Last week, my beloved cat, Bandit, died in
my arms. No big deal, you may say, pets do all pass away at some
time. Well, this was no ordinary cat. He lived to be almost 14
years, and probably had experienced all of his nine lives by the
time we had to put him to sleep. He was with me longer than my
wife, my children, or anyone aside from my parents. He traveled
cross-country with me for my fellowship, hung out on the streets of
Seattle for a year, and then returned with me to the East
Coast.
Bandit had acute renal failure, superimposed on chronic
disease. During his last week of life, when he had been
hospitalized at the local veterinary clinic, we had obtained an
ultrasound of his kidneys to see if there was an obstruction or
tumor. This was new to me; I had heard about vets performing animal
ultrasound before but had never had the chance to see one. Cat
kidneys are remarkably similar to the human kidney. In Bandit's
case, one kidney had been obstructed for a long time,
hydronephrotic with cortical thinning, and the other one was
enlarged and hyperechoic, which the vet and I interpreted to mean
acute renal failure (the feline equivalent of the more common human
term "medical renal disease"). The vet, who had three to four years
experience with ultrasound, asked for my opinion regarding the
scan, as I have been involved with sonography for 15 years. The
whole affair was pretty low-tech: the machine cost $20,000 (or the
average sticker price of a new car in the U.S.) compared to
$2-300,000 (the mean cost for a home in a pricey suburb) for a
state-of-the-art human machine. Lacking any prospects for a kitty
percutaneous nephrostomy tube or dialysis, and with the poor cat in
pulmonary edema and fluid overload with the removal pump shut down,
Bandit was euthanized at our house the day after the ultrasound was
performed. As the old Vermonter says, I "watered up a bit" at his
passing.
Now what on earth does this have to do with radiology? Two
points. One is the reassurance and peace of mind emanating from a
radiological test that was performed noninvasively and painlessly.
I know Bandit didn't appreciate the ultrasound, but he didn't mind
it either, and I was impressed with the knowledge that a "lowly"
ultrasound imparted to his care and management. We knew what was
ailing him, instead of this black cat that was Bandit suffering
from a mysterious yet terminal illness. This is an advantage of
imaging that we, as radiologists, and I, as an advocate of the
patient, tend to forget, being immersed in it so completely as
professionals. And for humans, the access to imaging is fairly
widespread in this country (please, no letters on the
affordability, or lack thereof, of healthcare).
Secondly, the whole experience served as a reminder to me, a
busy clinical radiologist who interprets a multitude of
examinations each day. I, for one, am prey to often forgetting that
the films I am reviewing are images of real people with real pain
and real anxiety. Not to mention the other family members, friends,
and support people who are sharing the same experience as the
patient. This incident reminded me that we are, after all,
physicians; we all took the Hippocratic oath, and should resist
being labeled as imagers or interventionalists or not "real
doctors."
Though I may take some degree of professional satisfaction in
making the diagnosis by CT-guided needle biopsy of a young
patient's deep-seated, small metastatic melanoma, all the while my
non-physician mind is fervently wishing for a negative cytologic
result for this patient. On one hand, there are our professional
abilities, but on the other, we have human sensibilities, and these
are not always working toward the same end. So, next time you are
faced with a monotonous mountain of plain films, picture the person
who was sitting in front of the x-ray tube, nervous or scared and
often hurting. It may help to keep the compassion and humanity
alive in our work, a physician's work.