(Working Women) - Lindsay, a Cardiac Sonographer

I met Lindsay our freshman year of college at UPS, when we joined the same sorority. I don't have a precise memory of the beginning of our friendship, but I imagine it involved some sort of bonding over our mutual shock and dismay at our willingness and eagerness to be joining the Greek system. We then roomed together in Alpha Phi, living in the "Quad" our sophomore year. And I even visited her family in Spokane and traveled to Schweitzer for some snowshoeing/skiing one winter. Lindsay and I briefly reunited in Portland several years ago when I started a book club - which is still sort of going, by the way, if you want to join us again, Lindsay :). Aside from the Grand Connector that is Facebook, we have since lost touch. However, I knew that she was back in Portland and working at OHSU (essentially my professional next door neighbor), and was interested to learn more about her career path, and she willingly obliged my request. I so enjoyed reading about the details of her profession and of the accomplishment of landing her dream job.

I must say, there is something about us Loggers - not too many doctors, lawyers, or presidents in the bunch - Ivy Leaguers we are not - but certainly a breed of bright, interesting, high-achieving people pursuing their dreams and helping to make the world a better place.

Bio info - who are you, how old are you, where are you from, where do you live, what's your living/family situation, what are your hobbies, etc. Essentially, what's your story?

My name is Lindsay and I am almost 32 years old.  I grew up in Coeur d’Alene, Idaho and moved to Spokane, Washington when I was 16 years old.  Currently, I live in Portland, Oregon with my husband, Colin, and my two cats Clementine and Birdie.  We just bought a 1969 split entry house that definitely has a Brady Bunch vibe inside and out.  I love living in Portland and take advantage of all there is to offer here: good food, strong coffee, well-established bike lanes, eccentric people to watch, public transportation, and close proximity to both the mountains and ocean.  My hobbies include sewing, crafting, running, riding my bike, and doing home improvement projects.

What is your current job/profession? What path did you take to get there?

I am a cardiac sonographer at Doernbecher Children’s Hospital which is part of Oregon Health and Science University (OHSU) in Portland, Oregon.  Cardiac sonography, cardiac ultrasound, and echocardiography are all used interchangeably which is confusing to people not familiar with my field and makes searching for job opportunities that much more difficult.  In the most basic of terms, I use an ultrasound machine to take pictures and movies of the heart, called an echocardiogram or “echo.”  Yes, this is the same technology, and the same machine, used for ultrasounds on pregnant women to evaluate their growing babies.  I have found that most people don’t realize that ultrasound can evaluate just about every part of the body: muscles, abdominal organs, arteries and veins, breasts, brains and hearts.  Specifically, I am a pediatric cardiac sonographer, so I echo children, fetuses, and some adults with congenital heart disease.

A still frame of the heart taken from the center of the chest, called the Parasternal Long Axis view.

The path to my current position was a circuitous one and I apologize for the lengthy description below…

I attended University of Puget Sound from 2000-2004 where I met Jo when we became sorority sisters (Hottie, Tottie!).  At UPS, I majored in Biology and minored in Environmental Studies.  After graduating from UPS, I spent a year living in New Zealand all by myself.  While there, I traveled and worked various jobs including: a waitress, a bartender, a barista, working at an outdoor clothing/equipment store, manual labor on vineyards, and cleaning hostels in exchange for room and board. 

When I came back to the states, I moved to Portland, Oregon and took a job at Nordstrom to pay the bills while I looked for “real” work but ended up staying there for a little over 2 years, which was perfect for my early 20s bar hopping lifestyle.  During this time, I met my husband, Colin, while waiting in line for coffee at the Downtown Nordstrom coffee shop.  I quit Nordstrom because I wanted to work regular hours (my shifts were mostly evenings and weekends) and wanted to spend more time with Colin.  I got a job at an environmental non-profit where I started out as a receptionist and was promoted to the sales team after less than a year. Shortly after that, Colin was accepted to law school in California and we spent a year and a half apart, travelling to see each other every other weekend or so. 

It was during this time that I realized that I needed to find a career that would allow me to work almost anywhere so that Colin and I wouldn’t have to juggle a long distance relationship, and started to look into healthcare professions.  I knew I didn’t want to be a nurse, so I started looking into other aspects of healthcare.  My mom brought up the career when she reminded me that she dated a radiologist, who gave me a light box with x-rays, CTs, and ultrasound films when I was a kid, and let me spend some time in the ultrasound department.  I decided to job shadow at a few places in Portland to see if this career was a good fit for me and ended up applying to most of the ultrasound programs on the West coast just to see what would happen. 

