Friday, December 28, 2012

The wind cries MRI

I have a frozen shoulder, which is like whatever it is the undead pirates have in POTC on Davy Jones's ship where they're all turning into coral and barnacles and fusing with the hull. The shoulder just seized up and stopped doing the things shoulders do. That in itself is annoying, but it also hurts like a motherfucker when a) I try to move it and b) when I'm not trying to move it.

I've been having physiotherapy for a while – and that's a saga in itself – but a couple of weeks ago my doctor suddenly said, "It might not be a frozen shoulder - it might be a rotator cuff tear...although probably not because the steroid shot I gave you didn't work...but it might be. Only an MRI can tell for sure. Have an MRI!" 

So I said, "Why? What would you do differently if it was a rotator cuff tear?" and he must have, at that point, taken something out of his pocket and said something along the lines of, "Look at this attractive shiny object. Just look at it!" because a minute later I was walking out of the office with a scrip for an MRI, and I couldn't remember whether he'd answered my question or not. So I'm not sure why I've had an MRI.

The physiotherapist was skeptical of me getting an MRI appointment before New Year, as 'everybody tries to get them in before then as they've already met their year's deductible'. I'm in a plan where it's not possible to 'meet' the deductible – like Little Joe's clients in Walk on the Wild Side, on my plan everyone just has to pay and pay. My health insurance is about $550 a month (this is lightly disguised as I pay some of it from my wages and the company pays the rest, but the company prints both amounts on the paycheck every month as it wants me to be fully aware that this is money it could be paying me but isn't because it's paying Aetna instead) and every visit to a health care practitioner has a $35 'co-pay'. This doesn't sound like a lot if you see, say, four doctors a year – though if you saw four doctors a year you'd be paying Aetna $1650 for each one and they'd be paying each doctor $90 ($360 total), so they'd be laughing all the way to the bank. However I haven't just seen four doctors this year – as well as the usual run of doctors I've had 15 physiotherapy sessions, for which I pay the $35 each, or $525 this year, on top of the insurance premiums. Aetna tells me that the physiotherapy appointments are 'fully covered' which means everything except the co-pay, so they pay about $50 a visit out of my premium and I pay the further $35. They are still laughing all the way to the bank.

This is a picture of my shower. It looks like I feel. 

Anyway, I phoned up the MRI people and they answered on the first ring and offered me an appointment the next day, as opposed to next year.

"No, I can't take tomorrow off – how about next Wednesday since I'm taking all Christmas week off?"

Done, they cried.

"Wait, that's Boxing Day…I mean the day after Christmas. Are you sure you're open?"

Yes, they cried.

So on Boxing Day I turned up half an hour early (to fill in forms) for a 10:00 AM appointment. To my intense delight and complete surprise, almost a quarter of the forms were already filled in by the computer. (Mostly the financial stuff.) I've been filling in crap about myself on doctors' websites for the past few months as they've been dragged kicking and screaming into the late 20th century recently due to HITECH and HIPAA. These attempts have not worked. When I finally turn up at the doctors, the computer is 'down', and I have mimeographed forms – I swear, mimeographed forms, and wavy lines from Xeroxing copies printed in Courier forms – to fill in. At the MRI center, a good 20% or so of the forms were prefilled. Good start; luck was not to continue in this vein.

The first symptom was that I was not called into the Second Waiting Room (there's always a second, hidden, waiting area; health care is a bit like Disneyland that way) until 10:45, which means that like almost all my healthcare appointments this year, the facility had managed to get 45 minutes behind schedule within the first couple of hours of operation. This suggests either stupidity or some pack 'em in and fuck 'em scheme that values their time over mine, every time. When I got to the Second Waiting Room, the uncheerful radiography technician looked right through me [1] and said to mid-air, "How many patients can they schedule in a day?"

"Merry Christmas!" I replied. Actually, no, I didn't! Joke! I just stared at her trying to figure out if she thought I was deliberately ruining her day or whether she was talking to a ghost behind me. [2]. She directed me into the little locker room where I was to take my clothes off, put on the gown (which fastens in the back, she reminded me), lock my gear in locker and the restroom is that way.

"Where do I wait after I take my clothes off?" I asked.

"Then you put on your gown…" she stated correctly, though unasked. She looked puzzled, perhaps because I'd deviated from her script. She recovered. "If you don't want to go to the restroom, there's a chair over there."

I interpreted this as meaning I should wait on the chair over there, rather than wait in the restroom. [3]

Another 25 minutes passed as I sat on the chair watching my ankles swell from sitting. (And yes, I did go to the restroom as well.) Eventually she let out a little old man (possibly had been virile young man when he entered) and allowed me in the room.  I offered her my locker key and she put it on the windowsill – I was expecting some sort of jeweled faraday cage steampunk radioactive Uranium 238 box, but no.  She gave me earplugs and warned me about the upcoming noise-fest. I dutifully put them in.

"Busy, are you?" I said smalltalkily.

"Busy?!" she replied incredulously, but declined to elaborate. "Which shoulder is it?" she asked.

"The left."

She got out some gaudy pauldron item much more to my Cyberpunk tastes and placed it on my right shoulder. "What's that?" I asked. For all I knew, it might be the Thing That Hides The Wrong Shoulder For A Better Picture.

She looked surprised once again that the question had come up. "It's the thing that makes the picture," she explained. 

Technical terms L

"Oh good."  Was it my place to explain to a health care professional what I actually needed? I guess I would have to. "That's my right shoulder."

