"That's ridiculous." Tim owns and runs a mobile radiology company and I had just sent him a text to tell him that a major home lab had suspended home phlebotomy. I wanted to check in to see if NY Home X-ray had done the same. The lab eventually reversed their initial panic protocol and resumed in-home phlebotomy, but NY Home X-ray never panicked. Tim's meta-message was right. If you are in health care and act ridiculously when your services are needed most, then you shouldn't be in health care.
Yesterday, the heroism of the work this mobile radiology crew is doing hit me more so than our first text exchange weeks ago at the start of our era of sirens. Tim himself was out in the field on a Sunday suited up to protect himself and my vulnerable home bound. He doesn't always call, but yesterday he did call to read the radiologist's report because it was abnormal, "viral pneumonia," "ground glass," "COPD." We talked about his crew of radiology technicians. No, none of them had become sick with novel coronavirus. I asked how they accomplished that despite a month of frequent exposure opportunities. Tim described a well thought out and detailed equipment use protocol. He told me about all the gear. He said he had plenty of protective equipment. Preparation is the foundation of a goal to provide continued service. "We have to get in and out." I have been in the home with them in the past. Tim's radiology techs are usually calming, social and chatty. They have always helped the sick patients feel comfortable so they can lay on a hard cold x-ray plate, but in our era of sirens, they can't linger anymore.
Yesterday Tim described how he knows when it's coronovirus. Radiology techs can't read x-rays, but they look at them. They have to look at the screen to make sure they got the picture which captures the truth in the same way you do with your camera. After years they come to know abnormal and they come to understand something about how the official reading of the radiologist fits the image that they saw on screen together with the real person whose picture they took. Radiology techs see both the image and the experience of the patient. The radiologist only sees the black and white image. Its coronavirus if the normal black of the lungs are more white where they should show more black and also if there is fear in the eyes of the patient.
"Stay home if you are sick," our leaders and experts say. There are very few of us to help those who are staying home with fear in their eyes. Yesterday, Marie who found me on the internet, said she had been calling her doctors plural and received no call backs from messages left on Wednesday, Thursday, Friday and Saturday. So much for the satellite hospitals of prestigious medical centers having available telehealth services. She was relieved that she had enough medications for her chronic conditions. She thought she was calling me for the kind of pneumonia that she barely survived seven months ago. She has coronavirus. I knew that was her diagnosis when I left her apartment. Just hours later Tim confirmed my impression when he read the abnormal report and also witnessed the fear in her eyes. She will never make the statistics unless she dies from it because I can't test her, so just add one to the stats of positive.
It is notable that the heroes of NY Home X-ray were prepared and protect themselves so that they can help me make a diagnosis one step beyond a pretest probability. Its a pandemic, by definition the pretest probability is off the charts, but the symptoms and abnormal findings can be other common diagnoses. Tim and NY Home X-ray help me determine that it is or is not something else. "Stay home if you are sick" is a more than a little "ridiculous" if your needs are a diagnosis and available doctor to mitigate the aloneness and fear. I appreciate the heroes of NY Home X-ray for generating the image that helps me help those who are told not to go to a hospital. They deserve to know too.