Wasted Medical Visits

A medical provider only has so many hours they can devote to appointments. I typically work 12-hour shifts (my choice) with a patient scheduled every 15 minutes, taking only one break (lunch) during my busy day. I reserve the hours of 5:30 PM to 8:30 PM for urgent care visits - about ten appointments. Our advice/triage nurses are supposed to screen the patients for these limited evening appointment, allowing only acutely ill patients; those who cannot wait until the next day, and those not so ill that they need the services of an emergency room. I never intended for these evening appointments to be "convenience care" - utilized by people who will not make an appointment during our normal office hours. People are so grateful that I have extended hours, three days per week. Some people do abuse this service, I have to say.

We do not have a lab or x-ray services after-hours, so any encounter that may need imaging or lab, like a suspected appendicitis or orthopedic cases, I send them to the ER. I get a great number of kids with otitis media, people with Strep throat, mysterious rashes, vomiting/diarrhea cases, and of course, fever of unknown causes.

I will see most lacerations that need suturing. Lacerations should be repaired within a few hours, no more than eight, so waiting until morning is not an option. I am one of the few providers in our group practice that will see kids with lacerations. I don't believe in sedating them, and I rarely restrain them on papoose board (probably not a politically-correct term). The vast majority of children (even two year olds), given an adequate explanation of what you are going to do to them (they are mostly concerned about pain, as you might imagine), will sit still and allow me to sew up their little faces without squirming. If I had to take a guess, I tend to have more issues with the parents, than the kids. At least once a month, a parent will faint or vomit while I am suturing their child. As I am suturing, I have to keep a close eye on the parents (mostly fathers) who are sweating and looking pale. On a few occasions, I had to suture both the child and a father that hit the floor.

Now that I have set the stage about what types of patients I like to see in the evening clinic, I would like to talk about "wasted visits". I guess I shouldn't complain too much, since even people who come in for unusually-minor problems; are still charged the same fee. What really tics me off are those who fabricate the reason for their visit in order to snare one of these precious appointments, those that have illnesses or conditions so minor that I can see them heal spontaneously in front of my eyes, and those that just need notes for work, school, or PE. If I could charge more for these wasted visits, I would.

• Jonas was a two-year old who was bitten by some sort of crawly creature (flea, ant, mosquito, or spider) two days ago. He had an appointment last night for two, tiny mosquito bites on this right foot. He didn't seem to notice them, but mother was particularly worried because he had a history of getting an infection in the past. Mother wanted to have him started on antibiotics right away, so that those bites would not become infected. Needless to say, she left disappointed and a few dollars poorer. In the vast majority of cases, antibiotics should not be used to prevent infections. The only thing that Jonas needed was a bath, nail-clipping, and some hydrocortisone cream. If you have ever made a doctor's appointment for plain 'ol mosquito bites; shame on you.


• Cory was 13 years old and was supposed to have a laceration of his scalp. My nurse put him in the treatment room and prepared him for sutures. After spending a few minutes looking for the spot that was supposedly-bleeding, I finally found a tiny, tiny, tiny scratch at the back of his scalp. He said that it suddenly bled during social studies class. He did not fall asleep and hit his head, nor was he shot by a random bullet or arrow. The hole was not big enough for brains to fall out, although I considered the possibility. After a period of denial, he finally admitted to scratching off a scab from previous injury sustained during wrestling. He left with a dab of antibacterial ointment on the wound - another wasted visit.


• Madison was ten days old and was bleeding from her ear. This got an immediate appointment. The new mother was in such a panic, she scraped the entire side of their new car pulling out of the garage. Upon examination, a tiny scratch was noticed on the outer ear, mostly likely self-inflicted by sharp, little newborn fingernails. Her nails were like razors, but the mother was reluctant to trim them. There were no other sources of bleeding found. The baby was perfectly healthy, mother was embarrassed, and Dad seemed pissed about the car. This was wasted visit number three.


