When Certain Cases Make You Feel Like You Had a Radiological Clobberin’

Long-term readers of this blog know I am something of a comic book fan. I started reading them when a sixth-grade mate snuck issues of X-Men into class, and they sparked my memories of low-grade Saturday morning cartoons from the 70s. I was amazed the franchise not only still existed but was flourishing.

Put enough of that stuff into someone’s formative years, and it will be baked into his or her mind for the long haul. Any given situation might prompt a recollection of this comic book moment or that. One should not routinely share these recollections with non-comic fans who might be around at the time. It is no better than being “that guy” who’s always ready to tell you what Seinfeld episode he is thinking of.

Still, sometimes the situation just seems too perfect, or motivation is otherwise stronger than one can resist in the moment. Today, it provides inspiration for a week’s installment of this blog.

First, I should share the comic reference (and I wish I had a way of knowing how many readers will recognize it, because I suspect it will be a fair number). Way back in 1964, a Marvel character called the Thing (strong guy made of orange rocks, in a team called the Fantastic Four, which has, thus far,failed to have a good showing on the big screen) first used his now famous battle cry: “It’s clobberin’ time!” I can still hear it in my mind’s ear from those aforementioned cartoons.

For whatever reason, the phrase comes to me most frequently when I am going through a typical workday and pull something from the reading list that I know will be a punishing affair: It’s time for me to get a clobberin’.

A case in point from this past week involves an abdominal MR following a metastatic neuroendocrine tumor (NET). At a glance, I can see it will be a long, drawn-out battle. There are multiple prior studies with differing technical factors. While the most recent one might be good for comparing some things, I will be going back and forth between that and other scans which had better detail in other ways. There are a gazillion lesions, poorly defined and/or distinguished from one another, so measurements are going to be iffy. Then there is an encyclopedia of incidental findings.

I would like to say I charge right into the fray without a moment’s hesitation but that would be a lie. I would also like to believe that I will one day have grown to the point that I don’t have even a little inner voice saying “Quick! Put that case back for someone else to deal with. Let’s go look at some kidney stones instead.”

I don’t expect that day to be here anytime soon. The fact is that most normal people don’t like being clobbered, and that is what reading cases like this feels like to me. I get through them, however slow and painful the process might be, and I know I have done my reasonable best (I did a body imaging fellowship after all) but when I sign my report, I feel kind of punch-drunk.

That is a stark contrast from most of the other cases I read. Some do feel like I administered a clobbering, such as when there is pretty much only one finding, it addresses the clinical question, and I move on in a fraction of the time it normally takes me to read that kind of case. They feel clean and neatly packaged, like I trotted out of my corner of a boxing ring and immediately KO’ed an opponent with a picture-perfect uppercut.

Others are almost as good. I have no doubts about my read, but there was no relevant clinical history, or a history that didn’t quite match (appendicitis but the “reason for exam” was cough). Further down the scale are normal studies or exams with some incidental findings, but nothing relevant to the history. I have no reason to doubt my work, but it doesn’t feel like I moved the needle for someone’s health care either.

In addition to the intellectual satisfaction of providing a good read with unambiguous results, there is the bean counting factor. I have spent less than half of my career in per-click jobs, but one pretty much always has an awareness of one’s productivity. I know how much time and effort any given case “should” cost me, in terms of modality and body part as well as clinical scenario. My sense of “that was short and sweet” versus “I just got clobbered” varies depending on whether I read a “R/O PE” as opposed to “F/U lymphoma.”

Rads with other practice profiles would probably feel differently. I am a tele guy who gets a lot of work done, and while stuff like NET and lymphoma are in my case mix, I usually see more ER and inpatient type stuff. Stack me up against an academician or tertiary-care center rad and you might find that they relish digging into the complex cases. Dealing with that stuff all day, every day, they might very well feel like they are clobbering the stuff that leaves me feeling clobbered.

I am a strong believer in adapting to circumstances. Adaptability itself is adaptable. The more regularly one pushes one’s limits, the better one will eventually be at pushing limits in other venues. On the other hand, huddling within one’s comfort zones will eventually lead to those zones shrinking smaller and smaller.

Accordingly, giving in to the urge to avoid being clobbered by challenging work is not a long-term formula for professional success. Today’s “I don’t feel comfortable reading this NET follow-up” becomes tomorrow’s “I don’t read abdominal MR.”

So, why do I think “It’s clobberin’ time!” when I see a case that will leave me feeling clobbered? Call it an affirmation. Every time I repeat the exercise, I am nudging myself a little more in the can-do direction. It can’t hurt.