Friday, December 16, 2011

Serendipitous Diagnoses

When I order an xray, I have to fill out a little slip of paper with the patient’s name and what kind of xray I would like to be taken.  The patient goes and pays 6 Kina (about $2.50) at our business office and then proceeds to the door with the red light to get their xray taken.  Presumably, the xray technicians look at the xray slip, takes the ordered xray, and then sends the patient and their xray back to the doctor who ordered it. 

I recently ordered a special xray called a barium swallow.  I was concerned that the patient had a cancer where the esophagus meets the stomach.  Typically, this xray takes about 20-30 minutes as multiple xrays are taken at various intervals to see how well the barium goes down the esophagus and into the stomach.  The pattern of the barium, which coats the esophagus and stomach as it goes down and shows up as white, helps me to know if there is a problem or not.  When the pt brought the xray back, I didn’t see one picture of the esophagus, all I saw was the lower abdomen and pelvis on every xray.  At first there was nothing white (barium) in the xray pictures, but then as time intervals went on, I found I was looking at the bottom of the stomach which was sitting very low in the pelvis.  This suggested the patient wasn’t able to empty her stomach and so was having nausea, vomiting and weight loss as a result of this.  I probably wouldn’t have seen this had I gotten the xray I had written for, but I guess God knew best.
Another patient came in complaining of hip and back pain.  I knew this wasn’t her main problem as she looked very thin and had been losing weight, but she denied any others symptoms outside of the pain.  The family was so concerned about her hip and back pain and was asking for an xray, so I wrote for a pelvis xray anyway, even though I wasn’t expecting it to show me much.  When she came back, her xray obviously showed that she had tuberculosis in a miliary pattern.  This wasn’t obvious from the pelvis xray that I had ordered, but from the chest xray that she had taken instead.  I would have missed the diagnosis had I gotten the pelvic xray, so I am thankful that this mistake happened, for the pt’s sake.