“Well Dr. Wrak, you have completed twenty weeks of surgery and Dr. Ony has passed you,” says Dr. Q.  Dr. Q is the chief of internal medicine at Amityville hospital and oversees the fifth pathway program offered by New Amsterdam College.   Dr. Q stands slightly taller than average, has a slight build, olive colored skin, thin hair, but bright eyes.  His teeth show that braces were too expensive for his family in his youth and now as a rich medical doctor, he still has not corrected the poor bite which stands out when he smiles.  “I think that it is time for a vacation for you.  What elective rotation would you like for six weeks?” inquires Dr. Q.   “I would like radiology because there is no call in Radiology,” says Dr. Wrak.  “Don’t you like call,” explores Dr. Q.  “Not when it is every third day and I have to do surgery in the middle of the night,” says Dr. Wrak. “You will like the Radiology vacation,” says Dr. Q. “Dr. Pine will be instructing you.” “He is an extremely busy man.  Do not speak as you sit in the reading room and Dr. Pine will instruct you.”  “Not a word!”  insists Dr. Q.  “Not a word!”  “I promise,” says Dr. Wrak, “When do I begin?” “As soon as you leave this room.” Says Dr. Q.  “Dr. Pine is a pioneer in balloon angioplasty and will let you assist him if he likes you.”  “They read at ten AM and Four PM.” “Be there.’  “Thank you Dr. Q.” says Dr. Wrak.  As Dr. Wrak walks out of the room he hears again in the hall “Not a word Dr. Wrak.”   “Yes sir,” says Dr. Wrak as he enters the stairway and walks down from the second story at Amityville hospital into the stairwell.  Radiology lives on the first floor next to admissions.   The sign says, “Radiology, Patients enter here.”  Down the hall a smaller sign says, “Doctors only.”  Wrak chooses to enter there.  The cryptographer at the desk next to the door says, “Dr. Wrak you are late.  They are reading now.  Enter the room and take a chair in the back if one is available.  If not stand in back until they finish reading.”  “Thank you,” says Dr. Wrak.  The reading room lies to the right behind a sturdy oak door.  Inside the lights shroud a huge wall of white fluorescent reading screens with cloth pins at the top of each screen to hold the transparent X-ray films.  Comfortable padded chairs sit behind the screen plush with padding. Dr. Pine sits with three residents looking at films.  The room is dark and a red light provides enough illumination to enable a person to walk safely.  Dr. Wrak decides to stand in back.  “Good morning Dr. Wrak,” says Dr. Pine and he resumes reading films.   “This one is an intusception. Notice the fluid level above the obstruction. Phone third floor now.”   He flicks the film off the wall and places it back into a manila envelope.  A resident grabs the envelope, stands up and leaves without speaking a word.  Dr. Wrak takes his seat.  “This film is reactivation tuberculosis.  Notice the cavitation in the right lung apex on an anterior posterior.”  He puts the film back in an envelope, hands it to a resident and the resident leaves like the first one.  “Dr. Wrak, remember tuberculosis prefers the right lung because the main stem bronchus juts at a right angle.  The left stem bronchus exits at forty five degrees.  Above all be systematic in your analysis.” Says Dr. Pine.  Dr. Wrak nods his head once.   Dr. pine shoots through ten more films, looking at a film, writing an interpretation, and throwing the film back into a manila envelope.  He does this quickly and the clothes pins holding the transparencies on the wall make a snapping noise with the speed and ferocity of the actions.  “I am done.” Exclaims Dr. Pine.  “Do you want to assist in a procedure, he inquires.”  Dr. Wrak nods his head once.  “Get a radiology badge from the front office and meet me in surgery in thirty minutes.” Says Dr. Pine.  Dr. Wrak nods his head once.   The cryptographer in the front office opens a large manila folder as Dr. Wrak enters the office.  Inside the folder are bunch of radiology badges like prizes in a cracker jack box.   She wears her hair short, has glasses and a professional looking blouse buttoned up.  “Here is your badge. Do not lose it.”  She writes the number of the badge on a ledger and asks Dr. Wrak to sign it.”  “Thank you very much,” says Dr. Wrak.  “Take the badge home with you too,” She insists.

     “This patient has a stenosis in the left femoral artery at the level of the inferior olecranon process proximal to the popliteal space.” Says Dr. Pine.  “You are going to hold her leg still as I advance the cannula from her femoral triangle down to the obstruction.”  We will take films periodically as the balloon stylus descends.  The films will reveal progress.  Hold her leg still with both hands because if I pierce the arterial intima, an aneurysm will develop and the procedure will fail.  Dr. Wrak holds the patients leg and Dr. Pine inserts the cannula in the arterial stent created by a general surgeon moments before.  The X-ray gun hums.  A picture appears on the screen.  “Pixels,” says Dr. Pine.  “It is the new technology.”  He advances the cannula further.  The x-ray machine hums.  He advances the cannula as Dr. Wrak holds the patients leg.  The x-ray machine hums with a buzz and another picture appears on the screen above the table.  “We are almost there,” says Dr. Pine.  “When we get to the obstruction, hold the leg extremely still and I will inflate the balloon. At this point we will take films at the rate of one per five seconds to monitor the progress of the balloon inflating.”  The x-ray machine buzzes and a picture appears on the screen.  Dr. Pine squeezes a bulb furiously.  The x-ray machine buzzes and another picture appears on the screen.  The closed artery is being expanded.  The x-ray machine buzzes three more times and then Dr. Pine exclaims, “the dilation is successful.”  He deflates the balloon and slowly withdraws the catheter from the artery like an angler pulling in a fish.  The catheter appears to be three or more feet long. “Bring the patient back to recovery.” Says Dr. Pine The anesthesiologist leaves with the patient, dragging her IV pole beside him.  “Thank you Dr. Wrak.”  Says Dr. Pine. “See you at four.”  Dr. Wrak nods his head once.  As Dr. Pine walks out the surgical suite door he says casually as he exits, “The procedure only lasts for six months then the artery re-occludes.  I do them anyway.”

