The Wild West

By Phillips CD

So we shall let the reader answer this question for himself: who is the happier man, he who has braved the storm of life and lived or he who has stayed securely on shore and merely existed?”
— Hunter S Thompson

I always keep an assortment of things to write about nearby. The writing bug is an odd thing. Sometimes it just bites you. Other times, it circles around just out of sight, buzzing in your ear. Occasionally, it is the editors of AR writing to tell me it’s time to get my little screed in so they can hammer on it.

This one has been sitting in my skull for a while, itching to get out. It concerns the old days, and I know how much you, my readers, love, love, LOVE hearing about the old days. Some of you get to relive them while others of you wonder what they were like.

I’ve been thinking about radiology training. How it has changed. And what it seems is that we (and by we, I mean those in my age bracket) trained in the Wild West. Great, wild vistas of training, with only a few sheriffs and things somehow still getting done. We “braved the storm.” Allow me to relate a few items.

We did angios at night. By ourselves. Occasionally with adult supervision, but usually alone. I’ve talked to colleagues who didn’t even have a tech or a nurse to assist. Master the one-hand stick, and then pass your own wire, run your own films. I was lucky: we had a tech school and that meant I usually had a tech, a tech student, a nurse, and maybe even a fellow around when I did trauma arches.

We learned, we made diagnoses, and I cannot remember once having to change a single report the next day. The week after I became an attending, I did an angio at night and called the clinician with the findings. Their word to me when I finished: “Okay but let me know in the morning after you check it out with your attending.”

“I am my attending now,” I said. The response: “Oh. Well, you know what they say, it’s tough to be a prophet in your own land.” We moonlighted, we read studies, and we were the final word. Before we were even finished training. And sometimes (read: often) our staff encouraged us to. “Develops character.” “Matures you.” “Makes you make decisions.” We read for hospitals. We read for groups. We read for surgeons with their own equipment. We read for anyone who needed a hired gun.

Sometimes I’d bring a copy of the films on a particularly interesting case back with me to show either as an unknown (I PRAYED it was an unknown) or one I was proud of getting right (I PRAYED I got it right).

It truly was the Wild West, in my mind. Shoot from the hip. Can you imagine any of this today? It seems that the pendulum has swung so far the other way that we can’t even imagine a trainee making so much as a phone call about a finding without someone there to hold their hand.

I think there is likely a happy medium we will gravitate toward, but the Wild West is forever gone. The oddity of life and aging is that now, as I look back on that time, I wouldn’t have had it any other way.

Keep doing that good work. Brave the storm. Mahalo.

Phillips CD. (Nov 02, 2022). The Wild West. Appl Radiol. 2022; 51(6):48.

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

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