Dying for an MRI: PTSD and scans

The radiology technician was a lovely, patient man, despite the complications.

Trying to put me at ease, he said he’d had plenty of MRIs himself – a half hour of boredom he cheerfully described it.

Well, for someone with a background of trauma, it was MUCH more than that.

The complications started in the waiting room as I ticked the box on the patient form which asked about claustrophobia. I’m not actually claustrophobic, but there wasn’t a checkbox for “traumatised” or “panic attacks”. I was hoping for a brief chat, an opportunity to mention PTSD, but my tick was never mentioned, leaving me wondering if anyone would know what to do if my ‘claustrophobia’ played up.

Nevertheless, I expected the greatest problem with the MRI was going to be keeping still inside the machine, having screwed up scans before with my stress-induced wriggling.

However,

within moments of walking into the room, stunned, I found myself putting my head into a moulded plastic bit of the bed while my technician shoved hard foam wedges into every gap, immobilising me from the neck up.

It’s true that I could still move every limb, but I never expected how fearful I’d feel unable to move my head, particularly after he put a white plastic cage over my face, attaching it tightly to the bed and destroying the only escape plan I had: to wriggle out of that tunnel if I got too panicky.

A freedom of movement I’d counted on.

The cage was the second surprise layer over my face, covering the surgical mask he told me to wear. After years of Covid, masks no longer stress me, but I did note that masked deep inside the machine, if something went wrong, no one would hear me scream.

Oblivious to my bubbling panic, cheerfully my technician finished off by draping a heated blanket over my body, neck to toe.

It was meant kindly. But it was like being gagged, strapped down, and then tucked into bed.

Helplessly, as I slid into that machine, each wall a smothering few centimetres from my body, despite his jaunty smile, I regretted agreeing to this scan.

He promised he’d be back in “40 minutes or so” (adding 10 minutes onto the time the specialist had promised), but in fact it was only three.

That’s all it took alone in the twilight of the machine, for my mask, blanket, and immobilisation, to become a hall-light shining into a dark bedroom, a hand across my mouth, the weight of a large, immobilising body on top of me, and the terror of death.

A very real fear.

As a child I was afraid he would smother me. As an adult I’m a vomiter. Never during the day; only at night if I lie on my back.

Trapped on my back in this machine, unable to roll onto my side, left me reliant on my technician (a laid-back stranger) to rescue me. Could he get off his chair, get in here, slide me out of the machine, detach and lift the cage off my face, remove the wedges, whip off the mask, and roll me into the recovery position, before I vomited, asphyxiated and died?

I wasn’t convinced.

And, predictably, stuck on that thought, instantly my throat was FULL of the acid-prelude-to-vomit taste. Heart in overdrive, sweating, gasping for air, I thrashed around desperately.

Irrespective of what cancerous thing could be in my brain, my terror was a fast-growing tumour, filling my mind.

So, I was seriously distraught when I squeezed that emergency buzzer, and nothing happened. Unlike a nurse call button, the MRI buzzer had a several seconds delay between squeeze and sound, a technical idiosyncrasy neither of us were aware of.

But the entire building probably caught on

because, due to my terrified repetitive squeezing (assuming the buzzer was broken), the buzz continued like an echoing scream, long after he trotted in.

Sliding me out of the machine should have calmed me down, but my anxiety racketed UP as he rattled off my limited options (my brain filling in the blanks):

get up, walk away, no pressure to do the test (and risk suddenly dying from some blood clot/tumour/stroke because I didn’t have an MRI to identify it)
have another go, and he’ll rescue me if necessary (lie on my back for 30-40 minutes, risking vomiting and dying in the machine because he can’t run fast enough to rescue me)

It was a cruel decision.

Complicating things, if I chose option 2, dissociation (an effective coping mechanism) was NOT an appropriate coping strategy, because I had to remain alert enough to squeeze that buzzer.

Pressured, blank eyed, and rapidly calculating a minuscule lower chance of dying in a hospital, I went for option 2, my decision helped along by his removal of the blanket - something I hadn’t thought to ask for but which surprisingly did help, as it reduced the body-on-top-of-me feeling.

Smiling goodbye, he slid me headfirst back into the machine, with the suggestion that counting backward from 30, might calm me down. An unexpectedly helpful tip as it reminded me that counting was a coping strategy I’d used in childhood. (Indeed, I found that counting was one of the things which helped me psychologically survive this scan.)

Nonetheless, it was a ??? terrifying minutes, full of prayers that I wouldn’t vomit, smother or dissociate, telepathic farewells to loved ones, silent screaming, fragmentary childhood memories, and 30 numbers.

To reduce the risk of dissociation I scratched one icy fingernail across my belly, under the gown, ripping back and forth, until later I looked like I’d been tortured.

There was a lot going on in my mind, but not enough to block out the noise of that machine. It had an unpredictability about it that tore at my nerves – different sounds, pitches, stop, start at random, like sudden blows from an invisible person. The bottom half of me jumped with every change of sound, every time.

Worse, without a watch there was no way to tell the difference between 40 minutes and 10, so like a child’s concept of time, the MRI seemed to go on forever.

How many more sleeps, until it ends?

I wondered which of the childhood memories playing through my head, were playing across my technician’s screen as he watched the machine draw my brain. Did he see a child on a bed, wide eyed, listening for footsteps on carpet?

I DID.

Which is why I was a complicated mixture of sooo grateful-relieved and adrenaline-exhausted-scared, when he strolled back in, trailed by his male colleague.

Suddenly hemmed in by two men as I lay trapped on the bed, my adrenaline surged as I realised that my frantic belly scratching during the scan had pried open a gap in my too-big gown, leaving one breast exposed.

A final trauma which I didn’t visibly react to – cornered animals often freeze.

Understandably, in my stressed state I misinterpreted my technician’s words, assuming that he was referring to something on the scan – perhaps an oddly shaped tumour?

After all, how else was I expected to interpret: “I’ve rarely seen that, you know. It’s very uncommon”??

Had I survived the machine, to die of some rare disease?

I was too shattered to care.

So, it wasn’t until I’d escaped the hospital that I understood his words, which left me blubbering all the way home.

“I’ve rarely seen that, you know. It’s very uncommon for someone to panic and then get back into that machine and have another go. Most people just get up and walk away”.

Well. I didn’t walk away. I was brave.

His words help with the flashbacks. Still coming, weeks later.

To mentally prepare, it’s helpful to know exactly, in advance, what’s going to happen during a scan.
- For every type (MRI, CT scan, etc), a one-page explainer (not a basic “you will lie on a bed in a machine”), but a “There will be a range of loud noises which will stop and start”. “You will not be able to move because you will have a cage/other type of restraint over [insert body part]”. “If there is an emergency XX will happen”. “The emergency buzzers are regularly tested”
  - Include diagrams
  - Issue copies to GPs, specialists, anyone who might refer. Email copies to patients at the time of booking an appointment and/or make available at the front desk
  - Update them as technology changes
Tell patients in advance if there are sedation options and how to access those
Use the question on the patient form (completed at the time of arrival) which asks about claustrophobia. Look at my tick, come and talk to me about it. Negotiate. Can processes be modified?
Add check boxes to the form for history of trauma, panic attacks
Add a tick box to the scan request form flagging special needs requiring discussion with the patient/patient’s doctor prior to a scan