Superwoman's Kryptonite

I had been feeling under the weather all week and yesterday at clinicals, I was eating Halls and Coldeze like candy. It's been a rough week (physically), so when my alarm went off this morning, I decided to call into work. It's not something that I typically do, but my body just needed a day to rest and recooperate. After leaving a voicemail for my supervisor at 5:15 am, I popped some NyQuil and jumped back in bed. I didn't wake up again until around 9:30 and felt somewhat refreshed despite the medication hangover. The truth of the matter is that I have been feeling rundown a lot lately, and I think that this cold is my body telling me to slow it down a bit. I have a tendency of pushing myself too hard sometimes and trying to be Superwoman (everything to everyone), but I'm learning to ask for help and simply letting some things go. THIS Superwoman's kryptonite is time management.

Yesterday was an interesting day at clinicals. It was a pretty slow day, relatively speaking, and we received a visit from the instructors at school (suprise!). I have been practicing on chest x-rays since Tuesday and have had several chances to comp, but just didn't feel as comfortable with them as I should. So, a requisition for a chest printed off RIGHT as my instructors rounded the corner into our department. And, they decided to observe ME in all my nervousness. :) The PA view turned out GREAT - the patient was short but extremely thin, and everyone (classroom instructors, clinical instructors, me) was amazed at how LONG his lungs were. When I went back into the room to position the patient for the lateral, I blanked out, and when I took the exposure, I realized that I chopped off the bottom fourth of his lungs. Yep. And my classroom instructors were there to witness it. :) I ended up getting everything on the second shot, and I overheard one of my classroom instructors saying, "Ah, much better" to which my clinical instructor responded, "I guess she won't be comping on THIS chest." :)

Later in the day, a patient came in that needed both chest x-rays and hand x-rays. I was psyched that I could comp on both exams and exclaimed to my tech, "I'm going to NAIL these!" Yeah...that was my first mistake: being overly cocky. :) On this particular patient, who was very muscular and wide, the lateral turned out perfectly, however I clipped the VERY ends of his costophrenic angles on the PA. We're talking the VERY TIP of his angles. So, it had to be repeated with a shot of just the angles. (As a sidenote, I *hate* having to take a shot of just the angles. I would prefer to retake it to try to get the whole lung fields on the same film, but my tech pointed out that we run the risk of having to repeat that if the patient's lungs are too big to fit on one film.) Chest Comp: NADA. When I moved the patient to the table to start his hand x-rays, I thought I had everything positioned correctly. When the image came up of the oblique, I realized that his distal radius and ulna were angled quite a bit on the film which made the oblique look really strange. The rest of my views were fine, but I repeated the oblique. Hand Comp: NADA.

The remainder of the day was spent staring at the printer waiting for a chest x-ray. At 4:00, I packed up my bags, had my keys in my hand and was ready to walk out the door when the printer kicked on. One of the techs yelled out, "Chest!" and I dropped my belongings. :) I was DETERMINED to get my chest comp before the weekend. The patient was an elderly female who had trouble standing on her own for long periods of time. I got the room set up and shot her PA. When the image came up, I realized I had gotten her full lung fields on the film, but JUST BARELY which suprised me because I almost certain I had her perfectly centered. When the lateral image came up, I noticed that her ribs were not entirely superimposed which would have suggested rotation. Frustrated, I showed the images to my tech and said, "I'll have to reshoot the lateral. I was certain I had her completely aligned, but her film shows that she was rotated quite a bit." My tech looked a little closer at the lateral then at the PA. She smiled at me when she said, "Take a look at her spine in the PA and tell me what you see." In taking a second look, I realized that the patient's spine was curved - she has scoliosis - not so much that it could be seen by the naked eye, but the x-rays showed a different story. We finished up the comp paperwork, and I walked out to my car to start my weekend with one more comp under my belt. :)

One of the hardest things I'm realizing about radiology is body habitus. EVERYONE is different, which makes it hard for those soon-to-be-techs like me who see most of the world in black and white. :)

Achievements for this week:
1. Increased confidence
2. Abdomen comp
3. Finger comp
4. Chest comp

Have a great weekend!

Comping...it's a beautiful thing.

Clinicals continue to get better every day I'm there. Last week, I comped on a wrist and could have comped on an abdomen but there was some confusion on how many views needed to be taken to qualify as a comp. For some reason, I was under the impression that to comp on an abdomen, I needed to perform both supine and upright exams, however it turns out that we only need one or the other. So, that means that I will comp on a supine abdomen tomorrow - hopefully first thing! We do a lot of small bowel studies which allows me PLENTY of practice on abdomens!

Comping on the wrist was fairly easy, and my comp was the first wrist exam I had done! My patient was very cooperative, and although it was difficult for her to turn her wrist for the ulnar deviation projection, I got a beautiful shot. :) I'm still learning how to choose the technique on my own, but I'm sure that will come with more practice.

