On the first day, I arrived at John Peter Smith Hospital shortly after 7 a.m., and met with Dr. Kurt Schoppe ’02, a radiologist with Radiology Associates of North Texas. Dr. Schoppe taught me about the fundamental workings of the MRI and CT scans, and we examined a large number of studies. He taught me about the systematic method of using search patterns to examine each case. In essence, this consisted of following a highly practiced and efficient search algorithm to check each and every detail of the studies. Dr. Schoppe would pull up online resources to triple-check that he had covered everything. I was impressed with the care that he demonstrated as he painstakingly examined every facet of every scan, even areas where no problems were identified.
Dr. Schoppe also taught me about the importance of examining the medical history of each patient—that is, one should use information that is already known to aid in the discovery of new information. There was something truly Sherlockian about the radiologist, who is in essence a medical detective, constantly on the lookout for clues. Dr. Schoppe warned me against flights of fancy, noting that while examining symptoms, it was important to assess the practical likelihood of each possibility. After all, when one hears hoof beats, he remarked, think horses, not zebras.
Throughout the day, I saw some extraordinary studies. For example, one patient had an extreme case of a horseshoe kidney; his kidneys had failed to ascend and one had tipped to one side. Such a condition may seem detrimental, but Dr. Schoppe explained that this was not so. Our bodies are truly incredible; Dr. Schoppe compared our physical limits to those of commercial airlines, which are designed to do barrel rolls and loop de loops despite the lack of a need for such acts. The many levels of redundancy built into our organs provide us with a great robustness and ability to withstand large amounts of damage. Dr. Schoppe truly illuminated me to the great complexity and wonder of the human body!
On the second day, I attended Tumor Board, a meeting in which many physicians – including radiologists, surgeons, and pathologists – gathered to discuss unusual cases and to determine optimal courses of treatment. A prevailing notion that I learned was that there is often no obvious solution. Each patient is examined in painstaking detail, with physicians pouring over pathological and radiological studies. On this day, five cases were presented. The doctors diagnosed each case as well as they could, and then talked about what steps to pursue. In one case, several physicians entered a debate about whether or not surgery was the best option. Many factors came into play, such as the fact that the patient was on one hand of advanced age, and on the other hand highly robust. I learned that many details which might seem to have little meaning to the layman are instrumental to treatment. For example, anal and rectal tumors may sound similar to an outsider but are treated completely differently, and the doctors fortuitously corrected a misdiagnosis.
I was surprised by the collaboration that the physicians at John Peter Smith Hospital engaged in with other medical professionals across the country. There seemed to be a regular exchange of data with the Mayo Clinic and several diagnostic laboratories. However, more striking was the level of informational exchange between the different physicians in the hospital; at no other point during my internship was I more heavily aware of the interconnectedness of all the different medical fields which fit together cog-like to power the life-saving engine that we call a hospital.
After the meeting, I watched as Dr. Schoppe examined a few more cases before eating lunch. One of the cases brought attention to the constant vigilance that radiologists must demonstrate. One patient was diagnosed with a fracture, but Dr. Schoppe discovered that in reality, the patient possessed an accessory naviculare bone, present in about 10% of the population. To the unwary eye, this bone had an appearance much like that of a fracture. We examined a case in which a tumor was wrapped around the carotid artery, ensuring that surgery would be extremely difficult. Dr. Schoppe identified peculiarities in each case with an expert eye and pointed out, amidst what appeared as amorphous patterns to the untrained watcher, grains of life-saving truth.
I would like to thank Dr. Schoppe for so energetically teaching me so much in so little time – not only providing lessons in radiology and anatomy, but also in the mindset of a doctor – and the Princeternship program for giving me a fantastic opportunity to learn about the medical field!