Radiology Medical Quotes

LAWS OF THE HOUSE OF GOD I Gomers don’t die. II Gomers go to ground. III At a cardiac arrest, the first procedure is to take your own pulse. IV The patient is the one with the disease. V Placement comes first. VI There is no body cavity that cannot be reached with a #14 needle and a good strong arm. VII Age + BUN = Lasix dose. VIII They can always hurt you more. IX The only good admission is a dead admission. X If you don’t take a temperature, you can’t find a fever. XI Show me a BMS who only triples my work and I will kiss his feet. XII If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII The delivery of medical care is to do as much nothing as possible.

Equally worrying, and far less recognized, medicine has been slow to confront the very changes that it has been responsible for—or to apply the knowledge we have about how to make old age better. Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has actually fallen in the United States by 25 percent between 1996 and 2010. Applications to training programs in adult primary care medicine have plummeted, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partly, whether we admit it or not, a lot of doctors don’t like taking care of the elderly.

For starters, of the four so-called weapons of mass destruction, three are far less massively destructive than good old-fashioned explosives.272 Radiological or “dirty” bombs, which are conventional explosives wrapped in radioactive material (obtained, for example, from medical waste), would yield only minor and short-lived elevations of radiation, comparable to moving to a city at a higher altitude. Chemical weapons, unless they are released in an enclosed space like a subway (where they would still not do as much damage as conventional explosives), dissipate quickly, drift in the wind, and are broken down by sunlight. (Recall that poison gas was responsible for a tiny fraction of the casualties in World War I.) Biological weapons capable of causing epidemics would be prohibitively expensive to develop and deploy, as well as dangerous to the typically bungling amateur labs that would develop them.

Tim Tigner began his career in Soviet Counterintelligence with the US Army Special Forces, the Green Berets. That was back in the Cold War days when, “We learned Russian so you didn't have to,” something he did at the Presidio of Monterey alongside Recon Marines and Navy SEALs. With the fall of the Berlin Wall, Tim switched from espionage to arbitrage. Armed with a Wharton MBA rather than a Colt M16, he moved to Moscow in the midst of Perestroika. There, he led prominent multinational medical companies, worked with cosmonauts on the MIR Space Station (from Earth, alas), chaired the Association of International Pharmaceutical Manufacturers, and helped write Russia’s first law on healthcare. Moving to Brussels during the formation of the EU, Tim ran Europe, Middle East, and Africa for a Johnson & Johnson company and traveled like a character in a Robert Ludlum novel. He eventually landed in Silicon Valley, where he launched new medical technologies as a startup CEO. In his free time, Tim has climbed the peaks of Mount Olympus, hang glided from the cliffs of Rio de Janeiro, and ballooned over Belgium. He earned scuba certification in Turkey, learned to ski in Slovenia, and ran the Serengeti with a Maasai warrior. He acted on stage in Portugal, taught negotiations in Germany, and chaired a healthcare conference in Holland. Tim studied psychology in France, radiology in England, and philosophy in Greece. He has enjoyed ballet at the Bolshoi, the opera on Lake Como, and the symphony in Vienna. He’s been a marathoner, paratrooper, triathlete, and yogi.  Intent on combining his creativity with his experience, Tim began writing thrillers in 1996 from an apartment overlooking Moscow’s Gorky Park. Decades later, his passion for creative writing continues to grow every day. His home office now overlooks a vineyard in Northern California, where he lives with his wife Elena and their two daughters. Tim grew up in the Midwest, and graduated from Hanover College with a BA in Philosophy and Mathematics. After military service and work as a financial analyst and foreign-exchange trader, he earned an MBA in Finance and an MA in International Studies from the University of Pennsylvania’s Wharton and Lauder Schools.  Thank you for taking the time to read about the author. Tim is most grateful for his loyal fans, and loves to correspond with readers like you. You are welcome to reach him directly at tim@timtigner.com.

By the end of the year, X-ray burns were front-page news in virtually every prominent electrical, medical, and scientific journal. No one, however, paid a greater price than the men and women on the front lines of this new technology: radiologists and radiology technicians, most of whom saw themselves as noble warriors, “martyrs to science,” in their quest to save lives with X-rays. In November 1896, Walter Dodd, a founding father of radiology in the United States, suffered severe skin burns on both hands. Within five months, the pain was “beyond description” and his face and hands were visibly scalded. When the pain kept him awake at night, Dodd paced the floor of Massachusetts General Hospital with his hands held above his head. In July 1897, he received the first of fifty skin grafts, all of which failed. Bit by bit, his fingers were amputated. Dodd waited as long as he could before amputating his little finger because, as he said, “I needed something to oppose my thumb.” On August 3, 1905, at the age of forty-six, Elizabeth Fleischmann, the most experienced woman radiographer in the world, died from X-ray-induced cancer after a series of amputations. Fleischmann had gained international renown for her X-rays of soldiers in the Philippines during the Spanish-American War. Upon her death, almost every major newspaper published eulogies about “America’s Joan of Arc.

