My Journey into Radiology

 My journey into Radiology

Nihal D Amarasekera

 

O

nce upon a time I was an unhappy and disaffected haematology registrar in a hospital close to London. After having completed the MRCP in 1976 I would have loved to proceed to a job as a medical registrar. But I was eminently aware such posts were reserved for local graduates. Then consultancies in general medicine were an impossible dream. I just couldn’t see myself looking through a microscope for the rest of my life. 

One soggy morning I was turning the pages of the BMJ when I came across an advertisement for a trainee radiologist at King’s College Hospital London. Being young, curious and impulsive, I applied and was called for an interview. I was impressed by the charm and the elegant spread of the Victorian buildings. There were several candidates nervously pacing the corridor outside the waiting room, an ideal scene to fur up one’s coronaries. Inside the suffocating confines of an elegant room, there were half a dozen wizened old men seated round a large table. At the interview I made a dreadful start. They were not impressed I had not visited the hospital before the interview and asked me why not. I said “Kings College being a centre of excellence I assumed it would be good and there was no need to make a visit”. They were shocked and bemused by my answer but accepted it reluctantly. Perhaps they were still unsure about me when they offered me the job. I didn’t realise at the time this was a well sought-after post. The hospital indeed was a centre of excellence with a golden reputation. Its Director, John Laws, was the president of the Royal College of Radiologists. A distinguished-looking figure, he was a quiet, formal and kindly man who commanded respect and received it. From now on I was in posh company. 

After having worked in general medicine for several years, from the outset I thought I knew enough about Xray film interpretation and believed training was merely to brush up and to learn the finer points. I soon realised how wrong I was. In reality I knew nothing and had everything to learn. The return to the very basics wasn’t easy. 

The radiology training was for 5 years. The first year was for radiation physics and radiographic anatomy and all about patient positioning for Xray images. There was a lot to learn about films and developing. The subjects were so far removed from patient care this was like being in the ‘block’ in our medical faculty. The training was done in-house and also at the smart precincts of the Royal College of Radiologists in the centre of town. The coaching and discipline was intensive and tough. The harsh environment in training was no different from what we were used to in medical school. 

Many of us working in the UK did encounter racial discrimination. When things didn’t go our way we often blamed it on prejudice. This was not strictly correct nor fair. Wherever we live be it gender, colour, race or social standing, there will always be some form of unfairness or injustice. To keep my sanity I learnt to navigate my feelings and get on with the job in hand. 

There were around 20 registrars. Among the trainees a strict hierarchy existed that was protected like the crown jewels. My colleagues were a cross section of society but a brilliant bunch. The atmosphere in the department was combative, stressful and intense. Everyone was competitive trying to score points over others. On our reporting whenever an interesting film appeared, we kept this for our lunch time meetings. These meetings were toxic in the extreme. Films were shown with little clinical information for a hapless trainee to struggle to arrive at a diagnosis. There was precious little feeling for the distress it caused. Despite the 40+ years I can still picture the rookie registrars sweating on the podium trying to eek out information from difficult Xray images. 

I came to the UK just 3 years previously. After having been treated with respect in hospitals in Sri Lanka I found this particularly hard to take. Those of us from the Indian subcontinent are hyper-sensitive to adverse comments. We sulked and ached for days, reflecting and grieving over them.  I struggled my way through the first year and passed the first exam. 

In 1967 it was my decision never to do anymore examinations and even sold all my medical text-books. Now I had 4 more years of this ‘hell’ to endure. I was restless and impatient for things to happen. There were times I felt all this was far too much for me. It was now I needed some good advice. My Indian dentist Rajeev Gupta was an intelligent and enlightened person. He was a maxillo-facial surgeon who had worked at the Middlesex Hospital. I went to him for guidance if I should give up radiology and return to clinical medicine. Rajeev was an inspiration. He discussed the pros and cons and advised me not to look back but to proceed ahead.  He bitterly regretted giving up his own hospital career for short term gain. Rajeev predicted a bright future for Radiology. It was a fast-moving speciality with the advent of computerisation. I am indeed so very grateful for his wisdom and scholarly advice. 