A school in Merced, California offered two separate programs: cardiac and general ultrasound.  I applied to the cardiac program because it started 6 months earlier than all other school’s programs and was accepted!  In 2008, I sold my condo and moved to a place that was essentially the opposite of Portland: Fresno, California.  In 2010, I graduated from the adult echocardiography program and was hired at two hospitals in Fresno, one full time and one per diem (as needed plus overnight call).  It was at this full time job that I learned about, and fell in love with, pediatric and fetal echocardiography.  I realized in order to be fulfilled in my life I would need to pursue that part of cardiac ultrasound because adult echos just weren’t my thing.

After Colin graduated from law school, we decided to make it our goal to move to Washington State.  He took the bar exam and got a job in Eastern Washington while I continued working in Fresno and searching for jobs close to him.  After ten months, I accepted a position working for Seattle Children’s Hospital at their outpatient clinics in the Tri-Cities, Wenatchee, and Yakima.  I will forever be grateful for the opportunity to work for Seattle Children’s because it gave me the experience I needed to cement my career as a pediatric cardiac sonographer.  However, driving for hours everyday to outreach clinics became tiring and I missed the hustle and bustle of working in a hospital (plus, Colin and I were engaged and living 4 hours apart) so I decided to keep my eye out for other positions in the Northwest.  Specifically, in larger cities that would have job opportunities for both of us.  A position opened up at OHSU and I decided to apply just to see what would happen.  After a nerve-racking two day interview and many weeks of waiting, I was offered the job (my current position) and within three weeks I got married, packed up my apartment, and moved to Portland to start my new job.


As a follow-up question, I asked Lindsay about the training program:

Most programs either require completion of a previous Allied Health degree (X-Ray, Nurse, Medical Assistant, etc.) or a Bachelor degree.  It is not a graduate program and there are a LOT of accredited programs at community colleges.  I have a "certificate" in Cardiac Sonography, but there are also a handful of Bachelor programs.  Currently, there are no graduate programs in sonography, however, I have heard that one is in the works on the east coast.


What are the pros and cons of your current position?

Pros:  I work with kids and cute, sleepy, little newborns.  There is always a Disney moving playing somewhere which means I get to see parts of the Little Mermaid many times each week.  I get to talk about the color pink, glitter, dump trucks, recess, and math with my patients.  I give out stickers at the end of an exam and usually get a big smile and a quiet thank you.  I spend anywhere from 30 minutes to an hour with my patients and their families, so we have time to get to know each other and I love learning about other people’s lives.  Since kids with congenital heart disease are followed by cardiology throughout their lives, and get routine echos, I get to watch kids grow up and change as people.  I get to spend time in the operating room during open heart surgeries (this might be a con to some!).  The echo lab is the center of a lot of discussions about clinical management of cardiac patients and I get to learn a LOT from cardiologists about congenital heart disease outside of my scope of work.  My coworkers are incredible and I feel like they are a second family to me.  I say this all the time to everyone I know, but I am SO lucky to have this job.

Cons:  I work with really sick kids. Patients with congenital heart disease sometimes struggle to live, especially right after an operation.  I’ve been present the moment a kid takes his last breath and have witnessed too many “code blues” to count.  I work with families that neglect their kids and DHS has to come take them away.  I get called into stressful situations where a patient is crashing and I have to image their heart quickly and efficiently while giving the cardiologist my impressions.  Trying to bribe a 2 year old to lie still for 30 minutes is totally impossible, even with Elmo.  I have to listen to Dora waaaaay too often.  My job requires me to take call on evenings, weekends, and holidays so I miss out on some fun events, Christmas’, and my sleep gets interrupted.  I still go to outreach clinics, which involve hours and hours of driving on top of a jam-packed day of patient appointments, and some of the outreach clinics are overnight.  I work in a dark room without windows, stare at computer screens all day, and my field is notorious for causing musculoskeletal disorders.