The techs who work at my clinical facility ROCK. They are so patient and seem to really want me to understand not only what I'm doing correctly but also what I'm doing incorrectly so that I can learn from my mistakes. Even though the drive is painful on the way home, I'm so glad I'm rotating at this particular site this quarter. The pace and atmosphere are a perfect fit for me and the way I learn.

We had our first test (of the quarter) in positioning this morning on the foot, toes, ankle, calcaneus, and tib/fib. I know for sure that I missed one question that was purely a stupid mistake (what bones make up the instep of the foot? my answer: tarsals. correct answer: metatarsals.), but other than that, I feel really good about it. I know I've said it before, but I REALLY like the tests in my positioning class. We had a pop quiz in Exposure today, and unforutnately I'm not as confident that I got an A. :) I didn't look over my notes last night, so I was a bit surprised when he announced the quiz. We're studying density, mAs, kVp, inverse square law, direct square law, 15% rule and the reciprocity law, and it all kind of ran together on the quiz. At least now I know what to focus on for the test next week!

I once read that goals are more likely to be achieved if you put them in "writing." In spirit of that, I am going to start working weekly clinical goals into my blog. (Thanks to Radiologic Confidential for the inspiration!)
1. Comp on abdomen
2. Comp on foot or ankle
3. Don't be afraid to try "new" exams that we haven't covered in class

Have a great week!

And They're Off...

My morning began as most mornings when I work at the hospital: the alarm goes off at the ass crack of dawn, I sleepily stumble my way toward the bathroom to shower and pry my eyelids open long enough to brush my teeth, put on some makeup, blow dry my hair and slip into some scrubs. I'm not FULLY awake until I slump into the kitchen and smell the sweet, sweet aroma of freshly brewed coffee. The DIFFERENCE this morning was that my scrubs happened to be embroidered with the name of my school. Today was the first day of clinicals. :)

The other difference in this morning's routine was the commute. When I work at the hospital, I usually leave around 6:00 to make it by 7:00 am. The drive usually takes about 25-30 minutes, so I have plenty of time to finish my coffee and get organized for the day. This morning's commute found me leaving at 6:00 only to arrive at my destination approximately 1 HOUR later. :) Knowing how unpredictable traffic can be sometimes, I knew I was giving myself quite a cushion, so I took the hour to read in my new Merrill's Pocket Guide to Radiography (thanks for the suggestion, John!) and call some of my classmates to wish them luck. I found that everyone I talked to was JUST AS nervous and excited as I was! (Why is it in times like these that we find such comfort in "feeling like everyone else" when most of us spend our entire lives trying to be unique?)

My prior experience with the Clinical Instructor was not at all the same today. Granted, we hit the ground running as soon as we clocked in, but in a "no-nonsense, I-really-want-you-to-learn-this" kind of way. Clinicals started at 8:00, and I bet I was mixing contrast by 8:05 and calling our first patient by 8:08. It was INCREDIBLE and the day didn't stop from there! Tuesdays and Thursdays are "Fluro" days at my facility, so I got to observe/assist with SEVERAL UGIs, Barium Swallows and Small Bowel studies. We also had several "walk-ins" that needed CXRs (chest x-rays), knees, hips, feet, hands, etc. The whole day really moved along well as I learned about ALL of the paperwork involved (much more so than in the inpatient setting I'm used to!), and before I knew it, it was lunch time. My fellow classmate and I took advantage of the beautiful weather and sat outside to eat lunch and reflect on the morning's activity. After lunch, I met a tech who works a later shift (who also happens to be a fairly recent graduate of my school's program) and followed her around the rest of the day. She showed me how to prepare a sterile field for a Hysterosalpingography (HSG) and volunteered me to assist the RPA (Radiology Practioner Assistant) during a second HSG!!! All I basically had to do was fold back the sheet covering the patient (RPA was wearing sterile gloves) and hand him the betadine swabs, but it was very exciting - AND I "got" to wear a lead apron. :) The only suggestion the RPA had for me following the procedure was to open the betadine swabs AWAY from the patient and the RPA. He said that he got some betadine sprayed in his eye one time, and while it didn't cause any permanent damage, it did burn quite a bit. I was happy for the critique and grateful for the tip!

Shortly before it was time to leave for the day, the clinical instructor asked one of the techs if she thought we would be good students. She responded by saying, "They'll only be as good as we teach them. But this one here [pointed to me], I like. She shows a lot of intiative and is a real go-getter!" WOW! My first compliment! :) I was thrilled and floated out to my car on cloud nine.

It was really an incredible day, and I can only hope that my other days at clinical are the same. Tomorrow we start classes, Positioning of Lower Extremities and Exposure, then it's off to clinical again on Thursday. What a great profession we are in!

Have a great week!