• The last of the inappropriate visits involved a rash that had completely resolved. The parent was hoping that I would be able to determine what it was. Based on history alone, I determined that it was probably hives, but now that it is gone, there is really not much that I can do, other than suggest Benadryl next time. I had to inform the parent that there are no blood tests that can conclusively determine what caused the hives. They needed a note for missing school today.

The other six were appropriate visits, however, one even needed hospitalized for RSV (respiratory syncytial virus). This child, having considerable breathing difficulties, is one should have been triaged directly to the emergency room.

When I was a child, there is no way that my mother would have coughed up $3.00 for a medical visit for mosquito bites, a scratched ear, or a bleeding head. Granted, my mother was not the best triage person either. I once came home after completely impaling my right foot (I still have the scar) with a rusty pick; ruining a good pair of tennis shoes. The pick went all the way through my foot between the metatarsal bones. She filled the holes (both ends) with Vaseline and wrapped with a clean rag. I can't recall a tetanus shot or even a subsequent antibiotic. After washing my shoes, I continued to wear them, holes and all. My right shoe tended to leak in the rain.

I excuse new parents for not having the experience or knowledge to make reasonable health decisions. Everything freaks out new parents - rashes, fevers, one bout of vomiting, moles, funny-colored poop, yellow mucous, fevers, yucky tongues, flat feet, ear-pulling, penis-pulling, fevers (I know I mentioned fever three times, but this is a big one!), constipation, diarrhea, and fussiness. The same folks that study pregnancy like an obstetrician, attend childbirth classes, and read books on childcare, tend to loose it when Junior gets a runny nose. Since most childhood afflictions are self-limiting, when there is nothing to treat, I use these wasted visits as educational visits. Education tends to last longer and have less side-effects than medication.

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Home Office Make-Over

It was reminiscent of a warehouse after an earthquake. Unlabeled, cardboard file boxes were stacked in the corner and in front of the bookcases. Various piles of papers were lined up in some quasi-organized fashion. There were two file cabinets, but nothing was filed - they were used as drawers. Desk drawers were filed with any number of things: ink jet cartridges (both new and empty), blank CDs, a few thousand pharmaceutical company ink pens, a sushi knife, carefully hidden scissors (so my wife won't take them), lots of business cards, random pieces of paper with phone numbers without names to go with them, old keys, a few hundred disks that no longer fit the computer.

In the office itself were four computers (only one that I use), three printers, two scanners, two telephones, two wireless modems, a skull, several hundred books, my varmint gun, a Celestron telescope, an antique pharmacy scale, three sets of hand-carved crutches, and a huge glass display case of my prized collection (award-winning, I might add) of antique laxatives. I could go on...

My walls held an eclectic collection of art, fine sculptures, a plastic "butt", two clocks with incorrect times, and a plethora of advertising signs (Fallout Shelter, Do Not Bed Sheep in this Area, No Smoking, Duffy's Cough Syrup, Pharmacy, No Dumping, etc.).

As a former bedroom, there was a closet in the room. It held even more file boxes, tax records, a twenty pound bag of assorted rubber bands that I bought at an auction, old cell phones, a hundred pounds of Costco batteries of all sizes, old cameras, lenses, expired 35mm film, and two walkie-talkies with a range of 20 feet (in good weather, without obstructions).

I found some treasures, too, like some traveler's checks that I forgot about; enough to help pay for some of the new cabinets.

Needless to say, I had a cluttered, disorganized, dysfunctional, and dusty work space. For the last eight years, my wife has been harping at me to get an office make-over. I resisted, of course, since I knew (basically) where everything was located within that clutter. Sadly, it was my (inside) man cave. My other man cave is the garage. I have a four-car garage that only has room for one car, especially now that I have gutted my office down to the drywall. The old desk, file cabinets, and book shelves are now in the garage.

