I can still recall my first day of medical school orientation. A humbling silence fell across a sea of 162 enthusiastic and largely arrogant aspiring trainees as the dean proclaimed, “As doctors, you will all kill someone at some point in your career.” I did not give this declaration much thought at the time. I already had a career as a diagnostic radiologist in my sites and believed that radiologists were intricately separated from patients such that the dean’s statement would not apply to me. Flash-forwarding six years into the future, I met “Jerry,” a very nice 52-year-old man who was referred to the radiology department after being admitted for pain control due to back pain. He had been scheduled to undergo a myelogram (injection of contrast into the spine following a spinal tap) at an outpatient center the following week, but the hospital provider overseeing his care decided to have it added on to my schedule while he was in the hospital even though the procedure was unlikely to alter inpatient management. Jerry was one of the nicest patients undergoing a lumbar puncture I have ever met. After explaining the risks and benefits of the myelogram and ensuring that he was not taking any contra-indicated medications, we chatted briefly about his family, grandchildren, and volunteer work at his church. Jerry’s lumbar puncture was my 40th in residency, 28 of which had been done as part of a myelogram. The procedure went smoothly, and there was no indication that this myelogram was any different than the others I had performed. I finished the day with an additional myelogram and a therapeutic lumbar puncture, neither of which was eventful. It was a normal Tuesday. A few days later, my supervising attending radiologist called me asking if there was anything unusual about Jerry’s procedure. While reading through the routine chest X-ray list, he came across Jerry’s exam, which had the indication “organ donor evaluation.” I called his hospital physician, incidentally a friend and former internal medicine co-resident, to find out what had happened. It turned out that Jerry had gone into status epilepticus several hours following the myelogram and was now clinically brain dead. The color drained from my complexion as the effects on Jerry and his family overwhelmed my conscience. My medical school dean was proven right, after all. It was not uncommon for my patients to pass during my PGY-1 intern year in internal medicine, but these were generally very sick people whose lives were being medically extended up until the point that nature was allowed to take its course. In Jerry’s case, he appeared to be in typical health for his age aside from his back pain. He had walked in on his own two feet and was joking with me leading up to the procedure and during it. But for the fact that he showed up to my procedure room on an otherwise normal day, he very well may still be alive and well, playing with his grandchildren and leading a youth group at his church. In recently reflecting on that fateful day, I wondered if his family knew the role that I played in his demise. A quick Internet search revealed his obituary. To paraphrase the first paragraph, “He went in for a diagnostic procedure, but the Lord had other plans.” Jerry’s passing changed me as a physician and radiologist. Even though only three percent of radiologists have reported a myelography-related seizure, the experience taught me that there really are no simple procedures despite how minimally invasive they may seem. Society grants us special privileges as physicians. Radiologists must honor these privileges by obtaining proper informed consent and being honest about possible outcomes, especially because our patients often come to us as relative strangers and remain under our care for only a short period of time. I revisit the memory of Jerry every time I perform or teach this procedure. One could say that I am haunted by the friendliest ghost you would ever meet. Rest in peace, Jerry. Cory Michael is a radiologist. Source
