A Purgatory of PACS

October 31, 2014

In a radiologist’s afterlife, let the punishment fit the crime.

A deceased radiologist, passed on before his time, in part because of a career of working ever harder to earn ever less, found himself facing scrutiny at the gates of Heaven.

The angel working the door finally shook his head, and sadly said, “I can’t let you in. You spent quite a bit of your life jeopardizing the well-being of patients for financial gain - rushing through their imaging cases in the name of better productivity.”

The radiologist was insulted at the accusation, frightened of going to a Hell he’d never believed in until now…and also a little embarrassed, since he had done much of his work in “eat what you kill” settings where RVUs were everything. As reimbursements had dropped and non-physicians in the mix (administrators, MBA types, investors) had protected their own bottom lines, physicians like himself had repeatedly found themselves faced with a bitter choice between working harder and earning less.

With a look of saintly sympathy (it was an angel, after all), the gatekeeper reassured him: “Don’t worry; we know you were in a tough spot. You never consciously chose to do wrong, and others have done far worse. Your redemption can be earned.”

The angel led him across the clouds to an area that looked, bizarrely, like a radiology reading-room. Dozens of other dead rads were already seated at what looked to be workstations, plugging away. The newly-deceased’s guide explained: “It is fitting for the penance to match the sin. You will assist us by screening others to determine what afterlife they deserve. Our celestial PACS has been designed to be intuitive for you, considering your previous livelihood. With it, examining a candidate’s life, deeds, and moral fiber will be as straightforward as was reading CT or MRI scans.”

Settling himself in front of a workstation, the radiologist felt gratitude to the angel for having brought him somewhere lacking fire and brimstone. Still, he asked, “So…how long do I stay here before I’ve worked off my debt?”

“For each of you, the answer is different. Your term here is proportional to how much you wrongly profited at the expense of those whose care was entrusted to you. To help you focus on your proper motivation, the actual number of screenings you owe is not to be revealed until you have completed them.” The angel bade him farewell, and he got to work.

The interface was, indeed, excellent. It was no time at all before the radiologist, like those around him, was able to swiftly yet thoroughly examine entire mortal lifespans to summate everything that mattered - good deeds, bad behavior, adversities overcome, potential wasted. Unlike his previous work of interpreting imaging studies, these cases always gave him all the information he wanted (no incomplete or inaccurate clinical histories, thank you very much), and he received follow-up on the ultimate destinations of all of the souls he screened.[[{"type":"media","view_mode":"media_crop","fid":"29024","attributes":{"alt":"hell","class":"media-image media-image-right","id":"media_crop_5006340109574","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2979","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 150px; width: 150px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

As he worked off his karmic debt, eventually he became aware of some supervisory-types prowling the celestial reading-room. Not angels, these were also deceased mortals. It didn’t take him long to find out that these generally hadn’t been radiologists during their mortal coils…and, as he found out what they had done instead, he grew increasingly disturbed:

A venture-capitalist who had made his fortune commoditizing and skimming off the hard work of teleradiologists; an insurance exec who had lived well by chiseling physicians for every penny of reimbursement he could; a bureaucrat who had made endless political hay by treating healthcare providers as his go-to whipping boys. Each one of these bosses could easily have been responsible for dozens if not hundreds of the rads doing time here.

It seemed so wrong that they should continue to ride herd on him, he tracked down the angel who had first brought him in, and fairly demanded an explanation. The angel apologetically told him that it would have to wait until his sentence was completed. Seeing his upset, however, the angel relented and quietly told him, “Soon. Very soon.”

Sure enough, it wasn’t long after that the angel returned to collect him from his workstation, and they headed off towards his proper afterlife. He remained just as eager for answers, and the angel knew it. “They’re working off their debt, the same as you were.”

“But how is it right that they were lording it over us rads just like when we were alive?”

As impish a smile as an angel can manage was his reply. “They aren’t. They think they are, but nothing they do actually is of any consequence. Their only purpose there is to watch the radiologists, one by one, earn redemption and leave. Only when the last of you has done so will they be permitted to follow behind.”

The rad had to admit, that was rather fitting.