"Oh!" She replaced it on my left shoulder. Then I got on the paper-lined bench (have you noticed doctors' bench-lining voodoo paper is getting thinner? It tears as soon as you sit on it nowadays. As a barrier to germs, bugs and cooties, I suspect it was never useful but it certainly isn't now) and she wrapped me up, like a mummy. Arms by my sides, wedged in with plastic, sheet wrapped around to prevent my arms moving. Then she gave me a panic button. Once again, it had never seemed to occur to her before – suddenly she realized! My arms were wrapped up and I couldn't take the panic button! She'd have to feed it in under the sheet until my fingers could grab it!

Then, of course, the actual MRI happens. They had asked me if I could stand an MRI before I got the appointment – a big advance over the first one I had, several years ago, when it was a complete surprise and also very painful (I had a torn rotator cuff on other shoulder[4], and was in for breast imaging, which means lying on your front completely still for about three eons. The shoulder did not take that, uh, lying down). So when the unit engulfed me, I knew what it was going to do. It's still like being buried alive. The unit itself is like a dryer drum. Not a big commercial Laundromat dryer either, like a little domestic dryer in radius, but long enough to enclose half your body length. This one was airplane-interior-colored plastic, that lifeless taupe that you can't possibly object to except on aesthetic grounds, and fitted with airplane-interior lighting strips, bright enough to shoo away that freshly-buried feeling. Since my left shoulder was the center of attention, I was lying slightly to the right, which made the light strips off-kilter and, because I'm long-sighted, more out of focus on the closer right lights than the more distant (by a couple of inches) left lights. The effect was of being trapped in a very, very small airplane. Without glasses. Then the imaging began.

Unlike CT scanning, which was reassuringly invented in Britain - in fact inside Buckingham Palace, at EMI by Wombles, or perhaps Teletubbies, using war surplus equipment consisting largely of Bakelite, vacuum tubes and aluminium kettles with melted bottoms thrown away by grannies, MRI was invented by John Bonham and Keith Moon on a bender, and the image is formed by demons banging on the outside of the dryer drum with dinosaur bones, large saplings and pieces of the altar of Stonehenge until the 3D image forms on a piece of cloth along the same principle as the Shroud of Turin. So the effect was now much like being trapped in a very, very small airplane while the CD Japanese American Noise Treaty played loudly all around me. After about 20 minutes, the infernal banging becomes your friend, and so whenever it gives up and goes away (which it does four or five times in a scan) the sudden silence wakes you up.  Once you're awake again, there's little for you to do except think about whether the designers made the machine fail-closed, so that in the event of a power failure, the dryer drum would recede away from you, or whether it just, like, fails, so the drum simply goes dark and continues to enclose you. While you are wrapped in sheets in a space too small to allow any form of sitting up, or for that matter even scooting, even assuming you didn't have a hurty shoulder. Which I did have.

But eventually it was over. The drum receded, or perhaps the bench moved, who knows? The sheets and restraints and pauldron were removed and I sat up and attempted to equilibrate before I got up, not wanting to fall over. "Are you ALL RIGHT?" the technician said after about 0.3 seconds of this. Apparently making sure I wouldn't faint when standing up shouldn't be on her time, it should be on my time. Fair enough. There were probably 25 people waiting outside by now, in their knickers and gowns…I picked up my key and went to get dressed.

There weren't.  There was no one in the chair or the locker room and the waiting room contained mostly tinsel. Clearly I'd been scheduled during the rush. 

STB is a 3D imager by profession, so I signed up to get a CD of my data (which would be released only after my doctor okayed it – because of course you wouldn't want a patient wandering around unsupervised with a picture of their shoulder. Anything could happen! Think, people!) STB asked the receptionist how many people signed up for their own images (at $10 a pop).

She thought for a moment. "All of them," she said.

Then we went outside to get, in my case, Pigs in a Blanket at the local medical complex's breakfast nook.

Mmm, Pigs in a Blanket.

[1] She had possibly developed X-Ray Vision, of course
[2] I'm watching Being Human (UK) and it's surprising how many ghosts, vampires and werewolves work in hospitals and places like that
[3] Later I found you could just wait in the locker room. This had not occurred to me
[4] I should do more shoulder exercises. Or fewer shoulder exercises, whichever it is that prevents them getting damaged


KaliDurga said...

I've wondered before just what an MRI is like and now I know. Sounds like it'd be horrific if you couldn't nod off inside the thing. What do they do for claustrophobics?

When do you get your results from the test?

And, Blogger screwed up. I can actually read the house numbers in the captcha.

Peromyscus said...

I think some hospitals have more open MRIs, the same way you can get stand-up tanning beds for if you can't lie down.

I don't have my results yet, but my doctor notoriously doesn't read his faxes (he has told me this) so I better give him a call and see if they're there yet. STB, who deals with radiologists, tells me they are under pressure to get each scan read in four hours. The rest of the time is waiting for your own doctor to open the results and get round to phoning you.

Peromyscus said...

PS I wonder about that house-number captcha thing. Are we somehow all involved in some sort of Google street-view privacy-breaking experiment?

KaliDurga said...

Get that doctor hoppin'.

How can in break privacy if it's only a house number that's not accompanied by a street or city name? I just had to go through four of them to get to one I could read...

Peromyscus said...

Google's street car can read street names. It just can't read this type of number as they are too much like a...captcha. So when you read it for google, it can check the house against the address it thought it had for that house.

Not that this means it has a clue where my place of work is. It just guesses.

Peromyscus said...

Here's an article on those house number captchas.


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