If you know that I applied for the match in neurology it might bewilder you to learn that I chose radiology for my last elective of medical school. Alternatively you may think it appropriate but only because you know how integral imaging has become to the practice of modern medicine, or how beneficial it is for a neurology trainee to practice “reading their own films.” I learned a lesson today that did not come from an attending, patient, or book. I hope it will give me the ability to communicate honestly with my patients in the future about the process of getting in an MRI, how scary it can be, and how they can get through it by being adequately prepared.
Today I had a completely unique experience in my medical training. It was enabled by the courage of several people including my attending, the director of my elective, and a fantastic MRI technician. The director of the rotation had the idea but it couldn’t have happened if my attending didn’t send me to MRI to meet the technicians and see some scans. During our introduction I mentioned it to the MRI tech and she totally ran with it. It was completely obvious how important she felt it was for me to have this experience. She immediately had me take off all of my metal and wanded me down after giving me a quick rundown (no implants? surgeries? ever been shot?) At this point it was sort of like a TSA experience. No major malfunctions and fear alarm only subtly sounding.
As soon as I put my head back in the cradle which immobilizes it completely I recognize my unpreparedness. I feel my heart pounding and she has not even put the top piece of the cage over my face or pushed me back into the tiny tube where I would reside for the next 20 minutes. Thankfully there were headphones, and there was music. Most importantly there was her voice and her presence coaching me through. I trusted her but still had a tiny panic sounding off: “did you forget to take off your name badge? It’s made of metal!?” Anxiety is real but now I have Al Green. As I push back into my tiny crawlspace of a cave of white plastic I go immediately to my breath. My yoga and budding meditation practice served me well this afternoon as I release my grip on the “panic ball” just a bit. The sequences are all unique. DWI is like a horrible alarm clock which you live inside which also shakes your bed at the head and then the leg over and over again. I exist. “I’m still in love with you.” Caught up alone with my thoughts but unable to think. My head starts hurting five minutes in and mysteriously stops after I escape the magnet.
There is no neurologically intact individual who would not feel some fear entering this machine for the first time. I wonder how many MRIs I will order in my career. I hope I can always remember what it felt like for me. I hope I never callously tell anyone “it’s no big deal” or “just take an Ativan.” I hope I never send a claustrophobic patient into that experience. There is nothing harder than being a patient. I repeat my mantra, and hope.
Isaac Goldszer MD 