I never thought that taking a black and white picture would make such a big impact.
Gabriela Parson Ultrasound Technician
When I was 15 my father died. I had money in savings that he had left me for college, but my brothers took it. Because I was a minor on the account, they got my mom to sign off and little by little, all of it was gone. Then she took off and I had to fend for myself. So I was homeless for a time, but not like where I ever had to sleep in the street; I had to sleep in my car once. But mostly people’s couches that would take me in, strangers. I had never gone to college. When I met Chad, I was doing an associate’s degree but I wasn’t really sure what it was that I wanted to study. I wanted something stable. Having been through what I went through, I had suffered so much when I lived out in the streets and I never wanted to suffer again. So money was an important thing for me. But with my kids, it was hard to find time to go to school and I had to keep working in order to take care of the household.
When CJ was born, we decided for me to stay at home. He had everything going on with his syndrome… they asked me: was there anything that I had done? Did I drink, did I smoke, any kind of bloodwork or tests that he was going to have what he had? I said no, I just remember someone telling me that one leg was shorter than the other in an ultrasound. I thought… this is a grayscale thing, how could someone figure this out? But it made me interested, in going through the horrible experience that we did when he was born, and them saying if I wanted to keep him, that he was a “bad” baby… And I said, I would like to work in the medical field where I could give somebody a better experience with their loved one; I would like to do ultrasound. As soon as he’s old enough and he’s done with all his specialists, I can start going back to school. I got information that Cypress College would be a good place to go to school for that.
I have specialties in whole abdomen for adults and pediatrics, and small parts which is thyroid, testicles; I also scan breasts. They’re doing that now a lot in conjunction with mammograms because of different tissue types in the breast. Sometimes the mammogram alone won’t catch a cancer where the ultrasound will catch it on a certain tissue type. That kind of imaging, though, with the women and breast cancer, you get really involved with the patients. Because you see them come back, or you’re in the room with them and they can’t have anyone with them when they’re doing the biopsy, so they’re super nervous. You feel the energy fill the room. You have to ask, “Can I hold your hand? Do you mind if I hold your hand?” I explain, “This is just going to be super quick and you’re going to be fine. Everything’s going to be ok.” And you don’t know if it’s going to be ok! Then they come back and it’s good news and they’re just doing follow-ups and they remember you… there’s a lot more hugging involved in that type of ultrasound.
When somebody comes in through the ER and they want to see if they have a clot in their leg, we check veins, we check carotid arteries to see if there’s stenosis, somebody fainted or somebody’s face kind of drooped and they thought maybe they had a stroke or something like that. Most times, those patients, it’s a really quick exam and they’re back on their way. You try to give them care the same way, but you don’t have as much time. You want to make them feel like this is how I would treat my mother, this is how I would treat my husband or my father or my children. But you only have a limited amount of time. Whereas with breast ultrasound, you have a lot more time and you see this person on a regular basis so they get to know you, too. It’s more personal.
I know you’re not supposed to hug patients, but I always end up hugging patients. You’re supposed to have some sort of detachment, but I’ll ask them, so it’s not inappropriate. I’ll say, “Would you mind if I gave you a hug? I feel like you need a hug right now.” Sometimes the hug won’t end for a while because we’re both just crying. I cry with them — I’m such a dork, I’m so emotional. I tear up now, just thinking of some of the patients, how much they’ve affected my life. I don’t ever want it to change to where I don’t care. I scanned somebody the other day and it reminded me of my whole journey with my son and I thought to myself, “Oh god, please let this person not see this as a curse, but see this as a blessing.” It’s not a curse, it’s been a blessing. It really changed my life. It inspired me to do what I do and to do anything for my kids.
