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Medical Humanities

On the Penetrating Capacity of Ultrasound

Sarah Bugg

January 17, 2018

“So, who would like to be our patient today?”

The good doctor looked around, smiling at each of us in turn. I had not volunteered to model on “Shoulder Day,” so I returned his smile and stepped forward out of the gaggle of my classmates.

I peeled off my scrub top and scrunched it into a ball to serve as a pillow. Today, we were practicing abdominal scans. Keeping my shirt on would mean an afternoon of goopy fabric plastered to my torso. The radiologist teaching the course squirted a dollop of gel onto his probe and flipped off the lights. My abdominal muscles involuntarily contracted as the cold jelly made contact. Just as instinctively, my classmates tightened their circle to see the screen. There, in 10,000 shades of gray, my organs offered up their secrets.

Beneath layers of salt-and-pepper muscles separated by white stripes of fascia lay my liver. Dr. D was already enlightening the class, “From the echogenicity alone one can deduce that this liver is non-cirrhotic.” With everyone reassured that my liver could handle all of the alcohol that medical school generally requires, the radiologist shifted his focus to a little sliver of black nestled more deeply in my abdomen.

“About 2 hours ago.”

“Pardon me?” I had no idea how to respond to this observation from Dr. D that was apparently directed at me.

“About 2 hours ago you had a snack, huh?”

I considered. “Yes. That sounds right.”

“Your gallbladder agrees.” I was stupefied. I was also no longer sure that I had signed up for this.
The transducer slid more inferiorly. “Your bowels say that you maybe had some coffee since then, though.” Dr. D settled his probe over a particularly feisty loop of ascending colon and demonstrated to the class how my recent caffeine intake was reflected in the frequency of the peristalsis on the screen.

I scrunched my eyes closed, already cringing in anticipation of the moment when the doctor would find a nice lump of stool to show off to my classmates, probably accompanied by a list of everything I had for dinner last night.

Instead, I heard him quietly chuckling. I cautiously opened my eyes and looked up at the screen. The joke apparently related to the image frozen there: a mysterious gray circle hemisected by an equally mysterious white line. He laid the probe down, the cord draped across my flank. With a single finger he points at the more superior gray semi-circle.

“So, you like to run, huh?” The shy radiologist continued to snicker, thoroughly tickled by the private joke whispered by my hypertrophied psoas and iliacus.

These muscle fibers lie deep within my torso, nestled next to my ilium. There they sit, tight-lipped, never gossiping to anyone about my pastimes. I suddenly felt betrayed. This man, with some well-aligned crystals, was able to elicit tales from my silent organs. I had not understood what power I had given him.

Still, he continued. The sound waves scurried through my torso and ran back to tell their secrets to the transducer. A view of my inferior vena cava was now on the screen. Assessing my volume status, he noted, “Evidently coffee was the only liquid she has had today.” It was true. Just for kicks, he scanned my bladder and reported exactly what size coffee it was.

 

Using his calipers and his probe, Dr. D told a story. He fully believed that he told my story. Unfortunately, all of the data he gathered had resulted in him knowing less, rather than more, about his “patient.” My psoas hypertrophied over months of stress-running, the pastime that has allowed me to maintain my sanity in medical school. The gallbladder-shrinking snack was eaten in a funeral home, a stall as I worked up the courage to say goodbye to the lady in a box in the room next door. The peristalsis-inducing coffee was lousy gas station coffee that I chugged to stay awake as I drove like a madman to make it back for class.

As I lay there, I began to worry. I worry that, as providers, we too stand shoulder to shoulder, crowding around tiny screens in dark rooms and going blind from staring at these vague shapes on monitors. We hole up in our close workrooms with our labs and our images and our track marks and we chuckle to ourselves—mental pats on the back for the cogent story we have managed to tell. We gather boxfuls of data scraps, select our favorite odds ‘n’ ends, and stitch these together into a ragged blanket. We take a corner in each hand, stretch our arms wide, and cover our patients in these quilts. We peek in on them and perhaps tuck in a frayed edge that has worked its way out. Once they are respectably cocooned, we see only the story we have woven for them.

Let us stop with these inane sewing projects. Let us simply turn on the lights, have the patient sit up, put their shirt back on, and tell us “what brought them in today.”

There are some matters an ultrasound beam cannot penetrate after all.


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