The Blind Radiologist

Increasingly long ago, I had time and inclination to read for pleasure. I briefly resumed early this year as I found myself traveling more frequently than usual and my all-time favorite author just happened to have put out a new novel. It came with me on my series of trips. It was like catching up with an old friend.

The guy primarily did sci-fi and fantasy, which is the sort of stuff that gets me to crack a book spine if anything will. In one of his first books, the protagonist finds himself needing to militarily assault a place that is protected by sight-based magic: Seeing what is defending the place will immediately undo the attackers. (I am deliberately being vague because there is a non-zero chance that the book will wind up being made into a movie and spoilers are to be avoided.)

The main character therefore brings along a bunch of veterans who have lost their vision and learned to get around in other ways. The blind soldiers lead the assault and heroically win the day long after many would have considered their glories to be over. It was a good read, one I have revisited more than a couple of times.

I recollect it every now and then when thinking about where my radiological future might lead. Specifically, what happens if I lose my sight? I can’t imagine many rads get far in their careers without thinking of that particular nightmare scenario. Acquired blindness is bad enough for anybody, but especially if it happens after your younger, more adaptive years are gone and your entire livelihood depends on being able to see diagnostic images.

Yes, there is disability insurance. (If you don’t have any, let this be a strong nudge to fix that). Unpleasant things happen, however, when you try to get an insurance company to pay up. They don’t always turn out to be as diligent as they were when it came to collecting premiums.

Once, I heard about “same specialty” coverage. A blind rad without it might be told he or she could still retrain as a psychiatrist and therefore wasn’t officially disabled. I tried looking into that and got nowhere (making new inquiries now as it happens).

Even if I did manage to get my income replaced by insurance payout, it wouldn’t exactly be making me whole from a professional perspective. Suddenly losing one’s sense of productivity, capability and mental engagement is a pretty catastrophic thing. It is one of the reasons I liked the bit about the blind veterans having a final triumph: They showed they could still cut the mustard even when nobody else could have.

All of this makes me wonder: Would blindness really end me as a radiologist? Couldn’t I find some way to carry on?

I recall, for instance, hearing of one attending in an academic environment who had lost his sight. His department kept him on staff. They would sit him with a senior resident or junior attending who would tell him what they saw on the images. He might ask some pointed questions but would then make diagnoses and offer differentials that others couldn’t.

There are some issues with that. He was brilliant. I do decent work but I am nowhere near the wizard he was. He had an established presence in his department and had earned enough of a reputation that they made the situation work for him. I am a hired gun telerad. Clients might like me, but not enough for them to make any such special arrangements. Finally, the logistics of radiology have changed a lot since that blind rad’s day. It might have been viable to have two rads doing the job of one, however brilliantly, but I don’t think that would fly now.

Maybe some non-clinical role would work? I wouldn’t be thrilled to be in the med mal or radiology benefit management world, but someone is going to fill those roles. Maybe I would be one of the “good guys” in such a position.

Another thought came to me this past week. I wrote a blog long ago, floating the notion of a “radiology whisperer,” someone who would use a thorough knowledge of imaging to explain things to patients and their families. Being blind might actually help with that. Nobody could ask me for a second opinion on another rad’s read, whereas if I tried to whisper today, I would constantly be asked to do it.

My recent thought added on to that one. I probably wouldn’t be able to fill entire days just translating things for layfolk. What would consume as many hours as desired would be reviewing rad reports for other purposes.

Many years back, as an intern and even as a med student, I found that I could mine an awful lot of useful information from reports of imaging, pathology, and even bloodwork. Admitting or otherwise assuming care of a patient, I would dig through their virtual paper trail as much as I could, often before even meeting the patient. I would wind up with the medical equivalent of a small biography, stuff that nobody would get from taking a history. The patients themselves might not remember or even know much of it.

I don’t have that kind of time on my hands in a typical workday now, but I do make the effort to look through previous imaging reports, above and beyond whatever study I am actually comparing against. Most of what I see adds nothing to my interpretation of the current case but some of it is relevant, occasionally crucial. A lot of the time, it is clear that whoever ordered the study I am reading would not have needed to, if they had had the same info at their fingertips.

As a radiology whisperer/historian, I would be in a position to push back against, say, abdominal MRs ordered to characterize adrenal lesions that were proven to be adenomata a decade ago. Given the opportunity to review and protocol incoming imaging requests, I might be able to fine-tune them. Hey, the last chest CT was marred by hypoventilation and respiratory motion. Let’s make sure we emphasize breathing instruction this time.