donated skeletal collection; one more skull was just a final drop in the bucket. Megan and Todd Malone, a CT technician in the Radiology Department at UT Medical Center, ran skull 05-01 through the scanner, faceup, in a box that was packed with foam peanuts to hold it steady. Megan FedExed the scans to Quantico, where Diana and Phil Williams ran them through the experimental software. It was with high hopes, shortly after the scan, that I studied the computer screen showing the features ReFace had overlaid, with mathematical precision, atop the CT scan of Maybe-Leoma’s skull. Surely this image, I thought—the fruit of several years of collaboration by computer scientists, forensic artists, and anthropologists—would clearly settle the question of 05-01’s identity: Was she Leoma or was she Not-Leoma? Instead, the image merely amplified the question. The flesh-toned image on the screen—eyes closed, the features impassive—could have been a department-store mannequin, or a sphinx. There was nothing in the image, no matter how I rotated it in three dimensions, that said, “I am Leoma.” Nor was there anything that said, “I am not Leoma.” To borrow Winston Churchill’s famous description of Russia, the masklike face on the screen was “a riddle wrapped in a mystery inside an enigma.” Between the scan, the software, and the tissue-depth data that the software merged with the

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But laboratory, radiology, and pathology results were computerized relatively early (many hospitals and clinics did so in the 1990s), and some healthcare systems began experimenting with giving patients access to them.21 While this information was less fraught than doctors’ notes, many in the medical establishment still worried about how patients might handle seeing such results unfiltered.

I anticipate diagnostic AI will exceed all but the best doctors in the next twenty years. This trend will be felt first in fields like radiology, where computer-vision algorithms are already more accurate than good radiologists for certain types of MRI and CT scans. In the story “Contactless Love,” we see that by 2041 radiologists’ jobs will be mostly taken over by AI. Alongside radiology, we will also see AI excel in pathology and diagnostic ophthalmology. Diagnostic AI for general practitioners will emerge later, one disease at a time, gradually covering all diagnoses. Because human lives are at stake, AI will first serve as a tool within doctors’ disposal or will be deployed only in situations where a human doctor is unavailable. But over time, when trained on more data, AI will become so good that most doctors will be routinely rubber-stamping AI diagnoses, while the human doctors themselves are transformed into something akin to compassionate caregivers and medical communicators.

LAWS OF THE HOUSE OF GOD I Gomers don’t die. II Gomers go to ground. III At a cardiac arrest, the first procedure is to take your own pulse. IV The patient is the one with the disease. V Placement comes first. VI There is no body cavity that cannot be reached with a #14 needle and a good strong arm. VII Age + BUN=Lasix dose. VIII They can always hurt you more. IX The only good admission is a dead admission. X If you don’t take a temperature, you can’t find a fever. XI Show me a BMS who only triples my work and I will kiss his feet. XII If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII The delivery of medical care is to do as much nothing as possible.

Charles Regis Perrone was a biologist by default. Medical school had been his first goal--specifically, a leisurely career in radiology. The promise of wealth had attracted him to health care, but as a devoted hypochondriac he was repelled by the idea of interacting with actual sick people.

By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.

ABOUT THE AUTHOR Tim Tigner began his career in Soviet Counterintelligence with the US Army Special Forces, the Green Berets. That was back in the Cold War days when, “We learned Russian so you didn't have to,” something he did at the Presidio of Monterey alongside Recon Marines and Navy SEALs. With the fall of the Berlin Wall, Tim switched from espionage to arbitrage. Armed with a Wharton MBA rather than a Colt M16, he moved to Moscow in the midst of Perestroika. There, he led prominent multinational medical companies, worked with cosmonauts on the MIR Space Station (from Earth, alas), chaired the Association of International Pharmaceutical Manufacturers, and helped write Russia’s first law on healthcare. Moving to Brussels during the formation of the EU, Tim ran Europe, Middle East and Africa for a Johnson & Johnson company and traveled like a character in a Robert Ludlum novel. He eventually landed in Silicon Valley, where he launched new medical technologies as a startup CEO. In his free time, Tim has climbed the peaks of Mount Olympus, hang glided from the cliffs of Rio de Janeiro, and ballooned over Belgium. He earned scuba certification in Turkey, learned to ski in Slovenia, and ran the Serengeti with a Maasai warrior. He acted on stage in Portugal, taught negotiations in Germany, and chaired a healthcare conference in Holland. Tim studied psychology in France, radiology in England, and philosophy in Greece. He has enjoyed ballet at the Bolshoi, the opera on Lake Como, and the symphony in Vienna. He’s been a marathoner, paratrooper, triathlete, and yogi.

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