Random groupings can seem like a cosmic plan

October 5, 2005

Recently, I read a CT with an unusual curvilinear density around the superior mesenteric artery. Not recognizing the finding, I turned to the radiologist's best friend, the old reports. Sometime in the past, Mr. D had been extensively worked up for what was eventually called an SMA dissection. You learn something new every day in this life.

Recently, I read a CT with an unusual curvilinear density around the superior mesenteric artery. Not recognizing the finding, I turned to the radiologist's best friend, the old reports. Sometime in the past, Mr. D had been extensively worked up for what was eventually called an SMA dissection. You learn something new every day in this life.

When I was on call just three days later, an elderly gentleman with severe abdominal pain presented to the ER. He got an abdominal CT, like all patients who present to the ER with an abdomen. I was swamped, so the ER doctor saw the study first on the PACS. He came over to ask me what the next test should be, since the CT was negative. I scrolled through the study about as fast as I could without seizing, then astutely told him it wasn't negative.

"The patient has a classic SMA dissection." I said. "In my experience, these are typically just observed, as there is no treatment."

Usually, in these circumstances, I qualify my statements with, "Of course, my series of these is somewhat less than 100."

But I like to BS, especially when I'm feeling lucky.

Grouping can also work against you, however. If you have ever diagnosed two intracranial bleeds early in an evening, you know a very painful night on call is coming. Every person coming through the ER door with a head attached to a torso is going to get a head CT.

This process can affect an entire community. Watch what happens if two or three kids in the same neighborhood get an unusual tumor. People will want to analyze the chemicals in the water, the school walls, and the dirt, and tear down all the power lines.

I personally believe the grouping of Three Mile Island, Watergate, and The China Syndrome was a major factor in our country's abandonment of nuclear power generation 20-plus years ago. Many of us are now paying per gallon for the reaction to that confluence.

Radiology manufacturers face this problem as well. We have had extensive problems with two remote fluoro rooms: over 100 service calls in one year. Company X just can't make them reliable. We bought their 1.5T MRI, and after six weeks of tuning, we still prefer a competitor's seven-year-old scanner. We're buying a 64-slice CT scanner soon, and my partners want to eliminate Company X from consideration. I suspect these unrelated events will strike a really good machine from our list and cost Company X $1.5 million.

At home, the process can be just as costly. After seven years in our current house, we are moving. Prior to placing our home on the market, I have been working diligently to spruce it up-fixing all those things I've tolerated for years, all for people I don't know.

In one week, both my little boys threw up food coloring-laced treats on their bedroom carpets. The following week Deana surprised our boys with their first puppy, who is peeing, pooping, and chewing his way through the entire house. I can't decide if this is random grouping, or if my family does not want to move.

People often ask, What did we do wrong? How can these calamities fall on us, all at once? Well, they do it because they have to. They are random events. If they did not occur in groups, they would occur at regular intervals. If they occurred at regular intervals, they would not be random events.

So the next time you get hit by a double whammy, don't ask why. Just enjoy shopping for new belts, eyeglasses, watches, and other chewed-up items. And never let your kids eat 12 blue snow cones at a party.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.