A friend and I installed a ceiling fan and light, ripped out the carpet and put down a hardwood floor, and installed some additional plugs (you can never have enough plugs). My wife volunteered to paint it (I hate painting). I sort of pride myself that I can do many different things, including carpentry, raising chickens, operating a backhoe, building sheds/fences, and installing irrigation systems. However, I have met my match. Apparently, I do not have the skill or patience to install crown molding. After some embarrassingly short cuts, improper angles, and mental anguish, I am having someone else do it.

We have always saved stuff for our adult kids. ("Don't take that to the dump, maybe XX will want it.") We still have boxes of their toys and Little League trophies. The fact that our youngest child is now 30, you would think we would give it to them. Every time we try, they make excuses. Next time we visit, we are going just leave it in their garages, so they can save it for their grandchildren.

I made at least two attempts in the past to get this office make-over, but never followed through after getting the shocking bids for built-in desks and cabinets. This time, I was going to do it. It was a locally-owned, family business and the price was reasonable. They are installing it today as I write this blog post. I am using my wife's computer. A few minutes ago, the carpenter (who arrived two hours late!) informed me that my room is not "absolutely square" so his cabinets may not fit "exactly". I guess as long as they don't hang out the window or keep me from closing the door, it will be fine. The cabinet under my window as four inches too tall, but he is modifying it. I insisted that I had not lowered the window since he measured.

Because he arrived late, he informed me that it is going to take a second day to install them. I think that is what he said. It was hard to hear him because the dogs are still barking at him and his empty truck. I really want to go upstairs can check the progress, but I am afraid...very afraid. There is a lot of drilling, sawing, hammering, and swearing going on.

I really envy those people who can manage their papers, collections, and clutter. I am trying, and I pledge that I will get rid of some things. Years ago, when we packed up, lock-stock-and barrel, and moved to Michigan from California, I was going to do it. Instead, I took every thing to Michigan, and then hauled it back again two years later, along with the stuff we accumulated there. I can really understand when kids pull out their hair when they clean out their parents' homes after they die or head off to the nursing home. My brother and I did it for our mother several years ago, throwing away plastic flamingos and brass monkeys. So, I guess our kids will be doing it for us someday.

I think that an ideal home would have one large bedroom; a living room that includes an uncomfortable, pull-out couch (for short-term guests); a big-screen television; a kitchen with one of those great, restaurant-quality, eight-burner, Viking stoves; a sunny backyard with room for a garden, and 30-car garage with room for a wood shop and at least one car. Someday.

Five Six Friends with Cancer

The older we become, the more likely we will have friends that will have cancer. In the last year or so, five close friends and relatives were diagnosed with various types of cancer. I am pleased to say that three are "cured", and two are under intense treatment.

Lymphoma: She was in her late fifties; never smoked a day in her life. Her only addictions were her grandchildren, traveling, and Bonsai trees. We were going to go to Europe with them. It would have been our first trip; they have been there many times and would be our guides. A few suspicious lymph nodes appeared in her neck. These were not the painful, reactive nodes we see with sore throats or dental infections. These were hard and fixed. Her doctor didn't like them either and sent her for a prompt biopsy. Once lymphoma was diagnosed, she underwent chemotherapy at a major cancer center. Today, she is in total remission, visiting her grandchildren, and as a Master Gardener, teaching Bonsai classes. Europe will still be there when we decide to go again.

Breast Cancers: She was also in her late fifties; a teacher and my sister-in-law. Because we had to cancel our Europe trip and had the time off, we decided to visit her and my brother. When we called to announce our visit, they had just left the doctor's office. Her annual mammogram showed a possible cancer; a biopsy confirmed it. After her lumpectomy, radiation therapy, and tamoxifen, she is now cancer-free. She hopes to retire this year to have more time to play.

Last year, a WebMD colleague - the person who edits the All Ears blog - also was diagnosed with breast cancer. She has undergone aggressive treatment and she, too, is doing well. She is taking time to walk with other cancer survivors and raising money for more research. I have never met her personally, but shared in her struggle and rejoiced in her remission.