When I first started school, they said, “You’re going to be scanning a lot of babies,” and I really wasn’t into scanning babies because I was interested in the other aspects of it. Physics play a big role in ultrasound. It can measure velocities of blood flow and you can see if there’s something going on at some point in the body. Every vein, every artery has a different waveform with a sound and a different measurement that’s normal versus abnormal. I was very interested in that kind of stuff. Because the majority of the exams that we do will be babies or pelvic exams for women, they said that sometimes we would have to assist for different procedures, just like we do for the breast biopsies or biopsies of the liver… we would have to assist with abortions. I thought, it’s no big deal. I was very strong about people having the right to choose, until I started doing this job. I never thought that that would change me. But doing this job now, I see that the heart is completely developed at five weeks. Having been somebody who actually had two abortions in my life, it made me feel guilty about it. It made me feel like, “Oh god, what did I do? They told me it was just…” I had no knowledge of this. They said, “Oh, it’s just a little blob, it’s not bigger than a grape.” Which is true, but at that point the whole nervous system and heart is developed. I hear stories from some of my associates who have assisted in these things, and depending on how far along you are, they’ve seen the baby put the hands out. We don’t know if they can hear; there’s not enough testing, you can’t test the fetus. But when we do an ultrasound, it’s supposed to be such a frequency that even the dogs can’t hear. I don’t know if because of the amniotic fluid and the sound travelling so well, that when we put the camera down, they tend to move their head to where the camera is a lot of times. So it’s kind of… I don’t want to say creepy, because I don’t want to be taken the wrong way! But I find it interesting, and so it’s changed my mind about the late-term. It’s rare to come in contact with another technician who does what I do who is for late-term abortion. I can see it’s ok for some instances but other instances when it’s just being used for birth control, that’s when we have a problem, but we respect everybody’s choices.
It’s really a touchy subject because in my line of work, the things that you see, it completely changes you. Sometimes we have cases where people will have in vitro and they’ll only want to keep the males, so they don’t want the female. That’s when they told us that we have the right to say “I can’t participate in that, that’s not my belief.” You can get a different person that doesn’t mind doing it. I wish I could never have somebody falling apart because they wanted that heartbeat so bad and it wasn’t there… I wish I couldn’t see that, either. You have to just tell them, “It’s going to happen for you,” or “Don’t worry, it’s going be ok,” or “I’m very, very sorry,” and sometimes they don’t want to talk, and that’s fine. At least the luxury that we have is that we don’t give diagnosis. People will try to ask all the time, “What did you see? What does it mean?” I’ll say, “Ohhh, the doctor’s the only one that can give you that information.” Sometimes the doctors, they struggle, too. They’re only human beings. They don’t want to come and give you bad news, and so they have to prep themselves for that.
We’re always supposed to have a poker face. A lot of times they stare at you when you’re doing their exam to see your reaction. They’ll say, “What’s going on, what’s wrong?” You don’t want to have that look on your face like, “Oh my god, what am I looking at? What is this?” Sometimes your poker face, you try to have the best that you possibly can and sometimes inevitably people will get concerned.
I lost it once. We have a garden where we can go and cry and you’re like, “Ok, I’m going to go and cry for 15 minutes, that patient’s life or story impacted me so much, I’m just going to go and cry,” and then splash water on your face and go on to the next patient. There’s been times where I was going to go do a portable, where you take the ultrasound, and by the time I was about to go out the door, they called from the floor where I was going to, the patient had passed away. Just the length of time… and I thought, “Oh my god…” I had to go to that 15 minutes of crying and then just wish the family well. Oh my gosh, it’s terrible. I just want happy stories! I’m constantly praying for every person that comes through, “Please, dear lord, do not let this person have anything bad going on in their life, just let it be good things for them, just let me give good news.” I just want to give good news. Because the bad news sucks. I never thought that taking a black and white picture would make such a big impact.
It uses sound to take images. There’s a certain type of crystal in the transducer, just like a camera. The crystal sends out impulses in a stop-and-start kind of pattern and that takes the pictures. Like sonar, or like dolphins do for echolocation, it gives you an image of what something looks like. Based on the angle of how you’re holding it, it’s very tech-dependent. Sound travels well in fluid, so blood, any kind of liquid. Sometimes for women it’s a hard thing, they’ll say, “They told me to drink 32 ounces of water and my bladder’s super full,” and here I am pressing on it, but that’s the best way to see the uterus and the cervix and the ovaries. If somebody’s gassy, the sound gets attenuated, or it stops, with any kind of gas. That’s where there’s differences not just in the techs but also in the time of day. Let’s say you went in and you were fasting, I could easily see your gallbladder at a specific time. But let’s say that for some odd reason the last meal you ate made you gassy and so even though you fasted, by the time you got there in the morning, you’re starving and your stomach is churning and it’s creating more gas, I’m not going to see what the other person saw because the sound can’t penetrate no matter what I do. The technology is getting a lot better. We do it with megahertz — a sound that dogs wouldn’t be able to hear. The higher the frequency, the better the image will come out as far as details. The lower the frequency, the better penetration you get but you lose the details. It’s also dependent on a person’s body.
