The clinician is something of an explorer, a navigator, whose job is to travel into the deepest nooks and crannies of the human body. He ‘sees the unseen’, using arteries like alleyways, slipping through veins like service tunnels, and probing the darkest corners where infections, tumours and mysteries hide.
He is a diagnostic and interventional radiologist and, as such, navigates a wide range of care. “My career has been all about breadth,” he explains. “In a heart and lung hospital you develop deep expertise, but patients don’t present in neat categories. You still need to understand the whole body.”
He has worked from “cradle to grave” on “everything that a heart and lung hospital would expect us to do.” But also on everything in between too – “because heart and lung patients don’t follow rules.”
Originally, he studied lungs. Then in 2005, the hospital acquired its first cardiac CT (Computed Tomography) scanner. This brought together two of the most complex and closely related systems in medicine: heart and lung. He is now a full blown diagnostic and interventional radiologist, dealing with the full ‘body map’ presented by the spine, pelvis, vessels and joints too.
“Diagnostic radiology is about understanding what’s happening,” he says. “Interventional radiology allows you to act on it, often immediately. I like the hands‑on, pragmatic, problem‑solving aspect. You can open blood vessels, block blood vessels… the techniques are so sophisticated now.”
Much of this work is urgent rather than emergency: patients who are stable, but require timely and precise intervention.
Take this morning. A woman arrives after coughing up blood – a lot of it. Sometimes it can be as much as a teacup. She has an underlying infection that makes her vessels fragile; a single cough is enough to turn a capillary into a cascade. “It happened in the supermarket. It was horrible,” she tells him. Her scan reveals a blood vessel that has grown too big and become too fragile. “She doesn’t need it,” he says. “So we’ll block it off.”
Inside the Diagnostic Centre, he deftly guides a catheter into her bloodstream, navigating it into the misbehaving vessel. Once there, he threads in an even smaller catheter and releases tiny polyvinyl embolisation particles – “like a snow globe,” he explains, suspended in dye, drifting through the capillaries until they lodge exactly where they should.
“These procedures are highly targeted,” he explains. “The aim is to treat the problem while preserving as much normal function as possible. Once the blood stops flowing, it tends to clot.”
Then there’s the 55‑year‑old man who arrives with back pain. Many diagnostic departments won’t scan someone with a pacemaker, but this one can. He studies the grey image of the spine on his screen, brow furrowed, then relaxes. “I’m not seeing anything too worrying.” Probably a pinched nerve. Annoying for the patient, but in radiology terms very fixable. “It doesn’t bother me looking at a spine. I’ve done plenty of those.”
In fact heart infections can start in the spine, one of those strange anatomical twists of the body’s geography. Accommodating that is all part of the radiologist’s refusal to succumb to what his father called “learned helplessness”: the idea that if you stop doing things, you forget how. “People say you shouldn’t do things you’ve not done regularly,” he says. “But you can help, if you haven’t forgotten how.”
“Radiology underpins a huge proportion of modern medicine. Whether it’s diagnosing disease, guiding treatment, or delivering it ourselves, it’s about providing clarity and, where possible, solutions.”
One patient has been under his care since she was four, afflicted with complications caused by cystic fibrosis, and is now 31. Over the years, she has needed everything from antibiotics to vein‑saving devices that sit under the skin, pacemaker‑style, feeding tiny catheters into the vein behind the collarbone for long‑term treatments. She recently arrived with more severe bleeding. The team scanned her, searching for vessels they could block deep in the lungs, where biopsies, ablations and embolisations happen.
“Oh, and this morning we also had a case of plastic bronchitis,” he adds, referring to a condition so rare that only a handful of places worldwide treat it. “So yes,” he says. “We do quite a range of things. There’s a strong problem-solving element. You need to integrate clinical information with imaging findings to guide the next step in care.”
He scans the horizon. Through his monitor, using gentle dexterity, and with a lifetime of expertise learning some of the body’s most complex systems, it is map reading and navigation that show the way. For patients, it’s a way out of the labyrinth; a pathway to brighter days.