Brain Cancer: It hit him without warning, like a lightening strike. Our best friend was preparing lunch for a visiting colleague when he suddenly lost his ability to speak the words he was thinking. Fearing that he was having a stroke, his wife called 911 (prompted after a phone call to us first). It wasn't a stroke. It was a brain tumor. As a matter of fact, it was the Mother of all Tumors, the Big Kahuna - an advanced-stage glioblastoma, the same tumor that recently took the life of Senator Ted Kennedy.

It has been nearly a year now; a year of brain surgery, radiation therapy, repeated rounds of chemotherapy, a few ER visits for unexpected seizures, repeated MRIs /PET scans, second opinions, and third opinions. He is holding his own right now, spending time with his children, grandchildren, seeing some great shows in Vegas, and enjoying the time he has left. He knows that his prognosis is not good, but still hopes for that miracle. If anyone deserves a miracle, it is George. We are going with him and his wife to the next consultation visit.

Prostate Cancer: He was one of my best friends in college and still is. On a routine examination, his PSA (prostatic specific antigen) was very elevated. A biopsy of his prostate was suggested. It wasn't a routine biopsy, either. The surgeon nicked an artery that would not stop bleeding; he nearly bled to death. Thinking that a person can only cheat death once in their lives, he hoped his biopsy would be negative. It wasn't. His prostate has been seeded with radioactive "rice" (brachyotherapy) and it has worked like a charm. He considers himself cancer-free and has done a long bike ride to celebrate his successful cure.

Lung cancer: I have known Harv for over 35 years. Together, we helped form the California Academy of Physician Assistants (CAPA), an organization that is still thriving with thousands of members. He was a smoker - a heavy smoker. This resulted in some pretty severe emphysema, so he has been on oxygen. Two weeks ago, like my friend, George, he suddenly lost his ability to speak an intended word. It was not those "brain-farts" that we all get from time to time; this was a serious loss of communication. He lives alone now in Arkansas, but knew he needed medical care quickly. A CT of the brain found a tumor; two, actually. A CT of the lung found the source. Harv has lung cancer that has metastasized to his brain. This week, he is undergoing gamma knife surgery, followed by chemotherapy. He is afraid, but is not letting a little cancer slow him down. He is still planning a cruise, going to his Navy reunion, and planning his annual trip to CAPA in October. He said that he was not surprised at getting lung cancer. As an astute medical clinician, he knows the reason, but his addiction to cigarettes was just too strong for him to quit.

As I have mentioned many times in the past, my father died of lung cancer at age 39. He was a smoker, too, compounded by his asbestos exposure in the Baltimore shipyards. He had a lung removed and endured painful cobalt radiation before he died six months or so after his diagnosis. This was in 1957, long before there was a specialty called oncology.

My brother has had a melanoma on his chest in the past. This is puzzling since he does not prance around without his shirt, even though he is a sailor. He, too, is a cancer survivor, cured by removing this early lesion before it caused additional trouble.

We need to take better care of ourselves, at least as well as we take care of our cars. The same people who become worried when they don't change their oil ever 3,000 miles, are really the same people who have not had a physical examination and baseline lab work for years. In the end, we will all die of something - humans do not live forever. Cancer is among us and we need to be diligent on looking for those suspicious signs and symptoms. Detected early and treated aggressively, cancer is no longer the automatic death sentence that it once was. We are slowly winning the battle, one survivor at a time.

FYI: My PSA and lipids are good. I passed my cardiac stress test with flying colors. I recently had a brain MRI for my tinnitus, so I know I do not have an occult brain tumor. My brain-farts are clearly due to something else. I have never smoked. I don't drink alcohol. I am happily married (married men live longer). I wear seat belts. I have no lumps in my man-boobs or moles that are suspect of melanoma.

