Are you claustrophobic Mr. Kaplan? A fine line between safety and indolence

As part of my ongoing evaluation and treatment for heart failure that I have mentioned previously (see: https://tissuepathology.com/2017/11/05/the-clinic-door-chapter-2-the-emergency-room/#axzz52Q1JZUgB) I underwent a cardiac MRI recently.

Prior to scheduling the MRI, I was asked about pacemakers, defibrillators and artificial joints or shrapnel in my medical history. I was told to show up 30 minutes prior to the appointment and not to have any caffeine after midnight the night before the study. Standard questions and instructions having had other MRI for head and knee injuries playing hockey. They apparently have since added not having caffeine for cardiac specific studies.

The day prior to the examination I was called by one of the radiology technicians to confirm my appointment and re-inquire about any metal in my body and tell me not to have any caffeine at 2 AM in case I thought I needed it (I don’t drink coffee in the morning regardless). The technician inquired whether I could still make the appointment as they have a busy schedule and again about metal objects in or on my body.

I started to get the idea if she could cancel my study this would have been a successful call for her and she would have been rewarded by a cancellation. And who could blame her? Knock off a little early before a 3-day weekend, perhaps even maybe 4 days if her institution offered the day after Christmas as a floating holiday. If she cancelled my study perhaps she could finish up some last minute shopping or wrapping or visiting or getting to the store to get more vodka or whiskey for the egg nog.

Below is a rough transcript of the call between Stacey from University Hospital (names changed to protect the innocent) with my responses italicized:

Good morning Mr. Kaplan, this is Stacey from University Hospital calling to confirm your appointment for tomorrow for a cardiac MRI.

Yes, Stacey. I will be there.

Do you have a pacemaker?

Not yet.

Do you have a defibrillator?

Not yet. Let’s see what the images show on the MRI and maybe I will get one. Do you know how much those cost?

No I do not.

Do you have any artificial joints or hips?

Not yet. I should play some more hockey and golf first before someone tries to sell me any of those.

Are you claustrophobic Mr. Kaplan?

What do you mean?

Are you claustrophobic?

I don’t know what that means. What is “claustrophobic”?

It means you have claustrophobia.

I don’t know what that word means either. No doctor has told me I have that. They only said heart failure and atrial fibrillation and some other things but nothing that begins with that C word. 

Do you like small spaces?

Like small cars?

Yes.

I guess so.  Does that mean I am claustrophobia?

What abought tight spaces?

Like a crowded elevator?

Yes. You like crowded elevators?

Well. I don’t like them but sometimes what are you going to do?

The study will take about 90 minutes and you cannot or breath during the study.

That seems extreme.

It is a tight space. Did the doctor ask you about claustrophobia when he asked you about having an MRI?

The doctor doesn’t ask you what tests or medications you want. They tell you. [Footnote about being a patient – you don’t question the doctor. I have never once asked “Why this test or drug?” Insurance companies have legions of people for this to see if it is ‘medically necessarily’.]

Did the doctor give you any medicine for the study?

I don’t think so. What medicine would he give me?

I don’t know all the names but there are several medications you can take before the test.

So I don’t move or breath?

Yes.

Can I get some of them tomorrow?

Probably not. You will need a prescription from your doctor and it won’t work if you take it before the study tomorrow.

I can call my doctor and get a prescription I can pick up at the hospital tomorrow early before the study. If I stop moving and breathing I want to be at a hospital. I guess I cannot take these several medications with my morning coffee and espresso shot.

You can’t have any caffeine tomorrow morning.

I didn’t say caffeine; I said coffee. And espresso. What about decaffeinated espresso?

That is fine.

Do you have any bullets or shrapnel in your body?

Not so far this week but your hospital is in a bad neighborhood so ask me again tomorrow.

Have you ever had an MRI Mr. Kaplan?

A couple for my head and knees.

Did you have any issues with those MRIs?

I fell asleep during the procedures, I don’t remember.

Do you have any drug allergies?

No. I thought you can’t give me any drugs.

Do you have an allergy to iodine?

Are you going to use iodine?

No.

Mr. Kaplan we will see you tomorrow. Please wear lose fitting clothes and remember no caffeine after midnight tonight.

Yes, Stacey. I will be there.

Where does reasonable safety end and indolence begin? When does more time going into exclude you rather than include you in your care cross a line that becomes annoying?

I understand wearing a watch made of iron into an MRI or medical devices pose a risk. I understand drinking a pop in the morning is not safe on many levels (atrial fibrillation aside when you are trying to image the heart).

I think the most annoying part of these calls is why do they take place within a day before the study? If you do have to cancel because you have a steel plate in your head like Cousin Eddie isn’t there a mechanism to not order the study a month prior if the risk outweighs the benefit?

Two calls came to confirm the appointment but the first caller picked up on the sarcasm a lot earlier in the call and gave up a lot easier to cancel my study.

Stacey did a great job.

I didn’t catch claustrophobia from the MRI machine and I can’t tell you much about the study beyond that because I fell asleep despite drinking a venti Black Eye on the way to the hospital.