Reflections on an Incident

Three "gifts" that I take from an occurrence at the hospital this past weekend.

1) No matter how nice you are, some patients will still file a complaint to the highest authorities.
2) When an x-ray exam becomes difficult because of a patient's angry state of mind, it's probably better to postpone the exam, if possible.
3) If you need to proceed, bring in a neutral party as an observer: not a family member, not another x-ray technologist.

From these insights, you can probably piece together the kind of situation that I refer to.

The craft of taking quality x-rays is a small part of the challenge of our occupation. Most people can be taught to do that. All the other challenges of a hospital setting and its patients require a level of physical and mental toughness for which we deserve to be compensated as much as any nurse.

Secrets of Shooting Student Videos in Radiologic Technology

Video can be used as an excellent tool to enhance the educational experience of student radiographers in the clinical setting. The production of the video over the course of one or two days with a small group of students can emphasize important issues such as how to prevent patient falls. I have found that the process is a fun way to teach terminology, work on communication skills as well as to explore the subject at hand. The bond that’s created between the participants is unforgettable when everyone reveals the actor within all of us.

Before going further, I’d suggest waiting long enough into a semester to gain the students’ trust and to casually discuss ideas. Make the project voluntary, as there are some who bristle at thought of being on camera. Others will turn around and surprise you when they suddenly volunteer to be the “drunken patient”. With a little instruction, most people can operate the camera instead of being in the video clip. You’ll note that I haven’t talked about the final product yet—ultimately showing the video is only the icing on the cake. The process itself yields the highest rewards.

Here’s an outline of my approach after making five or six student videos.

1) Pick a topic, have discussions with students and take notes. Brainstorm. Think about what can be visually represented without much dialogue. Take notes. Make lists. 2) Do a little research (for example: medical conditions contributing to patient falls.) Check textbooks. Look things up on the internet. Make sure you’re covering all the important points. 3) Go back to the students and refine ideas. Make a storyboard. 4) Use the storyboard to organize video into short sections with subtitles. Apply some kind of overarching format—for example: “Do’s and Don’ts” of Infant Radiography. This will assist you in creating a list of shots/scenes. Don’t fuss with this step too much, but be prepared to revise it as needed. 5) Shot list—who, where and what will be in each scene. Include props needed (such as a doll to pose as the infant). Close-ups, facial expressions and reactions really enhance a clip. Often, these occur to you when framing a scene. Show your enthusiasm by being willing to be an actor too. 6) Shooting day—Go over the shot list with your students. Pick who’ll be in each scene. Talk about what will happen in each scene. 7) Limit or eliminate dialogue. With dialogue, all must speak up. Turn up lights. Be aware of background sounds. I’ve often used clips with no speaking and added music and captioning later. 8) Use a variety of camera angles. Stand on a step stool. Lay on the floor. Stay close to your subjects. 9) Don’t move the camera around much. Don’t zoom in and out. Just hold it steady. Sometimes, it’s better to use a tripod and have the actor enter the frame. 10) Shoot lots of clips. Don’t delete anything. 11) Go with the flow—give new ideas from each participant a chance, but be in charge and move on to the next clip ASAP. 12) Review your clips. Give it a day or a week to think about what else you’ll need. 13) Do a second shoot. Everyone should be dressed the same. Think about continuity--use the old clips as reference.

14) Video editing: Look at your clips—pick some songs, some instrumental pieces. I use mp3s. Don’t worry about copyrights—unless you plan on selling your videos. Start with creating title slides in your video editing software. Create your videos in short sections, two or three minutes in length. Save these little clips with their captions and titles. If the video clip is no good, try creating a moving slide show by pulling out several images and captioning where necessary. Colorize or use repetition for emphasis. Avoid too many special effects. Make captions easy to read—no fancy fonts. Always save your individual clips first without music. Then add music. Save again.

Finally, put your clips in order and save the whole file. Your computer will be less likely to crash this way… and you can easily go back and revise a clip or change the music if you’ve saved a non-music version. Close any other programs while doing video edits and allow a full day for it. Show it to someone else to check for errors before burning a DVD. Or just keep it on a flash drive. If you’re going to show it on a computer, be aware that not all computers have the software to play all formats of videos. It pays to experiment. My Canon Powershot camera uses the AVI format which has worked well for me with Windows Media Player.

