I wanted to take a brief pause with this blog post from the usual discussion involving my job locations, to share some exciting news in regard to my rewarding career as a travel sonographer. But first, allow me to explain. As I may have eluded to in one of my very first posts, ultrasound has a variety of specialties. There are some who work perhaps in an emergency room setting or a radiology setting that need to become a jack of all trades in this profession, and I applaud them for their hard work and necessity to learn how to do so many types of ultrasound exams. However, like anything in life, to really excel and become an expert in any one area, you need to do the same thing repetitively and educate yourself well in that one particular area, to get proficient at it. And that is the beauty of specializing. Just as a doctor would specialize in pediatrics, radiology or obstetrics for example – requiring much more intensified training in their field and resulting in a higher competency level in their chosen specialties – so too, do sonographers who work in a specialty branch of ultrasound. Those ultrasound specialties include abdomen, OB/GYN, vascular, cardiac, breast, transesophageal, etc.
My specialty has always been OB/GYN, since graduating from a degree based college program in ultrasound over two decades ago. However, I also took my board exams in another specialty referred to as “AB” or abdomen soon after my graduation, to allow me the possibility of being able to work in a radiology department, if I chose to. Since very little of my training exposed me to this type of ultrasound (looking at spleens, livers, gallbladders, kidneys, scrotums, thyroids, and possibly even vascular exams of the arms and legs, and in some facilities willing to train you in vascular ultrasound, even the carotid arteries of the neck), I did not feel comfortable working in this ultrasound specialty. As you can see, this is a pretty big list to try to tackle with little to no experience, despite being able to pass the boards with all the current book knowledge of a new grad (I managed to do that at least). But book knowledge alone is not enough. Due to my lack of exposure in this area and the lack of interest in the schedule of a typical nurse working in a hospital with rotating shifts, weekends, or holidays, a radiology ultrasound job was not something I desired. Fortunately, that type of schedule was not the norm for someone working in an OB/GYN ultrasound position however – jobs which are more commonly found in doctor’s offices and high risk (aka antenatal) departments within a hospital, which is generally Monday through Friday, with daytime hours. Combine that with my massive exposure as a student to this particular type of ultrasound, and it becomes obvious why I gravitated to OB/GYN instead.
My credential for the past 25 years has been RDMS (AB, OB). Until recently….when after being afforded pretty much a once in a lifetime opportunity to land a job assignment working with fetal surgeons, in a department that also had a high volume of fetal echocardiograms, I was given the chance to learn the entry level skills needed to perform fetal echocardiograms. In addition, I had plenty of opportunity in that job to pick the brains of the talented echo sonographers and do a ton of reading on this subject, to have what was needed to apply for the fetal echo exam.
In September, I flew home to take the test. The ARDMS board exams are always incredibly hard and make you have to really think, so you really need to know your stuff for any of their exams, however their fetal echo exam requires you to fully understand the material presented. If you go into this test thinking you will pass just on “some” comprehension and a lot of memorization – you may as well not even try. Moreso than any of the other ARDMS exams I have taken thus far, much of this test requires a thorough comprehension of the fetal heart and the hemodynamics (pathway of the blood through the heart and how a blockage or problem in one part of the heart will interfere with the flow through a different part of the heart). Needless to say, I walked out of that test, grateful an entire year of studying was behind me, but not feeling overly confident that I passed! This test is 140 questions, about 2 – 3 hours in duration, and performed in a small environment where a handful of others are sitting at their respective partitioned off computer workstations and all your belongings are locked up outside the room – only you and your brain for these sonography board exams – and a proctor watching each of you to ensure even further, that you cannot cheat in some way. After 2 months of waiting, while back on my assignment, I got the news – much to my surprise and delight, I passed! Not with flying colors, but passing is passing. Now I need to put my additional hard earned credential – RDMS (AB, OB, and FE) to work for me. Which is sometimes a challenge when you are a travel sonographer, as facilities want to hire you to do what you are competent at and have experience in, in order to hit the ground running. But half the battle is being able to learn something of this magnitude as a traveler for the very same reason, so I’m hopeful if I was lucky enough to work in a facility that was willing to teach it to me as a travel sonographer, that there are also facilities willing to let me gain more in depth hands on experience as one too!
