Humbling Life Moment #4.7225K

So, I was going to get an MRI of my shoulder (no worries, minor problem).

This started with the expert placement of contrast into my shoulder under flouroscopy (and Conray tastes like magnesium). Yes, you can taste the contrast even though it’s injected elsewhere in the body. (Conray was so the radiologist knew where the gadolinium was going, for better delineation of the shoulder structures for the radiologist).

Then comes the MRI.  Never had one, but I’ve ordered several.  I’m wearing my very fashionable gown, lie down and the two nice techs start getting me ready.  I got some sort of contraption put over the shoulder that plugs into the table (pretty cool), get bolstered into place so I can’t wiggle, and some headphones playing classic rock.

They gave me a little black bulb ‘to squeeze if there’s a problem’.  I thought that was amusing.  All this happened out in the open, and life was good.

Then came the tunnel, and the first thing I thought of, looking at the fiberglass tunnel lining with two light strips embedded in it was HAL from 2001, which is weird.  Then I realized my heart rate was up, my hands and feet were sweating.

“Wow, this isn’t going to happen to me, is it?” was the higher-brain function; ‘get me the heck outta here’ was what my midbrain was yelling.  I’m a rational guy, so I can think my way through this.

Just by putting my chin on my chest I can clearly see I’m out of the tunnel from the knees down, I can see the control room windows, I could relatively easily wriggle out.  “Not. Having. It.” sayeth the midbrain, and by this time the lower functions have decided to side with the midbrain, now I’m starting to hyperventilate, a little, and the upper brain had a realization that’s never happened before: “You’re not going to reason yourself through this, and you’re going to have a full on panic attack if you don’t get out of this tunnel”.  Doesn’t matter I’ve never had one, if it’s imminent you know it.

That amusing little black squeeze bulb then got a touch of a workout.  Quicker than I would have expected “Yes?”  Surprisingly calmly I said “I need to get out of this tunnel Right Now”.  Not being slow, and having seen this a million times before (they said later) the tray of doom began moving me out of the tunnel.

When I got out I was shaky, hands and feet dehydrating me involuntarily, and the relief to be Out Of There was palpable.  I was effusively apologetic (I think I apologized to the tunnel and the door as well as both techs, several times).  They were very nice, said not only was I not the first, I wasn’t the first today.  One offered to stand at the bedside and talk to me during the procedure, but I was pretty sure I’d shot my chance for the day, and declined, apologized my way out the door, and went home.  Humiliated.  I’m a middle aged man, a doctor, I knew what this would be like, and it went almost as poorly as it possibly could.

I had no idea this was even possible for me.  I’ve worn all kinds of restrictive masks/headgear, been in several spots tighter than that, etc.  No reason to think my brain would stage a tunnel coup.

I’ll also say I now have more empathy for those who tell me they’re claustrophobic in the MRI tunnel (I have ordered sedation liberally before, and will continue to).  But, I always thought, in the back of my head, ‘what’s up with that?’, and now I now.  In spades.

So, I’m going to have to reschedule and repeat the thing, but this time I’m going to have some sedation.  It’s not for me, it’s for my midbrain.  Seems a little nervous about the tunnel of noise.


Comments

  1. I think the root cause is the very passive inactivity. If you had a complex task to do, lying on your back in the tunnel, even limited to one hand, it would be No Big Deal. On your back, ordered to lie still and do nothing lets the rest of the mind take over.

    Maybe there should be one handed knot tieing contest for each day’s group of MRI patients.

    Clinical hypnosis is quite out of fashion, though I think it would be very useful to relax folks for an MRI.

    Two unsolicited suggestions for the radiologist. I’ll take any royalties in Dr. Pepper, please.

  2. Aerospace Genius says:

    L’s boss, who is normally very solid, had exactly the same thing happen. Valium was the solution in his case.

  3. Wimp!

    I will expect no questions the next time I ask for more sedation for the trip to MRI.

  4. In line with what Glen said, what about Lamaze breathing? Gives you a distraction/something to focus on.

  5. If it’s any consolation behold the following embarrassment tale: I have mild spastic diplegia and am in PT school. We practice on each other and I have to try hard not to get panicky when other people *range my legs*. So there.

  6. Went through the same thing recently. Ask for, or bring a blindfold/sleeping mask. It’s a marvelous trick. If you can’t see the confined space, much of the panic reaction shuts right down.

  7. It is very humbling, isn’t it? Best to you

  8. Funny, 90 minutes in the tunnel of noise for a brain MRI didn’t bug me at all. I think 90 minutes in a tunnel of quiet — well, I don’t think I’d last 90 minutes.

  9. I went through the exact same experience with my first MRI, coincidentally for a look at my shoulder. Didn’t have a clue that I was claustrophobic and laughed at the possibility. Never even got started. Freaked out all the way home.

    I have unfortunately had to undergo several MRI’s since, 3 of the brain because the first one showed a mass and I didn’t trust the second; and one of the lower back.

    I am not getting used to the experience and hyperventilate all the way through my positive self-talk of “I’m not going to die, I’m not going to die” even with 10 mg of Valium on board. Did I mention that I’m a chick, even if not a small one?

