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You Can’t Clap with One Hand

By Dr. Ramadan Algamal

It was a fateful summer in 2013 when my dear friend showed me a CT brain study, revealing his father’s ongoing battle with intracranial hemorrhage. Something about the lesion troubled me. I proposed a further assessment through an MRI with contrast. Woefully, the results unveiled the presence of a hemorrhagic glioblastoma multiforme (GBM): a perilous brain tumor. Several months later, as the leaves fell gracefully from the trees, his father’s journey on this Earth came to an end.

Throughout my extensive career spanning over a decade in radiology within my homeland, I frequently encountered GBM patients, usually with an opportunity to meet them only once, as many would tragically depart before the next scheduled follow-up. Deeply affected by this heartbreaking pattern, I became steadfast in my belief that there had to be a way to aid those afflicted with brain tumors by enabling early detection and implementing appropriate management strategies. During the summer of 2018, I decided to pursue further training in my discipline in the United States to aid in my life-saving quest. Matching at Rush University Medical Center, a prominent medical facility in the vibrant heart of Chicago, proved to be the ideal decision for me. During my time at Rush University, I had the invaluable opportunity to familiarize myself with the intricacies of the American medical system, which holds utmost regard for every individual’s life until their final moments. It is an elaborate and interconnected machinery that operates in perfect harmony, constantly striving to enhance its standards.

Takeoff on My Journey to the United States

Encountering patients diagnosed with GBM and other brain tumors was not an isolated incident but rather a regular occurrence at Rush. These cases were diligently managed and closely monitored over the course of several years. The medical professionals at Rush University understand the significance of not only treating these patients but also improving their overall quality of life. My goal was to immerse myself in the intricacies of the radiology department, specifically focusing on the captivating realm of neuroradiology. At Rush University Medical Center, I found my place within the esteemed Department of Diagnostic Radiology and Nuclear Medicine, surrounded by a group of the nation’s top neuroradiologists who generously imparted their expertise.

As I delved into the daily practice of neuroradiology, I quickly realized that saving lives is not a destination but rather an ongoing journey. It follows a systematic pattern that commences with gathering crucial information, which is pivotal in prediction, prevention, and decision-making. The patient’s medical history, meticulously saved and securely stored in digital format, remains accessible even if originating from a remote healthcare facility or time. I navigated through the diagnostic imaging pictures, seamlessly transitioning from the macroscopic view to the microscopic realm of histology and molecular biology, all in pursuit of a definitive diagnosis. Furthermore, I recognized the significance of accessibility to diagnostic interventional techniques such as lumbar puncture, as they constitute an essential step in the diagnostic process.

I have witnessed the indispensability of advanced technology, state-of-the-art scanners, protocols, and techniques throughout my training. These elements are instrumental in ensuring accurate and up-to-date medical care. In the realm of healthcare, all data—including reports, imaging records, and laboratory work—is meticulously preserved within a digital library. This repository of information enables physicians to review, analyze, and provide feedback, fostering a culture of ongoing education and improvement.

There is an Egyptian saying that goes, “You can’t clap with one hand,” which emphasizes the importance of collaboration. In the field of neuroradiology, sharing knowledge among team members not only enhances productivity but also empowers radiologists to perform at their best. To help achieve this, we regularly organize various conferences and meetings. During these sessions, fellows and residents select intriguing cases and thoroughly review all relevant laboratory and diagnostic results. Staying updated with the latest articles published in our field is essential for delivering impactful presentations. This commitment to continuous learning ensures that our knowledge remains current and relevant.

One of the most exhilarating moments in my training here was attending the weekly tumor boards, such as the head/neck and brain tumor boards. These gatherings allowed for an exchange of insights and expertise among neuroradiologists, pathologists, neurosurgeons, and oncologists. It was during these sessions that we experienced the “eureka” moment, when the pathologist would reveal the definitive pathological diagnosis for a case that had presented with a complex radiological differential diagnosis. Collaborating as a team, we pieced together the puzzle and devised the optimal treatment plan.

By embracing teamwork and leveraging the collective expertise of various specialists, we transformed individual knowledge into a symphony of collaboration, where each person’s contribution harmonized with the others, resulting in the highest level of patient care and treatment outcomes.

Joyful Moments: Family Fun at the Outdoor Festival

The story of our patients, as well as their lives, continues to unfold. Providing deliberate and meticulous follow-up care is crucial to ensuring better outcomes and improved survival for patients. We schedule regular follow-up scans and discussions to track disease regression and determine the appropriate timing of intervention when necessary. When I compare images, diagnostic reports, and laboratory data spanning many years for a patient, I truly understand the profound significance of survival. By incorporating innovative techniques such as functional magnetic resonance imaging (fMRI), surgical outcomes can be significantly improved while reducing morbidity and achieving a high future quality of life for our patients. Additionally, using interventional techniques to establish a definitive diagnosis plays a critical role in selecting the most suitable treatment options. It is my dream to witness GBM patients attending scheduled long-term follow-ups accompanied by their loved ones. This vision symbolizes the commitment to ongoing care and emphasizes the importance of supporting patients throughout their entire diagnostic, treatment, and recovery journey.

The historic library in Alexandria, Egypt, has served as a symbol of knowledge and enlightenment for decades. Our civilization thrives on the continuous exchange of information and support, which cannot be achieved without collaboration. Based on what I have learned and experienced during my time training in the United States, I firmly believe that implementing simple additions to the Egyptian health system can lead to remarkable differences in my home country. Recently, the Egypt Healthcare Authority, led by a group of ambitious physicians, has brought about significant changes, aiming to provide high-quality healthcare to the Egyptian population. Given the opportunity, I would like to share a few important aspects with them.

First and foremost, the concept of patient privacy and the significance of adhering to HIPAA regulations should be emphasized. Second, the importance of maintaining patient medical records in electronic format to ensure ongoing and effective care cannot be overstated. Third, fostering multidisciplinary collaboration among treatment teams through regular meetings and discussions is essential for delivering the best possible care to patients. Remember: “You can’t clap with one hand.”