But one might ask, what is the interest in obtaining a challenging new credential in FE (fetal echocardiography) when you already learned to obtain so many of those views required for your OB (obstetrical) credential? The truth is, as an OB credentialed sonographer (a board exam that also tests you on gynecology as well), there are a lot of the same structural views of the fetal heart that you would take on both a high risk detailed OB and fetal echo exam, however there are several other more complex vascular views, doppler waveforms and measurements that you would not be expected to know or be equipped to perform, without learning fetal echo. Abnormalities could more easily be missed by a regular OB credentialed sonographer, without that in-depth knowledge of the fetal heart and how blood flows through it. An example of just one of the abnormalities that can be associated with improper cardiac development in utero, causing the right and left sides of the heart to be on opposite sides, can put the child’s life at risk, either immediately after birth or into early adulthood, if left undetected. Even more simple and common abnormalities like holes in the heart, can often be missed by an OB sonographer who may not have done extensive training to detect these and other abnormalities. Although never a guarantee that every abnormality will be detected, in every patient, by every echocardiographer, the chance of detection improves greatly by those who have earned this credential and obtain the sonographic experience in their field.
But beyond that, the heart is just a beautiful organ! When you consider that from the moment you were conceived and reached about 6 weeks old inside your mother’s womb, your heart has beated, hopefully rhythmically, every second .. of every minute .. of every hour .. in every day .. all the years of your life, to this moment? How it keeps doing that so flawlessly is miraculous!
As a sonographer examining the heart, I won’t deny that it can be a love-hate relationship for me. I love it for both its beauty and its power – to think that something so tiny (the size of your fingernail at 20 weeks) can be examined with all its major blood vessels, chambers and pathways in so much detail before you are even born and for those times when you can obtain a perfect picture of the fetal heart with excellent, crisp color fill of the ventricles and vasculature, provides useful diagnostic information to the doctor. But the hate part of that relationship is how it affects my body – especially in a fetus where they are a moving target inside their mom – having to twist and rotate your wrist, sometimes with pressure, to follow that movement and try to get the perfect angle, which is absolutely mandatory to obtain clear and diagnosable images of the heart (already a moving structure within a moving baby, no less), can really be a cause for sonographer injuries and pain – something I am not foreign to.
If however, you are able to achieve those perfect views, with the baby in the perfect position, and with the perfect visual both in image detail and color fill of the heart structures, you have just experienced what I mean when I say “the fetal heart is a beautiful thing!” Any qualified fetal echocardiographer surely knows what I mean by this. When the baby is on their back and the chest is up and they are cooperating in what I like to refer to as an almost synchronized dance with their sonographer, it is a glorious thing! And for the sonographer, usually pain free to boot. Unfortunately, the reality is, more times than not you have to really work hard to get those perfect pictures and the babies sure don’t make it easy on you. Which makes it all the more rewarding when you can get them in the detail you were hoping for. It is amazing that we can even see that kind of detail on such tiny vessels within the heart. I sometimes tell my patients, when they express concern and worry about the difficulty in obtaining the views due to their baby’s position, that it would be comparable to they themselves having an ultrasound of their own heart, but instead of lying on their backs or partially on their sides, they were lying face down on the exam table and the sonographer had to attempt to get pictures of their heart through their back, with all their bones being in the way of a good image. That paints a pretty good picture to the patient and helps them understand that it is not necessarily cause for alarm, but instead an incomplete exam, due to an uncooperative baby.
For anyone in this field who has a constant desire to learn as I do, and a desire to push themselves to reach for the stars in this challenging field, I say “go for it!” The road may not be easy, but the personal reward of knowing that you pushed yourself to achieve something incredibly challenging and fulfilling, something that may truly help you to save a life before life outside the womb even begins, is a goal worth achieving – good luck! For those of you who already have your fetal echo experience, I applaud you for your vast knowledge of this complex, but vital human organ (one that by itself needed its own credential for goodness sake!)…and thank you for helping me in my own journey to share the ranks with you!