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Editor's Comments on 'Neuroimaging'

 , July 15, 2016

Many medical students hear a story in their training that echoes so across programs that it seems almost apocryphal. A husband – a physician no less – buys his wife a full body CT scan for their anniversary, part curiosity, part novelty, part health screening. An unexpected, asymptomatic finding. A further rule-out test. Biopsy followed by complication. Death.

Fact or fiction, once we’re on the wards, we see a more subtle cousin of this story replay all too often. In “Neuroimaging”, author David McArdle, intern at the Royal Hobart Hospital in Tasmania, Australia, focuses in on one of those hard choices that patients, families, and their doctors are forced to make once the test has resulted in an answer we never wanted. The testing performed on the narrator's patient reveals an aneurysm. Now that the patient and provider are aware of this "bulging blood-filled berry" in the brain, the question becomes, to treat or not to treat? This choice is made more difficult by the fact that the anomaly involves the brain, the organ that makes us us; a ruptured aneurysm could result in lasting impairments to one's personality, motor skills, one or more of the senses, or, in the worst case scenario, could take one's life. Even with a complication at his fingertips, the narrator doesn’t question the patient’s choice to go to surgery; he feels only empathy for the position of having to choose. The poem’s final lines offer some of the hardest advice in an era where information, testing, and imaging are so readily available: “If you feel okay, avoid the choice / Don’t scan your brain.”

Benji Perin