What's Up, RAD?

By Cary J. Stegman MD

“What’s Up, Rad?” is a collection of vignettes; stories of brave patients, consulting colleagues, collaborating physicians, notable nurses and ancillary medical personnel—both heartwarming and heartbreaking. All stories are TRUE! Hopefully these narratives will bring insight—the insight that “The good physician treats the disease; the great physician treats the patient who has the disease.” You may shed a few tears, be awed by healthcare advances, reap some chuckles and garner increased empathy.

Dr. Cary Stegman practiced as a board-certified diagnostic radiologist and nuclear medicine physician for 43 years and through these vignettes we see his personal growth and how he met and exceeded the demands of his profession-a special profession in which the tree of life bears an extraordinary abundance of the sweet and sour fruits of life.

“This, his second book to be published, recounts emotional interactions during his 45 years in medical training and practice. His first published book, The New Old Testament, was an attempt to awaken people to the why and how of their poor critical thinking. He also wrote and spoke to state legislators and end-of-life national organizations about a new approach to end-of-life medical intervention. In his blog, jigSawpuzzlings, he addresses medical and other societal concerns.

Cary J. Stegman is a man of prodigious talents. He could have been an architect: he played a major role in designing many of the outpatient offices for our medical practice, and most thought his ideas were improvements on plans submitted by professionals. He redesigned his own home into a showplace. Cary could have been a graphic designer: he crafted the logo for our practice. After some years, a new design was sought from a local expert, who returned with many possibilities. All of these were considered, but none was better than the original. Stegman’s work remains the emblem of the practice after more than 40 years. Cary Stegman is a philosopher: He has thought so deeply about the state of the world today that he has written a book (THE NEW OLD TESTAMENT), which reconstructs Genesis and part of Exodus from the five books of Moses to reflect modern science and sensibilities. He is, of course, a physician. His many years of practice are marked by brilliance as a diagnostician and skill with (very!) small instruments. Cary is a writer, producing concise and meaningful prose, as you will find here.

But most of all, Cary Stegman is a caring and empathetic human being. His care for other humans shines through all he writes, and through all he does. You will find it here, seeping through the humor and pathos of his long years in practice. Read and kvell (ENJOY)!”—Jonathan Levy, MD

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Oct 16, 2023
• ISBN: 9798886540277

Book preview

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What's Up, RAD?

Cary J. Stegman, MD

Copyright © 2023 Cary J. Stegman, MD

All rights reserved

First Edition

PAGE PUBLISHING

Conneaut Lake, PA

First originally published by Page Publishing 2023

ISBN 979-8-88654-019-2 (pbk)

ISBN 979-8-88654-034-5 (hc)

ISBN 979-8-88654-027-7 (digital)

Printed in the United States of America

Table of Contents

Acknowledgement

Foreword

Introduction

Preface

My Treasure

Pair A Docs (Paradox)

What The Duck?

Headstrong?

Mind Your P's And Q's

Say Uncle!

IUDA

Where Will I Go?

Swab The Deck

Right Or Wrong

Pro-Choice

See Saw

Old-Time Medicine

Personalities: Patients And Doctors

Wired

Carrot (Chalk) Stick Fracture

Juvenile Diabetics

Erection Complication

Up Where The Air Is Clear

Miss No Remiss

Miscommunication

Malodorous

Death Of An Insurance Policy

First Medical Lawsuit

Empty Suits For Empty Suits

Trust

Down The Garden Path

Disabled Disability Insurance

The Cobra's Costly Bite

Viva

Spurious Coincidence

Doctor Death

The Urn And The Pacemaker

Medicine Magic

Rock And Roll Emergency Medicine

The Seer Of Chest Images

Review, Find Anew

Unanticipated Twists And Turns

Guinea Pigs

Two Minus One Equals Zero

One Cleft Or Two Clefts But One Beautiful Smile

Ass-Burn-In Trauma

Strangulation

Doleful Connection

For Better And Worse

Appendix

May Or May Not Be…

Stout-Heartedness

Compassion Action

Genes And Cancers

Gerd Cured?

Patient Impatient Patient

We Own Our Lives! Whose Life Is It, Anyway?

The Preamble To The Constitution

Abortion

The Power Of The Dog

Help Me!

End Of Life

Internment

Recompose Model

A Woman Of Valor

To Bravery… For Helen

That'S All, Folks!

