Radiologic Technology September 1, 2000 | Myers, Patricia
I was walking down 42nd street one day and this amazing thing happened to me. It was July, about 89 [degrees]. It was hot — hot for New York, you know. I was walking east and this humongous person was coming west. She had this big blue dress on, and it was covered all over with little white daisies. She was almost bald and sitting on the top of her forehead was this fried egg, which I thought was unusual, because in New York City the ladies with fried eggs on the their foreheads usually don’t come out until September or October. There was this demented lady with this fried egg on her forehead in the middle of July. God, what a sight she was.
And ever since I saw that lady, not one day goes by that I don’t think of her and say to myself, “Oh God, don’t let me wake up tomorrow and want to put a fried egg on my forehead.” Then I say real fast, “Oh God, but if by chance I should wind up with a fried egg on my forehead because sometimes you can’t help those things, don’t let anyone notice.” And then I say real fast, “But if they do notice that I’m wearing something that isn’t quite right and they want to talk about it, let them talk so I can’t hear. I don’t want to hear.” Because the truth about fried eggs — and you can call it a fried egg or you can call it anything you want — but everybody gets one. Some people wear them on the outside and some people wear them on the inside.
When I first told this story 22 years ago to a group of first-year students, I stayed very serious when they began to laugh. But they became as serious as I was toward the end of the tale, realizing that the purpose of this prologue, written by Bette Midler for a song titled “Hello in There,” was severe.
This may be an exaggerated story, but it sure makes its point. When I first heard Bette’s prologue in 1978, it hit me like a ton of bricks, and I felt unfortunate. I thought to myself, what a way to open the Patient Care course to a group of new students. I was never convinced they knew the seriousness of what they had gotten themselves into. So often, we judge people by what we see on the outside: a fried egg, call it anything you want. When I bump into my former students, they say, “I’ll always remember the lady with the fried egg,” I immediately know they still love their work and care strongly for their patients.
This memorial lecture honoring friend and colleague John B. Cahoon is to share with you my perception of why we need to reassess the academic and clinical curriculum of patient care in radiography programs as we know them today. Although many books on the market are written about patient care, few, if any, address the patient’s need for human kindness.
Also, are we, as radiologic technologists, prepared to administer life-saving techniques to medically failing patients while they are in our care? It goes back to the fried egg. If a failing patient wore a fried egg on his or her forehead while in the radiology department, we’d know immediately that the nurse had to stay during the procedure. But as we have all experienced, it’s not that simple. In today’s environment, we, as radiologic technologists, cannot always count on a nurse to care for the patient. It is now our job. And are we prepared for it?
The song “Hello in There,” written byJohn Prine, is about an older woman who still lives in an apartment in the city after raising 4 children who are now grown and no longer live at home. She doesn’t go out much anymore, and her husband rarely talks to her. She spoke of her children, whom she raised in this apartment. One was killed in the Korean War. She says, “I still don’t know what for,” and I don’t either. Her husband lost the ability to communicate after their son’s death. In other words, she and her husband are total strangers at this point in their lives.
Her solution to this dilemma was to call an old friend from work, but there was nothing new to talk about, so they had nothing in common anymore. She says, “I’d go out on the street, but everyone would just pass me by with their hollowed, ancient eyes, staring straight ahead like I wasn’t there.” She responded that she would like to say to these people, “Hello in there.” The moral of this beautiful but sad song is that she was willing to talk to people, but they didn’t want to see or communicate with her in any way, not even her husband or her 3 living children. This sweet, dear lady was carrying her fried eggs on the inside. She desperately needed to communicate with someone that anyone, even an outsider from the street, would have done.
Strangely enough, I returned to a commemorative lecture that I presented to the Pennsylvania Society of Radiologic Technologists on May 1, 1981, and part of that lecture related to communication. I want to read a few lines from what I wrote more than 19 years ago: “It is easy to communicate with outspoken, open, and friendly people. Communication with nonverbal people may be difficult. However, that does not mean they have nothing to say. Make an effort to interact with them — you may find the payoff overwhelming!” When I reread those lines while preparing for this program, I thought how fitting these words are. Even though verbal communication is essential, other methods may be more effective but are overlooked when dealing with patients and people.
I was sitting in church a few Sundays after I received the letter from the American Society of Radiologic Technologists informing me I was selected to give the John B. Cahoon Memorial Lecture for the year 2000. I thought, “What a thrill; I’m so delighted, but what will I talk about?” Patient care immediately came to mind. I always liked that subject and felt sensitive toward people in pain. First, I always felt that it was a weak area of my curriculum and second, it needed to include sensitivity and emergency patient techniques. From time to time, I had a well-trained educator who did justice to the course, but I was never totally satisfied.
As Mass went on, the priest began his sermon. I thought I better pay attention here. He began to talk about what we don’t see, or should I say, what we don’t know, when dealing with people who need help. What we don’t want to see hit an old familiar note: patient care. How did that priest know what I was thinking?