Finally, I’m unsure whether to put this as a pro or a con, but working with congenital heart disease is complicated and fascinating and exciting and scary all at once.  On one hand, a complicated congenital heart defect can be the highlight of my day because I’m the one piecing together heart anatomy and the flow of blood through a patient’s body and I know that physicians, surgeons, and medical students will be pouring over my echo to understand the patient’s anatomy.  It’s exciting to discover something rare or something I’ve never seen before.  On the other hand, complicated congenital heart defects are usually not compatible with life outside the womb.  I know a family’s world is about to change drastically because their child has a long uphill battle ahead of them that involves many risky surgeries throughout their lifetime.

Walk us through a typical day, week, or month ...

There are a total of six sonographers in our Echo Lab and we have four outpatient rooms going throughout the day in addition to inpatient orders and operating room cases.  We do three different types of echos in our lab: Transthoracic (TTE), Transesophageal (TEE), and Fetal Echos.  Transthoracic echos comprise the majority of my day and involve rubbing a probe across the outside of a patient’s chest to obtain pictures of the heart.  A fetal echo is an evaluation of a fetus’ heart when there is suspicion or increased risk for congenital heart disease.  This is my favorite exam and the best part of my day because fetal echos are challenging and unpredictable.  TEE’s involve the doctor placing an ultrasound probe down the patient’s esophagus to image the heart.  This is the method we use in the operating room before and after every heart surgery and sometimes during cases in the Cath Lab.  During TEE’s the doctor manipulates the probe while I man the buttons on the machine.

My day starts at 8am.  (Since this is Portland, I either ride my bike or take a bus to the base of the tram and then take the tram up the hill to OHSU.)  I usually have a patient waiting soon after I arrive.  After quickly scanning their chart and previous echo findings, I call them back into the exam room.  Our echos are scheduled for 60 minutes, but we usually get them done in around 30 minutes.  I start by asking the kids which movie they’d like to watch, then have them take off their shirt (and put on a gown if age appropriate!).  They lie down on their side and I hook up three EKG electrodes to their chest.  I then put gel on my probe and place it on my patient’s chest. 

Every echo exam goes through the same series of images every single time, with the ability to add additional imaging as the sonographer sees fit.  Contrary to popular belief, manipulating an ultrasound probe requires fine motor skills and problem solving to obtain an adequate image. We are taking 2D images of a 3D organ, and we have to understand the physics of ultrasound to ensure we are acquiring the best possible diagnostic information.  It’s much more than simply holding a probe on a person’s body.  For a transthoracic echo, I start at the center of the chest to acquire a combination of moving three-second loops and still frames of each part of the heart.  I also evaluate blood flow through the chambers and valves and obtain a velocity through each valve.  Next, the heart is evaluated from the left lower side of the chest, then from the belly (just below the ribs) and finally from the base of the neck to evaluate the top of the heart and the vessels coming into and out of it.  My echos usually contain 120 images and moving clips for the cardiologist to read.  Once I’m finished, I take the patient’s blood pressure and send them off to see the doctor. Afterwards, I spend 10-15 minutes processing the study in an imaging application to get it ready for the cardiologist to read.  This involves making measurements, writing my overall impressions of the patient’s cardiac anatomy and physiology, and bringing up any concerns I may have. On average, I do five echocardiograms per day.

When I’m not doing echos I read journal articles, review prior echos, work on random projects around our echo lab, and chat with coworkers.  I leave work at 4:30pm.  Some of my coworkers work four 10-hour shifts in the lab but I work five 8-hour shifts.  When I am assigned to outreach clinics, I usually start my day about an hour earlier and get back to the hospital between 5pm and 6pm.   If I’m on call, I’ll stay late if a kid is still in the operating room for the post-op TEE or if there is an urgent need for an echo on an inpatient.   


What is something about your job that other people might not know or expect?

We work REALLY closely with the pediatric cardiologists.  I think a lot of patients and families think an echo is just a small portion of their hospital experience and annual care because they generally tend to bond with nurses given the amount of time they spend together.  In reality, the sonographer is the first person to identify a problem with a child’s heart and the cardiologist’s really rely on us determine exact anatomy since we have our hands on the probe while imaging.  Our echo images are used to make surgical decisions (often without any other imaging technique such as CT or MRI) and medical management changes.  We participate in surgical conferences and have long discussions with physicians about our findings.  Patient’s names become ingrained in our memory along with intricate details of their diagnosis and subsequent surgical repairs. There are some last names I don’t think I’ll ever forget. 