I do need to eat more responsibly, lose 30-40 pounds to shake my Santa image, get a colonoscopy (so I can blog about it), and get my blood pressure in better control. Knowing what to do is the easy part; doing it is the hard part.

I would like to live several decades after I retire. I have places to go...things to do...family, friends, and dogs to love...patients to see....WebMD board postings to answer...and lots more stuff to write about.

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I Remember a Time...

I remember a time when people took more responsibility for the cost of their own health - a time when considerably fewer people had health insurance than today, if at all. If people became ill, they paid for a medical visit, just the way they pay to get their car repaired or pay for groceries.

I remember a time when medical care was more affordable, even when you compare today's higher salaries. People paid the doctor directly, paid for their reasonably-priced prescriptions, and they got better. Because even a small doctor's fee was a barrier, people tried "self-care" first. No one rushed to their doctor on the first day of cold. If you didn't get better after several days of chicken soup, Vicks Vapo-Rub, and St. Joseph's aspirin, maybe you would see the doctor, or the doctor would come and see you at home. No one used the emergency room for primary care - only true emergencies.

I remember a time when medical providers were trusted and held in high esteem; lawyers were few, and those were trusted, too. The idea of lawyers advertising on television for victims was considered ridiculous. Like today, doctors made mistakes; they missed diagnoses. Being held in high esteem did not mean omnipotent. Honest mistakes were just forgiven.

I remember a time when doctors could diagnose you by taking a careful medical history and examining you. They did not depend on expensive lab tests or advanced imaging studies like MRIs and CT scans. They listened and they touched. They utilized their carefully-honed diagnostic skills and were right most of the time. They treated a variety of illnesses with simple medications and people got better.

I remember a time when people trusted vaccines. Vaccines kept us from getting polio and measles. Vaccines were free and we were willing to stand in line to get them. No one seemed to get adverse reactions, other than sore arms. If we did get sore arms, we did not complain or call an attorney. No one became autistic. We had autistic children in the 1950's, but we did not call them that.

I remember a time when families took care of their special-needs children, and their aging relatives. There were few skilled nursing facilities, at least none that we could afford. If God gave you a child with Down syndrome or Grandma had a stroke, you loved and cared for them just the same, in your home. It was not the responsibility of the State to provide the care.

I remember a time when we had school nurses that were permitted to actually do nursing, not just call parents to come and pick up their kids. School nurses would fix wounds, treat headaches and tummy aches, and even kiss a few boo-boos. School nurses were there to listen to children who were having problems at home.

I remember a time when people took pride in their work, no matter what they did. Shoddy workmanship was rare and doing a good job was considered standard. If you bought a Chevy or a Ford, you knew it was made well. (The Edsel was an exception, of course.) Made in America meant "quality", Made in Japan meant "cheap". A plumber would fix your water heater the first time, or come back and do it again...for free. Car mechanics seemed to know what they were doing, even without on-board computers telling them. Mechanics did not charge $90 an hour. Refrigerators, stoves, and automobiles were made to last decades, so they were unusually reliable. Minor problems were fixed by the homeowners. If your car needed an oil change or new tires, you did it yourself.

I remember a time when kids could play outside, even in the front yard, without fear of abduction or molestation. You knew your neighbors and your neighbors watched out for each others kids. Kids happily played games because there were no video games, iPods, computers, cell phones, or movies on demand. Television was free but we only had three channels. It was okay to lose at a game, be picked last, or not make the team at all without having your parents intervening because of hurt feelings.

I remember a time when not everyone had a phone or a television. Long-distance phone calls were unbelievably expensive. Many people had party lines - two or more families sharing the same phone. You had to listen for your individual ring. Television screens were small and pictures were in black and white. Any colors that we saw were in our imagination. We knew the sky was blue, grass was green, and Lassie was brown/white. There were few stations and the reception was generally poor. Even then, we could have easily become television addicted, but our parents made us go outside and play.

