At The Radiologist’s Mercy

This post may seem like I have it in for radiologists. I don’t. The radiologists at our hospital are all top-notch. Just blowing off some steam and showing how we can sometimes be put at the mercy of another doctor’s statements. What a night.

An elderly patient comes in after falling in the bathroom and hitting her head and face on the bathtub. She has a nice shiner on her left eye and hasn’t been acting quite right since it happened according to the family members.

We subject her to various forms of ionizing radiation - probably the equivalent of being at “ground zero” - and find that her neck is OK and that she has no bleeding or other injury inside of her brain. After all of the lab tests are back, we still can’t really figure out why she her mental status is not quite right, so we admit her for observation. I make all the calls to the admitting physician, the consultant, the floor, write admitting orders, explain everything to the family, and make sure the patient is comfortable. Then the fun begins.

About a half hour after the patient goes to the floor, we get a fax from the teleradiologist. The radiologist who read the initial scan made a mistake. The patient actually has a subdural hematoma. Great. There’s no neurosurgeon at our hospital, its the middle of the night, and I’m the only physician in the hospital. We have to transfer this patient to another hospital for a neurosurgery evaluation - right after she’d been admitted. We call the nurses upstairs to stop admitting the patient and get her ready for transfer. I call the admitting doc and let him know what’s going on. I call the family to try to smooth things over as to why we’re suddenly transferring their mom after they had all just gone home. I fill out all the paperwork for transfer (yes, I know that the admitting doc could have done this, but I chose to spend 10 minutes doing it myself rather than making him get out of bed, evaluate a patient he’d never seen, write an admitting note, then fill out the transfer forms himself). No ambulances were available for transfer, so the receiving hospital sends one of their ambulances and a crew to come get the patient. Fortunately, we have great nursing supervisors that helped organize a lot of the transfer process.

I’m trying to catch up on the patients in the ED when we get another fax about an hour later. This fax says that the teleradiologist’s reading was incorrect and that the “subdural hematoma” was just a motion artifact. There really isn’t any bleeding.

You have to be f’ing kidding me.

Call the ambulance dispatch and have the ambulance crew turn around to go home. “I’m sorry they’re 3/4 of the way here. What am I supposed to do?”
Call the family and tell them not to go to the other hospital - mom’s staying here. “Well, there was another mistake in the reading on her CT scan. No, ma’am, I was not the one who read it. I don’t appreciate being called an idiot - I’m trying to help. I’m very sorry for the confusion. I’ll put you through to the administrator on call. Hold on.”
Tell the floor they don’t have that extra bed they thought they had. “I’m sorry you just tore up all the admission papers and have to re-write everything. She’s staying here.”
Even I wasn’t cruel enough to wake the admitting doc up again.

After all this, I was surprised that I didn’t have a subdural from banging my head on the wall.