How a Job Hurts the Ones Who Love It

Volume 8 | Issue 14 | February 3, 2015
This Hospital Life
STAFF
UCH Insider Central
For the Clinicians, Managers & Staff
of University of Colorado Hospital
Tyler Smith, Editor
Todd Neff, Joelle Klein,
Contributing Writers
Teresa Claus, Distribution
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Susan Follansbee, Proofreader
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Tyler Smith
([email protected]).
UCH Insider covers clinical, business
and staff news at the hospital.
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around the hospital community.
How a Job Hurts the
Ones Who Love It
It’s common to hear how much people can get
out of their jobs. Less frequently discussed is what
the jobs take out of the people who do them.
In 2003, Tracy Hill entered a classroom for
an important day in her budding work career.
Then 26, Hill had finished two years of
prerequisite coursework she needed to enter
an ultrasound training program and become a
cardiac sonographer.
Hill was anticipating a fresh day of learning, but
she got a different surprise. Her instructor handed
the class materials describing musculoskeletal
disorders (MSDs).
Echocardiographers Tracy Hill (left) and Amie Majerus
say working with ultrasound machines has taken a
steady physical toll on them.
“The instructor told us if we had back or neck
pain, we might not want to be in this profession,”
Hill recalled. The Occupational Health and Safety
Administration (OSHA), in collaboration with
the Society of Diagnostic Medical Sonography
(SDMS), Hill learned, had concluded that medical
sonographers on average experience MSDs or
varieties of pain within five years of entering
the profession.
It was “disheartening” news, Hill said. Having
worked for the U.S. Forest Service on a trail crew
after graduating from college, she already
had back and neck pain. But she finished her
ultrasound training, then took her first job as
an echocardiographer at the 370-bed Durham
Regional Medical Center in North Carolina. She
was one of only two full-time technicians handling
cardiac ultrasound at the high-volume facility.
She typically saw 15 patients during an eighthour shift, pressing and holding a transducer
against their bodies for long periods of time
to transmit the sound waves that produce an
image of the heart. She was on call every other
weekend and often worked 12 days in a row.
Paying the price. Four months into her career,
Hill said she began losing feeling in her arms,
the result of holding the transducer in place
for periods of 20 to 45 minutes. Within nine
months, she began suffering sciatica, with
pain radiating from her lower back, the cost of
twisting her body to get the transducer in the
best position to get a clear image, and moving
patients, equipment, and furniture to get ready
to scan.
She frequently came home exhausted, fell on
the couch, and woke up with no sensation in
her limbs.
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Volume 8 | Issue 14 | February 3, 2015 | Page 2
“I cried a lot,” Hill said. “I couldn’t believe I had gotten into a
profession where I could work so hard but be so miserable.”
Majerus’s most troublesome issue is iliotibial band syndrome, an
overuse injury to the strip of tissue that runs outside the thigh. In
Majerus’s case, it was caused by standing and stretching across
patients for a half an hour or more thousands of times.
“It got really bad about seven years into my career,” Majerus said.
She described the pain at its most extreme as “like a knife along
the nerves,” with a dull pain present all day.
Majerus pushes an ultrasound machine out of the
Cardiac Intensive Care Unit.
Don’t try this at home. A casual observer would never realize the
physical challenges that getting a high-quality image of the heart
presents. Sonographers sit or stand by the patient, not seeming to
exert themselves as they hold the transducer with one hand and
punch buttons or twirl knobs on the ultrasound machine with
the other.
She stuck it out for a year before leaving Durham to escape the
pain and the workload. She spent three years as a traveling
sonographer, where she enjoyed a more reasonable schedule
and time to recover from the physical demands – three months
on, one month off. In 2010, Hill took a permanent position in
echocardiography with University of Colorado Hospital, where she
had previously worked as a traveler. She’s still here, and there is
much she enjoys about her job and the place she works.
The equipment at UCH is excellent, the cases are complex and
stimulating, and the volume demands are challenging but far less
than those she faced at the beginning of her career, Hill said. But
she still endures significant, chronic pain in her neck, shoulders,
and lower back. And she’s not alone. It’s an occupational hazard
of sonography.
Sustain the pain. “I’m always in pain,” said Amie Majerus, 39,
a 14-year echocardiographer who arrived at UCH in 2007 after
spending seven years at Duke University Medical Center. She made
the move to continue working with Joseph Kay, MD, who left Duke
to head the Adult Congenital Heart Disease program at UCH.
Majerus cited a litany of work-related physical problems, including
plantar fasciitis, caused by long periods of standing; low back pain;
tennis elbow; and wrist and finger pain from the stress of holding
the transducer steady while making small movements to get a
better image.
Majerus demonstrates on a volunteer the extra arm and hip strain of
performing echocardiography right-handed.
In fact, it’s hard work. Obese patients, for example, are difficult
because the echocardiographer has to push through layers of tissue
that interfere with the sound waves. Majerus compared the effort
to thrusting against a sandbag, often for 30 to 40 minutes. Smokers
often have hyperinflated lungs that press on the rib space, giving
the sonographer a smaller acoustic window for imaging. Finding it
requires effort and applying pressure at difficult angles.
The echocardiographers also cover the Neonatal Intensive Care
Unit (NICU), scanning the hearts of tiny, vulnerable patients. That
presents a different challenge, said Hill as she sat at a machine
in the NICU on a recent afternoon.
“We have to make contact with the skin without applying
pressure,” she said. “It’s like suspending your arm in the air for
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Volume 8 | Issue 14 | February 3, 2015 | Page 3
an hour.” As she held the transducer, she used subtle movements
to scan the preemie’s heart from the top to the bottom, a subtly
difficult maneuver.