When I first started and a chest Xray was put up I often missed even the glaringly obvious abnormalities. Stress does makes fools of us so easily!! Making mistakes and getting things wrong in front of colleagues is not a pleasant feeling. This went on for a whole year. Like learning to drive a car, suddenly something clicked. The ability and confidence arrived from out of the blue. I soon began to see the wood from the trees. Before long I even began to enjoy the challenge of being shown difficult films. Regrettably, I even revelled in giving the other trainees a hard time. 

By now I had learnt about the British culture and humour and understood the subtleties of their language. This avoided the possible misunderstandings. Importantly I learnt to speak out, fight my corner and stand my ground. Quite early on in my training I was told by a Radiology Consultant that if I don’t blow my own trumpet no one else will blow it for me. In a trainee culture saturated with hubris I realised this was not a place for modesty and humility. I had to show off my knowledge and impress my bosses. My sound training at the faculty of medicine in Colombo was an invaluable help all through my apprentice years. 

Despite the tough regime I am forever grateful to Kings College hospital. They had the best structured training programme and the best examination results. There is no gain without pain was their mantra. I do not doubt they had the welfare of the trainees at heart. Above all after the training we emerged as safe and dependable radiologists. Many of my former colleagues reached those dizzy heights in the profession becoming influential names in British Radiology, examiners and office bearers of the Royal College of Radiologists. 

I was then living in north London travelling daily to the south crossing the great River Thames twice a day. This took me more than an hour each way. By then I had a young family and time at home was precious. I began to apply for Senior Registrar posts north of the river and closer to home. I finally found one at University College Hospital with a rotation to Great Ormand Street, Queens Square and the Royal National Orthopaedic hospital. It was indeed a great privilege to work in some of the prestigious hospitals in London. My only claim to fame is that I worked with those legendary icons in British radiology. It was such a privilege to have been tutored by the greats: Glyn Lloyd in ENT radiology, Simon Rees in cardiac radiology, Brian Kendal in neuroradiology and Donald Shaw in paediatric radiology.  I had the opportunity to share clinico-radiology meetings with Sir Roger Bannister and Sir Magdi Yacoub. Here I must apologise for ‘name dropping’ and for being so boastful. Perhaps, my humility was a casualty of the rough and tumble of radiology training. 

The atmosphere at UCH was more sedate and civilised. With an easier journey to work I was able to give more time to my family. Life got infinitely better for me. I became more confident and good at my job. In radiology we were trained to write reports on the images we saw. My interest in writing helped me enormously to construct precise, concise and useful reports. I made many friends at UCH who have remained friends for life. 

At the end of 5 years in radiology I passed the final examination. The FRCR(Lond) was a fearsome examination, a particularly difficult one with a meagre pass rate of 14-15%. Interestingly, most candidates did badly in plain Xrays than in cross-sectional imaging. 

Life had now come a full circle for me. The hardship and the struggles of the past have borne fruit and were at an end. I was appointed a consultant in a hospital 50 miles north of London.  I spent the rest of my professional career in the green and pleasant Hertfordshire countryside. Within 8 years of my arrival in the UK I was given their top job. I am ever so grateful to the National Health Service. Professionally I couldn’t have done better anywhere else in the world. 

Since the discovery of Xrays in 1895 by Wilhelm Roentgen, for fear of radiation, its usage has been confined to Xray departments at the basement of the old Victorian hospitals. During my lifetime radiology has been transformed. It is now a safe and invaluable tool in the early diagnosing and treatment at the forefront of clinical care. The rapid progress and the dependence of modern medicine on cross sectional imaging will always remain a source of pride and fascination for me. 

On reflection moving into radiology was one of the best things I’ve done. Looking back on my career I feel a tremendous sense of fulfilment.  After such a prolonged professional training, retirement came all too soon. Since then the years have flown by. Occasionally my mind goes back to the time when my ambition was to be a DMO. Fate had other plans for me. I then became a drifter in Colombo spending the evenings drinking at the Health Dept. Sports Club at Castle Street. I find it hard to explain how life took a change for the better. I call it the awesome force of destiny. 

(NOTE by Speedy: The image of ND is a self-portrait and I “doctored” the rest!)