Ultrasound is limited by body type and size!  If a patient is really skinny and bony we have a really hard time getting good images.  Similarly, it is difficult to get good diagnostic studies on overweight patients.  We are limited by the physics of ultrasound waves and sometimes we just can’t image the heart well enough to answer a doctor’s question.  Therefore, other, more expensive and risky imaging techniques may have to be ordered such as CT or MRI.

We wreck our bodies in this profession.  I just read a journal article that found 90% of us are scanning in pain (myself included) and many people have to end their careers early due to work related musculoskeletal disorders.  Our arms are fixed in unnatural positions while scanning, overweight patients require us to push with all our strength for 30 minutes straight, and grasping probes cause carpel tunnel problems.

What other jobs could you work with your education/training/experience?

My training is very limited to what I do: echocardiograms.  I could transfer to an adult only lab but if I want to work in other areas of ultrasound I would have to go back to school or find someone interested in training me on the job. 


How much do you make? (Too forward?!? Probably. But let's be real, a large part of the reason we work is to make money - give us some deets about your income, as much as you feel comfortable sharing, whether specific to your personal salary, or generally speaking, as in, What Would Google Say). 

I work for a union, so I’ll share the range of hourly wages.  At OHSU, cardiac sonographers currently start out at $33 per hour and the pay scale tops out at $46 per hour.  That equates to an annual salary of approximately $69,000- $96,000 per year and does not include on call time or overtime.  When I’m on call I make one hour’s pay at straight time for each 6 hours on call while I’m not at the hospital and if I get called in to do an echo, I automatically get paid for two hours of work at my overtime pay rate (which I think is time and a half) even if I don’t stay the full two hours.  I take call approximately 3 week nights and one full weekend every month.  Working full time, with additional overtime and on call pay, it is easy for experienced sonographers to make six figures in this field.  Of course, hourly wages vary with location, but a recent salary report found the median income for sonographers in the United States was $78,000 (including overtime and on call time).


Do you anticipate making any career changes in the next 5 to 10 years?

No.  The Doernbecher Echo Lab is my dream job.  I feel incredibly lucky to have landed this job so early in my career.  Of course, because I’m relatively new to this field there is a possibility I could be unfulfilled in the future but I’m feeling optimistic about a long-term presence here.

If you could have any other job in the world, what would it be?

A veterinarian!  I LOVE all animals and wish I would have thought about this career when I was younger.


If someone else was interested in your job, what piece of advice would you give them?

The most important advice I have for someone thinking about this career is to visit the CAAHEP website for a list of accredited programs.  Accredited programs guarantee time in a clinical location (such as a hospital or Doctor’s office) which ultimately leads to employment after graduation.  There are many programs out there that aren’t accredited and charge $40,000 a year without the clinical experience piece of the curriculum.  In my opinion, these programs are a waste of time and money as most places will not hire graduates from these schools.  Also, graduating from an accredited program guarantees eligibility to sit for ARDMS board exams.  Most employers today list ARDMS credentials as a requirement in their job postings.

I also recommend trying to job shadow or interview a local sonographer to evaluate comfort level in a healthcare environment.  How are you with bodily fluids?  Odors?  Life and death situations?  It’s funny, if I would have known about the stressful parts of my job I probably wouldn’t have pursued it.  I get nervous when all eyes are on me and a physician is asking me a string of questions over my shoulder.  I was VERY squeamish before this career and my job has definitely taught me to be more tolerable of gross things.  Also, I’m so much better at dealing with stressful situations.

How do you balance work life and home life?

Right now, work life and home life feel pretty balanced.  I enjoy my shift; I don’t start too early or leave too late, so I have time to pursue activities that fulfill me.  I have most of my weekends free to do as I wish. Luckily, my work doesn’t require me to bring it home and once I leave the hospital I don’t have to think about checking email or returning phone calls.  I’ve learned to make the most of my free time because when I’m on call my day is so unpredictable that I can’t really make plans.  However, I do really worry about work/life balance once Colin and I start a family.  I think I’ll struggle working full time or being on call with a kid at home and no immediate family in Portland.  It’s sad to think about having to work on holidays, weekends, and throughout the summer as kids are growing up.  I’m sure I’ll strongly consider working part time or reduce my hours if we do have kids.  However, at the moment, life is pretty dang sweet and I’m enjoying every moment of it.