It’s just like any other picture that you would take. Like, you know if you’re developing it in liquid, how long you have to develop it. Or if you’re using a different camera, you know what button to push to do a different filter or different lighting — it’s the same with us, except we pay attention to a mechanical index and a tissue index that will indicate how much sound and energy we are putting into a person, in order to optimize the image, and also in order to not cause them any undue, unforeseen damage because there’s not enough research on ultrasound to know what long-term effects it would have. A baby exam, for an OB exam, we monitor that and keep the number to where it cannot move beyond a certain tissue index because we don’t want too much heat. Any energy creates heat, so you don’t want to keep producing all of this energy and it’s creating more and more heat in there for the developing child. Even for testicles, you don’t want to create too much heat where it’ll cause reproductive damage.
I don’t need to know the inner workings of how cancer starts on a cellular level, but we did learn that. I didn’t have to know the fetal circulation, but… I do have to know it. It’s a weird balance that you have to have. You have to be confident in what it is that you’re looking at but you have to know, “I see a certain part of the brain dilated. So that’s going to tell me I need to look at the spine closer.” Or, “I see the feet look a specific way; that could be part of this syndrome, so now I need to take pictures of their kidneys or their stomach or any kind of related issue that could arise with that syndrome.” So you do have to know as much as you possibly can.
You have to have 30 learning credits every three years so that you learn more as new technologies develop. What if they discovered that now you can use contrast with ultrasound? Where they only did that in Europe, now they’re starting to do that in the U.S., so now there is some radiation involved and you have to learn what that looks like. Not a lot of places here in the U.S. do that yet. With better penetration they can discover different things, then you’d have to learn what the normal would look like. Because now you’re seeing something a little more detailed and so you want to know, “Is that not normal? And if it’s not normal, then what’s related to that and where else should I look?” Sometimes urinary variants in a person that are completely normal will cause other issues, so you have to look at the reproductive, because of the kidneys, or some odd relations like that that have to do with development at the embryological stage.
There’s different criteria for a malignant mass versus something that’s just a fluid-filled cyst. With ultrasound, if it’s fluid, it looks completely black. If it has a solid component, you can put the color Doppler on it, which is red and blue scale, and it’ll indicate if there’s blood flow going to this mass or not, and if there’s any increased amount of blood flow going, then you know that something is suspicious, that it has the potential to be malignant. Then they’ll biopsy it.
We have to know normal versus abnormal but sometimes, there’s a normal variation where somebody could have an accessory spleen or something and that’s completely normal, but for us, we’ll look at it and go, “Oh wow, that’s not what a normal spleen looks like, could that be something malignant?” So we just have to document as much as possible. We can even take a short little video now on the machines and you present it to the radiologist. You get to work closer with the radiologist than other modalities, and we’ll ask the radiologist, “Hey, I just scanned this person and I’m not sure what I’m looking at, I’ve never seen that before. This is something very weird.” And the doctor’ll say, “Ok, I’ll be down there in a second and I want you to scan in front of me.” Or “Take additional pictures, these are the pictures that I want you to take,” and then they ultimately make the call. All we know is what it’s normally supposed to look like versus what it doesn’t look like. If we see something like that, you just take more documentation and the doctor ultimately decides. But we can’t make a call and say, “This is what you have,” because it’s dangerous.
I never thought I was going to like being in the medical field as much as I do. Even though you see sad things… like, you’ll see that there is not heartbeat in an ultrasound and they really want that heartbeat. Or you see cancer, they have no idea they have cancer and it’s an aggressive cancer. Sometimes you catch that cancer early and it gets to help that person. Or you get to be part of their happy day — they’re having a baby. Or you get to give them good news — they don’t have breast cancer or they don’t have cancer in their thyroid. I feel like I’m doing something good and I’m also feeling good that I work, so I don’t mind that I work so many hours. I’m on call, so they’ll say, “Hey, can you come in and work?” “Yes!” Luckily, my kids are big enough now and I don’t stress out about CJ, he’s doing fine. I get to do things for them… I probably shouldn’t spoil them. You want to give them everything that you didn’t have, and I went with so much that I did not have. I feel like they’re proud of me. I never thought that I would finish school. What’s amazing is that I went from somebody who’s completely dependent on my husband; now, I make more than he does! I’ve never been in that position in my whole life. I feel so empowered. But I try not to let it go to my head! I’m just really excited.