So far, I’ve managed to make it through life without needing to undergo a magnetic resonance imaging scan.
I’ve heard the experience can beÂ rather, uh, claustrophobic. Although I’m usually OK withÂ confined spaces, I’m not sure I’d like the sensation of being enclosed inÂ the noisy metal tunnel of the MRI machine.
Multiply the “not like” factorÂ by 10 times or so and youÂ might have an experience like this one described by Dr. Allen Roberts, an ex-Marine, emergency room doctor and blogger from Texas whoÂ goes by the name of GruntDoc.
Dr. Roberts recently needed an MRI of his shoulder. He didn’t think the scan was going to be a big deal. He was even rather amusedÂ when the technologists “gave me a little black bulb ‘to squeeze if there’s a problem.'”
Then came the trip into the tunnel:
…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.Â 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.”
The techs quickly slide him out, he apologizes, declines a chance to try the procedure again and goes home humiliated. He writes: “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.”
There there, Dr. Roberts. Welcome to the club.
Medical care, let’s face it, often involves exposing patients to sights, sounds and experiences that can be unsettling and even trigger panic. Take MRI claustrophobia and anxiety, which are thought to occur among somewhere between 1 percent and 5 percent of patients. Some patients get so anxious that, like Dr. Roberts,Â they have to be removed from the machine before the scan is completed.
When I blogged last year about needle phobia, I heard from someone whoÂ can’t tolerate needle procedures unless she’s fully sedated.
And what about fear of blood? Or dental procedures? Or anesthesia? It’s not always clear how prevalent these phobias are because these people, understandably, tend to avoid settings that can trigger their fears. Their reluctance to see a doctor or dentist can sometimes be exacerbated by clinicians who are impatient or dismissive of them for being “irrational.”Â The woman with needle phobiaÂ probably speaks for many of them:
Â I try to negotiate with medical providers on alternatives, but somehow they think if they reject my reasonable accommodations, I will agree. I wonâ€™t. I will forgo treatment or diagnostic procedures if they involve a needle unless I am sedated. Fact is, most of the medical profession has no clue that people like me (and there are lots of us) exist since their close-mindedness has resulted in our avoiding even presenting ourselves for medical advice. My hope is that â€“ somehow â€“ those like me can connect and speak with a unified voice in favor of revised protocols that accommodate our condition. Otherwise, most of us are destined to shortened lives due to lack of medical care.
GruntDoc’s experience prompted several of his blog visitors to relate similar stories about their own encounters with the MRI machine. One person had a few flashes of panic, “though not enough to pull me out of the tube.” From someone else: “Didn’t have a clue that I was claustrophic and laughed at the possibility. Never even got started. Freaked out all the way home.”
There are ways, of course,Â to make an MRI scan more tolerable. Sedation can help; so can placing the patient in a prone position, or lying face down, if this is feasible. Ear plugs, music and sleep masks also can help distract the patient and make him or her feel slightly less trapped in the MRI tunnel.
As for Dr. Roberts, his brief trip intoÂ MRI land was eye-opening. “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),” he writes. “But, I always thought, in the back of my head, ‘what’s up with that?’, and now I know. In spades.”
Image: “The Scream,” Edvard Munch,Â from a series of paintings and prints, 1893-1910