Every Monday afternoon three hours were devoted to teaching conferences. It started with the 2 p.m. Radiology session and was followed by Morbidity and Mortality, in which complications and deaths throughout the preceding week were discussed in detail. In addition, all scheduled elective surgeries for the week were reviewed, emphasizing the indications for each. This last conference usually dragged on for as long as the professors wished to pontificate, confining their serfs to soporific CO2 levels as the evening’s scut work continued to pile up, making it impossible for an off-call resident to head home at a reasonable hour. For the on-call residents who had to drive back across town to the trauma center, their workday would not end until late evening, if at all.
At the Radiology conference, residents and professors sat in rows of five metal folding chairs, the faculty in the front with the residents behind, allowing them to step out of the room to answer frequent pages. The room’s only light emanated from the X-ray panels, casting eerie shadows that sometimes gave the presenting resident a Bela Lugosi flair.
Neuroradiology professor Larry Harris slid a CT scan onto the multi-panel screen and asked the group, “Can anyone tell me what this is?”
Without really thinking—for the picture, strange as it appeared, could logically only be one thing—Alex blurted, “A vein of Galen aneurysm in an infant.”
Dead silence. Harris seemed shocked at the answer. After a few beats, he asked, “What made you pull that one out of your hat?”
Alex had to stop, back up, and think about his shoot-from-the-hip conclusion. “Well, the shape and thickness of the skull along with the open sutures make the patient an infant, probably a newborn.” He went into detail, as the point of the conferences was to provide in-depth explanations to teach residents logical clinical associations. “The abnormality is located in the midline, exactly where the venous sinus are. This lesion is large and contrast enhances, which indicates it’s filled with blood. The smooth, linear, discrete borders and the enlargement at confluence support it being a vascular structure. Lastly, the mesial edge is perfectly straight, suggesting it abuts the Falx”—the membrane that separated the two hemispheres. “Keeping those things in mind, the only reasonable diagnosis would be a vein of Galen aneurysm.” Then again, he realized, it could be something really off-the-wall weird, like a bizarre vascular tumor. But he seriously doubted that.
Harris nodded approval. “Very good, Dr. Cutter. Impressive. Especially since this is the first one I’ve seen on CT.” The professor pointed to a first-year radiology resident. “Hansen, what’s the prognosis?”
Hansen’s horrified face blanked. “Uh, don’t know, sir.”
Harris turned to the pediatric neurosurgeon. “John?”
John Luciano, a boisterous surgeon from the Bronx, boomed out in his New York accent, “Typically these kiddos die of heart failure before anything can be done. But commonly nothing can be done because there’s no known way to effectively treat them.”
Harris replaced that image with two views of a different skull. “McGinnis, what’s this X-ray show?”
And so it went.