Appendix 1: Oaths

Appendix 2: Famous Medical Scientists

Appendix 3: Imaging Advances

Appendix 4: Digital Images

Appendix 5: Sample Radiology Reports

Appendix 6: Archaic And Folk Medicine And Quackery

Appendix 7: Reading And Bibliography

Appendix 8: Quotes About Medicine To Be Remembered

Appendix 9: Have Fun. Be The Rad. Play Where's Waldo? (The Abnormality)!

Appendix 10: Graphics By Zev Lee Ware (11) + Ayla Liana Ware (9)

About the Author

To Shirley and to all who mentored me, supported me, and had faith in me.

This book is dedicated to all men and women of times past and times present who have dedicated their lives, their intelligence, their compassion, their empathy to provide mankind with medical care based on scientific method. Their courage to face pernicious societal conventions, ancient and contemporaneous, has benefited us today with healthier and longer lives.

And to all the medical scientists and healthcare providers whose competence, courage, intellect and empathy have saved innumerable lives.

The good physician treats the disease; the great physician treats the patient who has the disease.—William Osler*

A physician can be neither good nor great without nurses, technicians, technologists, aides, innovative medical scientists and many others committed to advancing healthcare.—C J Stegman

*Sir William Osler, 1st Baronet, FRS FRCP (July 12, 1849–December 29, 1919) was a Canadian physician and one of the Big Four founding professors of Johns Hopkins Hospital. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.[1] He has frequently been described as the Father of Modern Medicine and one of the greatest diagnosticians ever to wield a stethoscope.

Wikipedia

Acknowledgement

I have finally completed this book. It was a joy to write. Memories, good and bad,

are my life, my spirit.

Most books give acknowledgements to those who have supported the author. I

find this a very hard task, particularly with specificity. There are so many people to

thank, who have made me what I am. It takes a village…

One individual deserves individual mention. That is my wife, Shirley, whose love

and care have been my greatest support. I must commend her as my primary

reader. A difficult job to do. But there are many more people who have built me.

My family, my in-laws, my teachers from elementary through med school and onto

residency, my especially knowledgeable and competent colleagues, the many

nurses, technicians and technologists without whose support, in several situations,

my treatment of patients would have been compromised. And to the often-unwitting patients who trusted in my care.

It is my hope that in reading this book the reader will know that most healthcare

professionals are motivated by beneficence, compassion and the constant drive to

do better and better and…

If you want others to be happy, practice compassion. If you want to be happy,

practice compassion.—Dalai Lama

Wherever the art of Medicine is loved, there is also a love of Humanity.—Hippocrates

One of the deep secrets of life is that all that is really worth doing is what we do

for others.—Lewis Carol

Today was a Difficult Day, said Pooh. There was a pause.

Do you want to talk about it? asked Piglet.

No, said Pooh after a bit. No, I don't think I do.

That's okay, said Piglet, and he came and sat beside his friend.

What are you doing? asked Pooh.

Nothing, really, said Piglet. "Only, I know what Difficult Days are like. I quite

often don't feel like talking about it on my Difficult Days either."

But goodness, continued Piglet, "Difficult Days are so much easier when you

know you've got someone there for you. And I'll always be here for you, Pooh."

And as Pooh sat there, working through in his head his Difficult Day, while the

solid, reliable Piglet sat next to him quietly, swinging his little legs…he thought

that his best friend had never been more right.-A.A. Milne

THANK YOU TO ALL MY MENTORS AND COLLEAGUES WHO WERE THERE!

For forty years, I have embraced science-based medicine most times for better and occasionally, sadly, for worse. Here is my story.

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Foreword

You will enjoy reading this short book of entertaining stories that will give you insight into the world of medical imaging—a part of medicine that is rarely seen. As an introduction, please consider these three topics.

The source

I have seen firsthand the practice of medicine at Duke, Mayo Clinic, the US Navy, and Arizona and Yale Universities as well as in Scottsdale, Arizona. To practice for over thirty years with Dr. Cary Stegman as a partner, trusted colleague, friend, and teacher has been one of the high points of my medical career. He is among a handful of doctors who, without hesitation, I would choose as one who exemplifies the highest characteristics that we would all want in our physicians and friends.

During his professional lifetime, medicine changed more rapidly than ever before. Diagnostic radiology increasingly became the core of clinical decision-making. Computed tomography, magnetic resonance imaging, diagnostic ultrasound, interventional procedures, and both diagnostic and therapeutic nuclear medicine procedures developed far beyond what anyone might have foreseen in the 1960s. Dr. Stegman mastered all these areas and was doubly certified in both diagnostic radiology as well as in both diagnostic and therapeutic nuclear medicine using radioactive isotopes. He was also one of the few radiation safety officers in the state of Arizona.

