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It had been 57 years since I last looked at a chest X-ray with any serious intent of providing a diagnostic comment. And this time, the X-ray was mine.
As the radiographer passed it to me, my mind went back to a sea of white coats. It was Dublin, 1961, and I was submerged in that sea, skulking away from the inquisitive gaze of one Dr Gerard T O’Brien.
‘Doctor…’, he began, as the blood drained from my face. He was a precise man but this was his only imprecision. I was still very much a medical student but for some reason he and all the other consultants referred to us as ‘doctor’. Sarcasm or optimism, I know not which.
I see the whole scene more vividly than I recall what I had for lunch today. The bare-chested patient, the portable X-ray viewing box beside his bed. I see the shuffle of white coats as my grinning colleagues all too obligingly cleared a path for me to approach my consultant, my patient, and my fate.
I placed the stethoscope on the patient’s chest, and the poor man protested that it was freezing cold. Dr O’Brien’s lips were moving, but of course I could not hear him, and so I freed my ears.
‘Think of your patient’s comfort, try to warm the diaphragm before use.’ That was not difficult; my hands were extremely hot and clammy.
Back to auscultation. And despite the small matter of his breathing and wincing, the patient lacked a heartbeat and so I suppose was best summed up as miraculously dead. Or, as Dr O’Brien pointed out with a kindness and patience entirely atypical of the consultant cadre at that time, I had forgotten to alter the bypass switch from bell to diaphragm.
I listened to his heart, and to his lungs, in the manner of a child who sits quietly in front of the television for fear of being sent to bed. I listened as long as I was allowed. I wouldn’t say I hoped for an abnormality, only that if there was one to be found, I’d appreciate it performing a little dance for me. But it was normal, everything was normal.
There was a sign at the end of his bed which read ‘nil by mouth’, suggesting he was scheduled for surgery, but I was not allowed to ask him anything about his condition, as this was a test of my examination skills.
‘Alright doctor, that’s enough. Now check the X-ray film.’
Heart (one). The outline of the bronchial tree. Normal, normal, maddeningly normal. Why did it have to be normal?
‘Well doctor, what do you think?’
My only option was to tell the truth and risk the resulting humiliation. ‘I can find no abnormality, sir.’
The smug expressions on my student colleagues’ faces turned to broad grins as they relished the rollicking which was to come.
Dr O’Brien smiled. ‘You are perfectly correct, doctor. This man’s heart and chest are both perfectly normal and he has kindly volunteered to be a guinea pig. He is due to have a hernia repair later today.’
I smiled. The patient smiled. And I felt a dizzying sense of relief, bordering on elation.
What that medical student didn’t know back in 1961 was that he would have to wait 57 years to feel that same sense of elation over an X-ray film.
But I felt it, I really felt it, when the radiographer handed me the X-ray of my own chest.
‘Normal,’ he said.
Peter Docherty is a retired consultant ophthalmologist from Derby
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