregularly irregular rate and rhythm; might be atrial fibrillation, might be multifocal atrial tachycarda. Clinical correlation is advised.” And this, dear reader, is exactly the sort of thing radiologists like to say.

“Who knows what evil may or may not lurk in the bodies of men? Might be an early infiltrate, might be a nodule, might be an artifact. The SHADOW DOCTOR may or may not know! Clinical Correlation is advised!!!”

On a final note, Dr. Cranky is not the only one who feels this way. The Cranky Father himself would often express similar frustration regarding his younger colleagues. “I trained in the 1950’s and we were taught to say what we thought,” he would say. “These younger types seem to be trained to avoid giving their opinion.” According to the Cranky Father, the symbol of the American Roentgen Ray Society (the oldest society of radiologists in the United States) should be a weasel (symbolizing the radiologist himself) eating a waffle (since he will often refuse to give a clear opinion as to what he might or might not see), under a hedge (since he will inevitably try to give himself an out by stating that what he does see might or might not represent something specific).

This may or may not represent Dr. Cranky’s opinion based on his astute observations.

Clinical correlation is advised.

About Dr. Cranky

Dr. Cranky is a residency-trained, board-certified emergency physician who has been fighting in the trenches of American medicine for far too long. Each day he tries to stay one step ahead of burnout. Despite his best efforts, burnout seems to be closing in fast.
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