What follows are just parts one and two of our seven part Patient Identification and History Video, entitled, "Who? What? Why?" As you'll see, it's packed with useful information.

How to Publish Your Own Book Using Print-on-Demand

I’ve gone through the do-it-yourself process three times to create my medical suspense thriller, a collection of short stories and an illustrated children’s book. I’ll give you a general outline of how I created them without spending much money. You can decide if this process is right for you.

I’m assuming you’ve written and rewritten your work several times. You’ve saved backup copies on your computer periodically. You’ve had people read and comment on your stories. Your editing and proofreading is superb. (A note on proofreading: use only hard copy-printed paper for proofing—not the computer screen.) There are free-lance editors out there, too. Look at the back of writer’s magazines. I relied heavily on my supportive spouse—who proofreads often on her job and is a voracious reader.

I chose Lulu for my print-on-demand books (www.lulu.com). It’s easy to use and has no minimum and no start-up fees. They have two small paperback sizes that I’ve tried—but beware of their pocketbook size. I love the convenient size but they do not offer a distribution package for it. In other words, you can’t get an ISBN and you can’t link to Amazon, etc. You have to go up to 6 x 9 inches to qualify for that. So you need to decide. Am I going to create a book that will follow traditional publishing guidelines? Lulu has those guidelines on its website. Or am I going to create a book for just my private selling and selling through Lulu? If you make the latter choice, then you can do anything you want inside your book—forget numbering the pages for example.

So I chose the pocketbook size for my new collection of short stories, TROUBLE AHEAD. I set up the page size and margins based on that size in Microsoft Word. Use mirrored margins with a gutter. I looked at several paperbacks to see the standard words per line—about eleven—and the number of lines per page—about thirty. Then I typed up some mock pages in a variety of fonts and font sizes and compared them. Choose the most readable for your book size and format your story.

You’ll need to create section breaks and possibly insert blank pages where needed. This will take a little practice, especially when it comes to getting the page numbering to start and finish where it’s supposed to. Books are printed in total pages as multiples of four. Because the title page, etc. is not numbered, your total pages are more than your last page number. Lulu will add blank pages to the back if your total is not a multiple of four.

A pointer on formatting a children’s book: for THE UNSOLVED MYSTERY OF A DOG NAMED COOKIE, http://www.lulu.com/content/1418695 I used a larger page size and decided to use a full bleed for the picture pages (artwork covers entire page). That necessitated alternating the page sizes to achieve this. In other words—the picture page and its JPEG were bigger than the copy pages so that the printer had a margin to trim.

Designing the cover is fun. If you use Adobe Photoshop or your digital camera software, then first get the dimensions in pixels for your book cover size from Lulu. This size will include a small extra border that will be trimmed (called a bleed). These days, people have thousands or photos on their computers. Try one with a strong vertical axis. Tweak the colors if you wish. Look at paperback covers and note the large lettering, the drop-shadowed fonts. Pump up your title with outlines and contrast. The final design should be a JPEG of correct pixel dimensions and 300 dots per inch. If you prefer, use Lulu’s cover design program. I used my scanner software to create the cover of ART & ARTifact, my medical thriller.

Convert your book interior to a PDF. Microsoft Word has a converter to download from their website. Lulu can convert it, too. I prefer to do it myself and check it over.

You’ll be selecting binding, page size and paper type. Upload your interior PDF. Upload your cover JPEGs. (you can design the back cover & spine, too.) Check everything before ordering your first copy. Just order ONE book for now. There will be corrections to be made.

You’ll wait with excitement for six days or so. Finally your book arrives at your home! It's quite an amazing experience. But you’ve still got work to do. The entire book needs to be proofread, again! Have a few people look it over and mark their corrections. This is not a time for rewriting, however. That should have been done before. Be extremely careful making your final edits and saves. You don’t want to accidently erase anything. Evaluate how your cover printed. Does the title pop enough? Does the font capture the mood? Show it to several people. Ask them to be honest. Even though I have a strong background in graphic design, I still got great ideas from others and then revised my cover several times based on their suggestions. One example is how the photo of New York has been tilted to make it more exciting—that wasn’t my idea. Get help on this! Now just order ONE book again-- unless, of course, your first copy was perfect. Check over the corrections you’ve made. Are they all there? Yes? Congratulations! Now, if you want, go put together a bulk order to bring to book signings and readings. Or spread the word that your book is now available—to be printed and shipped on demand.

