Unexpected dependencies

It is almost topical to talk about we never appreciate the things we have until we do not have them anymore, in particular with health. But at least we are, on some level, aware of the fact that we are healthy, even if we do not pay much attention to it as long as do not suffer an ailment. But sometimes we enjoy advantages of which we are totally unaware, and the dependency becomes painfully present when something breaks in the background and things that we took for granted are not there anymore.

Yesterday evening I took part in the weekly video conference with my mother and my two brothers. David, the youngest one, is working as a radiology technician while he is going through medical school and told as about how a totally unrelated event had put him under a lot of stress for the whole day yesterday and this morning until the situation got defused around lunch.

As part of his daily routine, he works with a fluorine-18 (18F), radioactive substance which is used in an imaging technique called "positron emission tomography" (PET). In essence, the patient gets a very small injection of this radioactive substance that flows with the blood and "glows" in a certain way that can be measured with the adequate machines, so a technician can trace a map of the blood flow in the patient. The substance is innocuous in these small doses and the 18F decomposes fairly fast: every 110 minutes the amount of radioactive fluorine is divided by 2, so after roughly 24 hours there is only 1/8000 of the original amount.

Photo: sanko

Unfortunately, fluorine-18 is not created spontaneously in nature, so it has to be produced in a heavy piece of equipment known as a cyclotron, which is a type of particle accelerator. And of course, because it decomposes over the course of a day, a new batches have to be fabricated every few hours to be used on patients quickly before it vanishes. This practice is not a problem in areas in the vicinity of the cyclotron, but in other regions the fluorine has to be transported there and fast. And that is where the dependency arises.

David lives in a region know for its beaches and tourist attractions, and lacking much in terms of industry and research, in particular heavy facilities like the ones that could have a cyclotron. For years, they have been receiving two shipments of 18F per day, one at 8 a.m, one at 12 p.m. so that they could diagnose patients in the morning with the first shipment and in the afternoon with the second shipment. "Thanks" to COVID-19 and the subsequent reduction in passenger traffic, the regional airline in charge of the fluorine transport from the manufacturer decided to scrap the midday flight, with disastrous consequences: on the one hand, it made impossible to perform PET scans on patients in the afternoon, so essentially half of all the appointments in the next few months had to be cancelled. But the more dire consequence for David is that, instead of working afternoons as he has been doing all along med-school to be able to attend classes in the morning, he would be forced to either come in the morning (and miss all the classes, practices and labs) or even lose the job and therefore his sustenance.

Luckily for him, around noon yesterday the airline got in touch with them and confirmed that it had been an error and they were cancelling a different flight, so the whole diagnostic system was not going to be affected. But you can imaging the dreadful 24 hours that David had to go through. You could tell during the video conference that he had barely slept the night before, but at least a heavy weight had been lifted from his shoulders, and I bet that he slept like a baby yesterday evening. I hope you do not suffer much from this kind of COVID-related dependencies. Have a nice evening.