Majerus faces another problem: She’s right-handed. An echo scan
requires that the patient lie on his or her left side so that gravity
pulls the heart away from the sternum. That means that Majerus
and other right-handed echocardiographers must reach across the
patient’s body to position the transducer.
Hill said. It’s particularly difficult in intensive care units, where
patients are typically very weak.
Echocardiographers serve not only patients, but also the clock,
another source of stress. Hill and Majerus work four ten-hour
shifts each week and typically must complete at least eight scans
a day. Something as simple as a conversation between a provider
and the patient can lengthen a scan. When the patient speaks,
his or her lungs get in the way of the sound waves, and the
echocardiographer has to stop the test, Majerus explained. Each
time that occurs, the schedule gets a little tighter and the pressure
gets a little greater, she said.
Much of the challenge goes with the job, Hill acknowledged. The
hospital performs many complex studies on patients with severe
heart disease who are candidates for left ventricular assist devices,
transaortic valve replacement, and other high-tech devices. “That’s
what makes the job exciting,” Hill said, “but those scans all take at
least 45 minutes.”
Hill performs an echocardiography scan on a preemie in the NICU.
Holding the transducer lightly against the skin for long periods of time
produces arm and thumb strain, she says.
“It’s like giving the patient a huge hug,” Majerus said – one she
might maintain for 30 to 40 minutes with her body twisted. The
result: Her cervical spine is bent to the right and her trapezius and
deltoid muscles are pulled in the same direction. Hill, who is a
natural right-hander, was trained to scan left-handed, so she avoids
that stress.
Self-care. As candid as they are about the physical toll their
jobs take, Hill and Majerus emphasize that they aren’t asking for
sympathy, only for greater awareness of the job-related challenges
all sonographers face. “Everyone in our lab suffers in varying
degrees, both vascular and cardiac sonographers,” Hill said, noting
that ice packs and ibuprofen are constants among her colleagues.
Hidden stressors. The physical challenges for echocardiographers
extend beyond the scan itself. The least taxing occur in the
Echocardiography Lab, on the third floor of the Cardiac & Vascular
Center. There, patients lie in special “echo beds,” which have a
drop section that helps the sonographer easily get underneath their
bodies and position the transducer at the apex of the heart, Hill said.
Far more often, however, they must travel to inpatient units for
the scan. That means pushing the ultrasound machine – carpet
increases the strain – moving furniture and equipment to set up,
working around booms in the middle of the room, and positioning
the transducer through bed rails and fitting it underneath the
patient. Moving patients into position can also add to the strain,
Hill holds the transducer with her left hand while working the ultrasound
controls repetitively with her right.
In fact, Hill and Majerus say they want to go on working and have
for many years sought relief for their symptoms so they can.
Majerus, who estimates she spends $1,200 a year to keep her pain
in check, said she gets acupuncture, relaxes on orthopedic pillows,
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Volume 8 | Issue 14 | February 3, 2015 | Page 4
bathes in Epsom salts, and applies soothing oils. Foam rollers help
to relieve muscle tightness. High-intensity interval training also has
helped. She’s tried cortisone shots in her right thumb, but said
the pain of the needle convinced her that the cure was worse than
the problem.
Hill said at some point, the neck and shoulder pain that has been
present from the beginning of her career became “normal.” She
was prescribed, and continues to take, antidepressants. “The idea
was to alter my perception of pain, since it is something I have to
live with,” she said.
But Majerus also acknowledges she often considers the looming
question of where her career will lead. She’ll go on maternity leave
soon (her due date is in June), offering a respite. But at some point,
a decision awaits.
“If I want to continue, I’ll probably need to start scanning lefthanded,” she said. She’s considered returning to school to become
a physician assistant, teaching, or going into imaging applications
with a manufacturer, like Philips or GE.
“Those are the only ways for a physical break,” Majerus said.
“We’ve all thought about what we will do next. There isn’t much of
a career ladder.”
Hill said she feels lucky to work at a hospital that is at least
cognizant of the physical limitations inherent in sonography. Until
the recent retirement of Doris Peterson, the echocardiographers
also had a supervisor who spent years doing the job herself and
knew the field “inside and out.”
But it’s tough for those who don’t scan to understand the price the
job exacts, Hill added.
Hill uses a folded towel as a makeshift arm rest.
She also makes regular and emergency appointments for massage,
chiropractic work, and physical therapy and doctors herself with
frequent stretching, yoga, and the foam roller. All of it is necessary
if she is to continue to work, Hill said.
“I often wish that we could wear T-shirts that say, ‘Have you
hugged your sonographer today?’ or ‘Be nice to us. We hurt,’” she
said.
—Tyler Smith. Smith is editor of the UCH Insider. To comment
on this story, contact him at [email protected] or
[email protected].
“I try to be more proactive when the pain flares up,” she said. “You
have to be physically fit to sustain yourself. It’s hard to be at your
best if you are bogged down in pain. It affects the quality of the
study.”
Career conundrum. Majerus said she doesn’t regret her choice of
career; she originally trained in physical therapy but decided during
clinical rotations that it wasn’t a good fit. Rather than working with
patients on long-term therapy, she wanted a profession that took
her from one task to the next. Echocardiography fit the bill. She
also values the time she spends one-on-one with patients, and the
camaraderie between Hill and the other echocardiographers.
“We have a good team,” Majerus said. “We’re in the trenches, like
the Army. We show up every day and give a good effort.”
Continued
Volume 8 | Issue 14 | February 3, 2015 | Page 5
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