I know this article is an oversimplification, but it will get you started. Message me if you have specific questions along the way. I’ll be glad to help.

How to Write Short Stories

I have been asked how I write my stories. Here are some ideas that have worked for me.

What makes you nervous? Is it a situation—such as speaking in public… or when you see something you weren’t supposed to? Is it a place—like the doctor’s office or a taxi? Do certain types of people make you nervous—such as someone with eccentric ideas? Take a walk and think about this.

Start with just three named characters. One should be your main character. Tell the story in a close third person with some access to his or her thoughts. The reader won’t hear anyone else’s thoughts directly. You can add up to two more named characters later. Keep anyone else nameless.

Write about something you care about… or something that intrigues you. It could be anything from bike riding, to how bees make honey. Your character needs to have a goal, a need, a passion.

Other characters have their own goals, needs and passions. Some are the same as those of your main character, some are opposite. Perhaps, it’s not your main character who has the more powerful passion. Remember, every character is different and no one is perfect. Flawed characters are more fascinating.

Write your story a little at a time. Think of it in scenes, like a movie director. Don’t fuss too much. Evaluate your first draft. Does the beginning fit? Does it hook the reader? Soon enough, there should be a situation for the main character that must be addressed.

Striving to be original or creative is important but don’t worry about it too much in your first draft. Instead, try to be genuine and fearless in your quest to get to the underlying issues at hand. Like a volcano, things are always brewing beneath the surface!

I hope this helps. Your comments are welcome.

ART & ARTifact Gets SCANNER Review

The latest issue of SCANNER (the magazine of the American Society of Radiologic Technologists) has a review of my medical thriller novel, ART & ARTifact. The reviewer ended by saying that we (as health care professionals) could all benefit by reading the book! I believe the story has aged well in the three years since I wrote it--the entertainment value holds as well as the issues we currently face.

If you enjoy medical thriller stories, you may want to check out "Finishing the Job," one of eight tales in my new book, TROUBLE AHEAD.

Sink or Swim?

Would you ever throw your child into a lake without a life preserver? I think that's the way we often treat new technologists. Sink or swim. Do or die. Baptism by fire. Send her to the ER by herself and leave her until she either quits or begs for help. Then when she does ask for help, humiliate her by telling her that maybe she's not "cut out" for this kind of work. Far fetched? Believe me when I tell you this happens where I work. It seems like they want to see you fail instead of succeed.

And then there's the OR. Every hospital has one or two surgeons that seem to take out their frustrations on the circulating nurse, the OR tech or the x-ray tech. After working in x-ray for fifteen years, there are still occasions I am subjected to verbal abuse by a surgeon. This happened again recently and this time I took my complaint as far as it would go. Now, a month later I still don't know what was done about it or if anything will change. Where's the support from management?

I've seen so many good people bail out of x-ray because of both these issues. Why? What happened to helping each other, team building and moral support? It's no wonder that techs get so hardened and end up hating their work. There's the attitude that "I had to pay my dues (I got screwed) and so do the new people." Now then, would you throw a poor swimmer into a lake and hope they'd make it back to shore? Or would you throw them a line?

Grand Tour

I gave a tour through the hospital for all the new radiography students the other day. I first took them down to the huge x-ray archives in the basement. Of course it's locked, which brings to mind the increased importance of patient privacy laws. The archives are also thinning down as each year passes since we went to PACS. This shows real change made by our use of technology. But the fact that struck me was how the x-rays that we take are part of a patient's record and in some cases (legal, for example) are not "ever" destroyed. An x-ray that you took several years ago may be pulled for reinterpretation. Your best and worst work doesn't really disappear after they are first read by a radiologist. I'm not sure if the typical seventh year (now they are purging 1999) will be applied to PACS. What do you think?