To master the science of these most rapidly growing technical fields in medicine required intelligence, dedication to lifelong learning, interpersonal skills, and a clear understanding that medical diagnosis and patient care are not only rigorous science but also art.

In the rapidly evolving world of medical imaging, he constantly served as an ideal—a radiologist that you could trust to be honest, sensitive, informed, and constantly learning and teaching us new things.

He was a radiologist who

was trustworthy honest, helpful, and friendly;

constantly read, studied, and taught the latest techniques and procedures of not only radiology but nuclear medicine and radiation safety, in which he was also certified;

was focused on follow-up, accuracy, and outcomes (for forty years, he reviewed thousands of hospital and outpatient surgical pathology reports to compare with prebiopsy radiology diagnoses, leading us all to be more focused on cost benefit and accuracy while productively learning from our mistakes);

consistently exemplified dedication to continuous improvement and making our workplace and those around him better;

knew that the patient always comes first (his relationships with patients, physicians, nurses, technologists, and hospital staff were always open, respectful, and considerate, and he was sensitive to their medical and personal needs; Dr. Stegman truly embodies the science and even more the complex art of medicine);

embodied the skill and intelligence to master the most rapidly growing technical medical specialty blended with the interpersonal skills to embody the fusion of medical diagnosis and patient care; and,

finally, as the reader will learn, was always circumspect in recognizing that woven into the ups and downs of medical practice and life itself are interesting stories and lessons to be learned.

The context

These stories are from a time and place that have rapidly disappeared. The recent years have seen the corporate transformation of American medicine. Like the family farm, the neighborhood store, and the corner service station, the small medical partnership or individual practitioner is increasingly rare.

The city of Scottsdale, Arizona, and the medical environment in which these stories occurred have also disappeared. As one of the most rapidly growing cities in America, during his years of practice, Scottsdale tripled in size from about 70,000 to above 225,000 people. The social implications of such rapid growth are reflected not only in the organization and culture of the city but also in the medical community, with similar potential for disconnection, hostility, loss of communication, and less-efficient patient care.

These stories are gleaned from a time when the medical community was much closer and enjoyed personal interactions daily. In Scottsdale, the door from the doctors parking lot entered the radiology department near the file room and reading room. Among others, Dr. Stegman was there, working to make their entry a welcoming focus for physicians coming to the hospital to see their patients.

Rested or tired, happy or frustrated, there was a rich and close relationship between radiologists and clinicians. This camaraderie was often not seen in other hospitals where radiology departments were more isolated. His seat at the hub of not only radiology consultations but also daily face-to-face clinical patient updates, personal stories, abnormal and normal psychological needs, and the lubricant of medical life—jokes—are the foundation and enrichment of these stories selected by Dr. Stegman.

What's there is to enjoy

Medicine continues to evolve into an increasingly complex system where each of us will likely need care. Many of our critical choices will be made based on diagnostic radiology findings, which lie at the core of medical decision-making. Although in the coming years, artificial intelligence will assist in detection of certain abnormalities, only the perspective, experience, and wisdom of a radiologist consulting with other caregivers will optimally integrate the patient's other data and personal needs to provide the kind of medical care that we all should desire. From his reflections on a life at the core of these interactions within the world of medicine, Dr. Cary Stegman will provide you with insights that you will enjoy and that will broaden your understanding of medicine's often unseen world.

John K. Crowe, MD

concept of medical technology, MRI scan with digital brain analysis interface

Innovative Experiments Prove/Build Science for Innovative Technology

X-RAY

Some prowl seabeds, some hurtle to a star

and, mother, some obsessed turn over every stone

or open graves to let that starlight in.

There are men who would open anything.

To see what's within!*

Harvey, the circulation of the blood,

and Freud, the circulation of our dreams,

pried honorably and honored are

like explorers. Men who'd open men.

And those others, mothers, with diseases

like great streets named after them: Addison,

Parkinson, Hodgkin—physicians who'd arrive

fast and first on any sour deathbed scene.

I am their slowcoach colleague, half afraid,

incurious. As a boy it was so: you know how

my small hand never teased to pieces

an alarm clock or flensed a perished mouse.

And this larger hand's the same. It stretches now

out from a white sleeve to hold up, mother,

your x-ray