    The sedation does allow me to get through the study, and the techs always praise me to the heavens, so take the meds- use a sleep mask- they do help- and do the test. And be nice to all of your future patients. I always feel particularly sorry for stroke patients that can’t tell us if they are claustrophobic or not

  10. When I had a 45 minute MRI for a shoulder problem there was a countdown clock superimposed on some kind of mirror. It really helped. With a breast MRI, I was face down looking into a lighted hole. That wasn’t so bad.

  11. Eyes closed, ear plugs in place, music on and a fan blowing down the tube all help reduce the claustrophobia feeling. Think the air movement is the key for me.
    I’ve had multiple MR scans. I’ve felt like I was going to hyperventilate a couple times, but have never had to be removed from the tunnel. A little valium goes a long way.

  12. I guess, being a big guy, I should count my blessings that I have not gotten claustrophobic attacks [raps on wood].

  13. Very scary, and that is even after surviving several and telling my lizard brain “we are fine, we are fine, we are fine!”

    Last time it was the fan, the music, and a step by step inventory of every room in every house I have ever lived in. Since I am third generation military (19 places just since 1980) that seemed to keep all the neurons too busy to

  14. ..too busy to FREAK OUT!

    (sorry~~~suffering from premature posting disorder today!)

  15. I had an MRI a few years ago (for a shoulder injury, this seems a common trend here…) and experienced a few moments of panic, as well, though not enough to pull me out of the tube. The thought of going under flouroscopy again was enough to get me past those first pangs (while not really a painful procedure, it is singularly uncomfortable). Once I got past that, I was mostly just bored, so I tapped into my Army-born ability to fall asleep under any conditions (including standing up-you just need a wide enough space to properly set your legs) and napped my way through the rest of the procedure. I actually worried the techs a bit when I didn’t respond immediately to their occasional “are you doing OK?” inquiries, but I was definitely able to remain still enough for a clear image.

  16. I have new empathy for my patients. I shreiked like a little girl for someone to get me out of the machine at my first breast MRI. I was not expecting to be claustophobic!

    Be careful with the benzo’s. I took two mg of Ativan for my next MRI and I was amnestic but walking and talking for two hours. If you don’t regularly take Ativan, don’t take it, get your MRI and then walk back to your office to do a little paperwork!

    for the third MRI, I prepared by listening to a Bob Marley CD, in the same position I would be in for the MRI, increasing the amount of time daily by one song’s worth. I was able to memorize the songs of the CD in order so I had some idea of how much time had passed. It was much easier. My facility allowed me to bring in my own CD to listen to for the exam

    I also try to engage in a mentally challenging task, counting in a foreign language.

  17. Slept through the last one I had to do. I am lucky that way after a number of years as a miner, when I was a young man, I am alright in confined spaces.

  18. I would suspect having something to do would help keep the lizard brain under control. In other words, having some control over the situation.

    I have never been in an MRI, but the first time I suited up in structural firefighting gear (at 49 years of age), with the heavy bunker clothes, the SCBA tank and mask, hotter than blazes, movement and breathing constricted, and then followed my partner by feel into a pitch black room with obstacles and narrow passageways I had to crawl through — man, my claustrophobia demon started clawing his way out of his box REAL HARD.

    I toughed it out, but was very agitated about doing it again. I did tho, and this time I was in the lead, and that made all the difference. I still couldn’t breathe “normally”, was hot and constricted and couldn’t see anything, but now it was up to me to make the decisions — go forward, over, under, back, whatever — and that control kept me calm.

    I don’t know what you would do to give a patient control in an MRI — maybe some how operate the tray, lights, whatever — but being in a narrow tunnel with no control does sound nerve-wracking.

  19. Sounds harrowing, but I’m sure you’re the better man & doc for having the experience. I’d accept the Valium. I had a lovely Demerol day once – if that’s an option, I recommend.

  20. As a doctor, you never think that you will be the one to get a panic attack! do we?

  21. When I was 9 or so, I needed to have an MRI done to see why I was getting so many awful migraines. I never consciously did the test. I was so scared of the big loud machine, that I even pissed off a child psychologist who was sent down to talk reason into me. They tried everything, like going in at 5 am, bribing with toys, etc. I eventually was sedated, as I only recall having to count to 100 and I don’t think I got to 10. It surely is a wakeup call for anyone who has to go in it for the first time, despite being around them all the time.

  22. I’ve had a whole bunch of MRI’s of late, and weirdly, it’s not bothered me, even 60+ minutes at a go… But, the first time I went to lie down in my berth on a medium size ship (we were quad stacked in that quarters), and I couldn’t sit up in my sleep if I wanted to, I felt my midbrain speak up…loudly. It took me more than a few minutes to convince myself that my bed for the next week was perfectly adequate. And, I have done underwater escape training, crawled through confined space training and been down deep, dark mines. I think it’s just one of those things…once in a while, in weird and wonderful circumstances, that pesky midbrain reminds us it’s there. So, take some meds, get someone to drive you home, and good luck with the MRI.

    T.C.

Trackbacks

  1. [...] the “not like” factor by 10 times or so and you might have an experience like this one described by Dr. Allen Roberts, an ex-Marine, emergency room doctor and blogger from Texas [...]