A patient has a tube that connects her insides with the outside (technical terms). A clog forms within the tube. Multiple people with a variety of letters after their last names try different methods to dislodge the clog; no one succeeds. The surgeons want to visualize the area where the tube is located before pursuing any procedures. This results in the saga of…

How to Get a Radiology Study for a Patient in the Hospital:

1. Tell the patient you have ordered the study and why. (0 hours.)
2. Fax the radiology request to the radiology department.
3. Call the radiology department to confirm receipt of the request. Someone states that the procedure will be done before the day ends.
4. The day ends and the weekend begins. (8 hours.)
5. Ask the nurses of the unit if the study was completed. The nurses say no. One of them proactively calls the radiology department to ask why the study never happened; someone replies, “We never got the request.” (15 hours.)
6. The patient expresses umbrage at the shoddy care.
7. Call the radiology department and ask when the procedure can be done—it’s not exactly urgent, but it’s not routine, either. Someone replies, “It’s not an emergent procedure; it won’t be done until Monday.”
8. Call the radiology resident on call and repeat the request. The radiology resident replies, “It’s not an emergent procedure; it won’t be done until Monday.”
9. Consider climbing the academic hierarchy to coerce the radiology staff to do the procedure, but realize (probably correctly) that the effort is futile.
10. Page the surgery resident to explore other options that may or may not involve a radiological intervention. (16 hours.)
11. The surgery resident calls you back. (17 hours.)
12. The surgery resident kindly offers to brainstorm with the radiology resident so that a study can be obtained within the next few hours.
13. The nurses offer to contact their supervisor to prevent this type of shoddy care from occurring in the future. Say, “Thank you.”
14. The surgery resident pages you. (18 hours.)
15. Call the surgery resident back. (18.016 hours.) The resident offers another radiological study that includes injection of a dye. This procedure can be done over the weekend. The resident asks you to write orders.
16. Call the radiology resident and ask how dye can be injected into a tube that is clogged. The radiology resident stalls, but ultimately states the study is warranted and that perhaps, a small bit of dye will make it through the tube.
17. Call the nurse and politely ask her to take down a verbal order for this study. She politely does so.
18. Your attending pages you. (19 hours.)
19. Call your attending back. He says, “Just wanted to give you a heads up—radiology didn’t do that procedure yesterday.” Nod vigorously in an annoyed fashion, though he can’t see you. Tell him that you’re taking care of it.
20. Someone from radiology pages you. (22 hours.)
21. Return the phone call. The radiology tech reports that he cannot perform the procedure because he is not permitted to inject the dye. “You can, though,” the tech says. “You’ve got an MD.”
22. Look at your growing, disorganized queue of consult requests. Ponder throwing the phone across the room.
23. Say, “Thank you,” and hang up.
24. Call the radiology resident and argue your case: Psychiatry residents don’t routinely inject dye into these tubes, are unfamiliar with this dye (and what adverse reactions can occur from it), and are uncomfortable doing this. “Plus,” you add, “we’re getting slammed today with consults.”
25. The radiology resident agrees and generously states that he will push the dye. “But please re-fax the order and note on there that I’ll push the dye.”
26. Re-fax the radiology request.
27. Confirm that the radiology study has been completed. Call the radiology resident to learn the findings. (24 hours.)
28. “The tube wasn’t clogged,” the radiology resident dryly replies. “The dye went in without a problem.” Smack yourself in the forehead. Twice, for good measure.
29. Thank the radiology resident and hang up.

(sigh)