I remember a time when teachers could give the grades you earned. School days were longer and homework could be finished in less than an hour, so kids had time to play and just be kids. Teachers and principals could exercise reasonable corporal punishment (a paddle) for bad behavior and not be put in prison for it. Your butt and pride were momentarily hurt, but adverse behaviors were rarely repeated. I spent my share of time standing in the corner because of talking, and yes, I had a few spankings at school which were duplicated when I went home.

I remember a time when a child's first experience at school was in kindergarten. There were no preschools or day-care. The kindergarten teacher taught us to count, learn our ABC's, and learn our colors. Learning to read was the responsibility left to first-grade teachers. We did not start preschool as soon as we were potty-trained, and we still went to college anyway. Early childhood education focused on behavior, not algebra. Children from foreign families were expected to know English before attending classes.

I remember a time when playing on a playground was at your own risk. If you fell from a sliding board and broke your arm, it was not the fault of the city or the sliding board manufacturer. It was your fault and your parents knew it. Fathers and sons could make a backyard tree house without a building permit. Kids rode bikes on the street, and drivers looked out for them.

I remember a time when parents would do anything to support their families, including taking menial jobs to put food on the table. The government would offer subsidies like cheese, flour, or peanut butter when families were struggling, but no one handed out cash. The idea of being on welfare (or "relief") was embarrassing and short-lived. It was not a way of life for generations.

I remember a time when parents cooked at home and we all ate at the table. We ate a lot of macaroni and cheese and stews. The smell of homemade bread still evokes memories. We did not go to fast-food outlets or restaurants. School lunches were packed in brown paper sacks or in cool lunch boxes with the Lone Ranger and Tonto. Tonto was not looked upon as being a stereotyped Native American - he was an Indian.

I remember all of these things, but things were far from perfect. We have made some important strides since the 1950's:

• Cars may be more complicated, but they are safer. This is good, since they are faster and not made of steel. We now have seat belts, safety glass, air bags, electronically-locked windows/doors, built-in roll bars, and impact-absorbing bumpers. Kids are restrained in the backseat like astronauts, not standing or jumping from the back to the front.


• Kids and motorcyclists are required to wear helmets. Although there have been remarkable advances in neurosurgery, not all brains can be fixed.


• People are recycling now. In the 1950's, it was common to throw trash out of car windows or dump it along the side of a country road. We did recycle soda bottles - they were worth two cents each!


• People are more tolerant of different races and alternative lifestyles. If you were gay in the 1950's, you kept it to yourself and were forced to lead a very lonely, cloistered life. Black people do not have to sit in the back of a bus (or the back of the classroom like they did in my integrated, first-grade class). There are better opportunities now for all minorities, but we still have a way to go.


• There are more and better vaccines now, preventing illnesses that killed and maimed many of my childhood friends. Vaccines are not perfect, but they are infinitely better than the diseases they prevent. I look at an iron lung in the medical museum, and rejoice that those days are over.


• We now have a larger and more comprehensive drug formulary, treating diseases that were once a death sentence. Like vaccines, not all drugs are perfect, but I would not want to live in a world or practice modern medicine without having that pharmaceutical armada. Drugs are generally safer. Remember that the 1950's gave us thalidomide


• It seemed like everyone smoked in the 1950's. Most people did not know that smoking was a form of population control, as fathers, mothers, and grandparents died in the thousands due to the adverse effects of tobacco. There is overwhelming evidence that cigarettes will eventually kill you, but the young and stupid are choosing to allow history to repeat itself.


• Medicine is more advanced - better surgical techniques, better diagnostic technologies. The practice of medicine may have suffered, however. Gone are the days when a doctor stayed at the bedside of a dying patient, or treated a sick patient, whether they had money or not. Doctors still have hearts and many of them still do these things, but they are the exception rather than the rule.