   “Dr. zel wants you to assist him in a lower GI barium swallow,” says the cryptographer. “Enter the room down the hall. You do not have to scrub.  The procedure will take about an hour.  You will rejoin the radiologists at four PM after lunch.  “What a morning,” thinks Dr. Wrak.  “Another surgical procedure.  I thought Radiology would be my vacation!”   Dr. Zel stands at medium height with large owl like spectacles and wavy dark brown hair.  He wears a pressed shirt and tie underneath the hospital smock.  “Take off your hospital smock and put on this lead suit says Dr. Zel.  Dr. Wrak complies. He puts his smock on the desk outside the radiology suite.  Dr. Wrak looks like the alien invader from Earth versus flying saucers. Dr. Wrak feels ill at ease.  The patient wheels in and the radiology orderly runs out.  Dr. Wrak helps Dr. Zel position the patient on a movable table and fastens the patient down.  “When I invert the patient hold them so they do not fall off the table. Assist the patient whenever possible, “teaches Dr. Zel.  Dr. Wrak helps Dr. Zel by moving the table into various positions as Dr. Zel takes pictures with an x-ray gun. About a half hour into the procedure something strange happens.  On the wall behind the screen a metal plate falls off the wall and a blue glowing flame appears in a steel box like a reactor core melting down.  The flame is intensely blue and Dr. Wrak cannot bear to look at it.  The room starts to smell like a lightning flash during a thunderstorm.  Dr. Wrak moves behind the lead glass screen and gesticulates to Dr. Zel about the huge blue flame in the metal box on the wall.  Dr. Zel smiles and says, “I have to finish the procedure,”  “You can go.” Dr. Wrak pounds on the glass and jumps up and down.  “It’s Ok” says Dr. Zel “the procedure is nearly over, you can go.”  Dr. Wrak nods his head in prayer and implores Dr. Zel to leave.  “It’s OK,” says Dr. Zel.  Dr. Wrak exits the room from behind the leaded glass and throws off the radiation suit.  He grabs his smock and proceeds to the cafeteria.  “Finally time to sit around and eat,” thinks Dr. Wrak.  “Where are you,” inquires a resident. “I am in Radiology now,” says Dr. Wrak.  “If you want to help in surgery, just stop by says a fourth year surgical resident. “I most certainly will,” says Dr. Wrak and he begins to eat the chicken fricassee with broccoli, mashed potatoes and gravy, chocolate milk and a cup of coffee with free refills to residents only.

   “ Good morning Ms. Kleb,” says Dr. Wrak.  “Dr. Wrak, you radiation badge is red and you must see the head of Radiology immediately.”  Dr. Wrak examines the radiation badge clipped to his left breast pocket and by Jove, the badge turned from ivory white to a bloody crimson red.  The chief of radiology is an older man with white hair and looks like either the God Thor or Loki the evil elf.  Dr. Wrak hands him his badge.  “Where have you been?” inquires the chief.  “Just a few procedures,” says Dr. Wrak.  ” I left my badge outside a procedure yesterday because I was wearing a lead radiation suit head to toe.  Somehow the badge got exposed to radiation.  The Chief says, “When a badge turns red , the event signifies a lethal dose of radiation.  You do not look sick.  If I report this badge, you cannot continue your residency until you complete medical treatment. I am going to throw it away and issue you a new badge as if this event did not ever happen.  I will alter the books.  Here is your new badge.  You can go back to the wards. If you feel sick in any way, come back and see me.”  “I will,” says Dr. Wrak.  “Good luck,” says the chief. 

     This is how radiology is. Even amongst educated elite, the world is a tooth and nail fight for wealth and supremacy.  All rivals and competitors face instant elimination on a daily basis and interact with  the forces of evil constantly.  Dr. Wrak hopes he was not exposed to high energy ionizing radiation.  Lots of radiation destroys the immune system.  Today is a new day and more films are to be read and more procedures done with x-ray guns pointed nearby.  Dr. Wrak finished the book on Clinical Radiology in one night and now knows what to expect and what to do in the hospital.  The future of Medicine lies in imagery because viewing things in situ, de facto, in surgery portends morbidity, mortality and worse for the patient and the staff.  Dr. Wrak runs with the new technology of Radiology and feels proud to be part of the new wave.  With the new wave comes great danger and in danger heroes are made. Some things must be done and not talked about.  Reading x-ray films expertly requires high intelligence, a background of medicine and the ability to visualize anatomic detail in the  mind as a doctor  correlates the information with the imagery presented on the film. Hope springs eternal even for the damned.

     “Dr. Wrak, are you finished with Radiology yet,” inquires Dr. Q from across the hall.  “We need you back on the ward.”  “I am still on vacation Dr. Q,  Still on vacation. Nice to see you. Two weeks to go.” 

Dr. Wrak did not know what was in store for him or he would have left six weeks ago.