What we don’t want to see gives us the false impression that we don’t have to deal with it and that we’re not responsible if anything happens. Unfortunately, we see this all the time, in hospitals and our daily life. Was it easier for us to laugh at the lady with the fried egg, or did you feel sorry for her? Well, at least we know she was demented according to the story, so that lets us off the hook. But what about the other elderly lady in the song “Hello in There”? She had no outward signs, yet she had the same amount of pain, and we passed her by, too. This is sad but true.
We need to learn to communicate with our eyes, hearts, and minds. It is our job as health care providers to develop ourselves and teach our students that extrasensitive perception. That does not come quickly. It takes practice, and, unfortunately, some never learn. Take the lady with the fried egg: A simple “hello” acknowledging her existence would have made her day if we saw her with our hearts and not just our eyes. And the elderly lady in the song, if we saw her with our minds rather than with hollow eyes, a warm “hello” would have renewed her faith that someone cared. It is so simple! What does it take? Nothing, nothing but human kindness.
If you keep all three senses open totally and are aware of what you want to accomplish, you will be keen enough to identify patients in trouble simply by walking past them. This is not a given; however, it takes practice.
Before entering a healthcare program, all prospective students must fulfill the prerequisites of the program they want to attend. A list of courses and grades must be met. Some high schools have a sensitivity- or diversity-focused course as an elective or part of a cultural awareness program. If the student applying for a health professions program had this type of elective available and did not take this course, I’d be interested in knowing why.
We do learn, sometimes too late, that it is not always students’ choice to enter a healthcare profession: they were convinced by family members. There are standard tests available that predict with some certainty the level of an individual’s tolerance for dealing with physically ill patients. However, I have to admit there are pros and cons to this type of testing.
A limited noncredit sensitivity course could be developed and offered to all students interested in health care and college-track programs dealing with patient services. That would give all students an advantage before entering their chosen medical field. Incoming students need to know upfront that they will be caring for seriously ill patients and radiographing them. How often have we heard, “I didn’t know I had to do that!”
It is more important than ever that incoming students are informed of what is expected of them, so we must give them the uncut version of the accurate picture. A video of duties, from the beginning to the end, needs to be developed. I’m not speaking of a recruitment video, although they are necessary and have their place and purpose. This video would depict the job authentically. A weeding-out process with this video would save time not only for educational institutions but for students as well.
After the accepted student has completed the prerequisites and is aware that taking care of patients goes along with taking radiographs, Sensitivity 101 should be presented in the first semester. The primary patient care course that we now teach is imperative and should remain a standard for the first semester. An extended patient care course should be given later on. This course should include caring for seriously ill patients, which has been overlooked in current programs. The psychology department would teach the sensitivity courses, and the extended patient care course taught by the nursing program.
Are we, as radiologic technologists, prepared to handle a seriously ill patient? My answer is no. It is difficult for me to explain in this short period the changes to the current curriculum needed for radiography students to meet the challenge of dealing with seriously ill patients. It isn’t good enough anymore to learn how to deal with a failing patient. “Learn one, do one” will not cut it these days. In today’s managed care environment, we cannot yell out for the nurse to help us with our patients anymore because the nurse may not be there. We need to be trained to handle this service ourselves.
Cross-training is not the terminology I would Prefer to use to describe this course system, but it would follow along those lines. The radiography curriculum would be coordinated with the nursing program curriculum to include courses dedicated to seriously ill patients. Student radiographers would participate not only in the academic component but also in the clinical environment. This 2-fold program would assure the student technologists that they are prepared to provide patients with emergency medical care at the same level of competency as an RN.
The current curriculum for radiography programs includes electronic and darkroom chemistry credits that, by today’s standards, are obsolete. We still are teaching autotransformer ratio, spinning top, valve tubes, developers, and fixers, which are useless in today’s modern profession. It’s as if we are programming our own PCs as we once did when computers first came out. We could learn so much more in this time frame that would better serve the patient. Electronic and darkroom information is only helpful to students for passing the Registry examination. This is not to say that they do not need to know about fundamental equipment failure and have limited darkroom knowledge. They do. But that could be taught in a 1-credit course. It would be better to reassign the electronic credits to courses on trauma patient care.
In summary, the patient care component of the radiography curriculum as we know it today has served us well. However, it is important to reevaluate this part of the curriculum. Sensitivity and life-saving technique courses must be included. A successful radiography student is one who knows and understands before entering the program that the patient is what it is all about.
My dear colleagues, may I leave you with this thought: When you’re walking down the street one day and a lady with an egg on her forehead passes you, say “hello” to her and wish her well, for you see, but for the grace of God, there go I.
Patricia Myers, B.A., R.T.(R), FASRT, delivered the memorial lecture in honor of John B. Cahoon, Jr., R. T., FASRT, at the 2000 ASRT Annual Conference in Albuquerque, NM. This article is based on her lecture.