I miss the simplicity of the 1950's. In my opinion, they were truly "Happy Days", but what did I know? I was a kid. Would I go back if I could master time travel? Maybe; as long as I could bring some of our good things with me.

What do YOU remember?

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My MRI

Liz Henry / CC BY-ND 2.0

When medical providers become patients, we often have similar issues. We complain if we have to wait, moan about filling out forms, especially forms that are asking for private information that you don't think anyone should know, like your social security number, birthday, and of course, your weight. I purposely put the wrong social security number or none at all. No one has ever called me up to tell me that it was incorrect, so I know it is not needed. I can handle identity theft, but I am not going to be honest about my weight. The only time that I was honest about my weight was when I was teaching with the University of California - Davis. One of my jobs was to evaluate medical students at their rural clinical teaching sites. A pilot would fly us in to some scary-looking dirt runways, so it was important that he balance the plane properly - equal weight on each side. I did not want to be responsible for a crash simply because I put on some pounds over the holidays.

So, I lied a little bit about my true weight to the MRI tech today because I knew it was irrelevant. I had arranged an "open" MRI with a bigger chamber for those of us who are claustrophobic. I knew I would fit. Besides, the MRI was of my brain and it weighs pretty much the same as it did in high school.

They made me take off all of my clothes, except my underwear, making me wonder which brain they were imaging - the big one or the smaller one (Men, of course, have two "brains" which direct many of our activities). I donned the gown, open in the front, but I kept on my black socks and shoes. I am glad there were no mirrors. I was directed to sit back in the waiting room. I knew what I looked like based on the stares and some subtle smiles I detected from the other patients. I stared at them, too, for a little revenge.

I didn't really talk to anyone in the waiting room, since I have discovered two things about myself. When I am anxious (MRIs are stressful for me), I evolve into a comedian, or become sarcastic. I was fighting those feelings. My first challenge was with the eight pages of forms I had to fill out. I had an appointment for this test about a month ago, but when I arrived, more than thirty minutes early as they requested, they were one hour behind. They told me to go out for breakfast and come back! I was not hungry, and besides, I had developed a nice cough. Trying not to cough while lying on you back for an hour was not something I could really accomplish, so I rescheduled. My appointment today was for 12:30 PM (lunch time for most people), so I decided to ignore the "come in early rule" and arrive promptly on-time. I insisted on keeping all of the papers I filled out last month so I could use them again. The receptionist handed me new ones, so I gave her the ones that I had completed already. Confused, she accepted them as long as I would sign and re-date them. Nothing had changed, other than the fact I was a month older.

I had been ordering them for my patients for years, so when I had my first MRI about 15 years ago, I did not think it was going to be a big deal. I was wrong. If the smaller MRI chamber was any smaller, I would have needed to be naked and covered in KY jelly in order to slip inside. As it was, my arms were jammed in my side and my nose an itch or so from the top. I felt like a cannon ball. I have never been a fan of tight, closed-in places and this was the worst. I handled it with a lot of mental distraction, but I will never order another MRI for one of my patients without first explaining it to them, and offering them an anti-anxiety medication.

My second MRI was in an open one. It wasn't like being in a tube at all. The "open MRI" that I was in today wasn't the same. This one was like a large vise. It was open on the sides, but my nose was still itches from the top of this flat, metal chamber. Having it open on the sides is not that helpful, since you are not permitted to move your head during the scan. So it was back to the mental distractions again. I did take a half dose of Xanax before I left home and I am sure that helped. At one point in the long scan sequence, I woke myself up with a snore. So it wasn't that bad. I slept through most of it, apparently.

I had an IV half way through the MRI to further enhance the image. Although I couldn't see, the technician commented that I was bleeding.

"Why are you bleeding so much? Are you taking aspirin or an anticoagulant? "No. I am pretty sure I am bleeding because you put a big hole in my vein and my blood tends to leak out."

I was pleased to be able to be sarcastic. It was building up inside.

I wanted to look at the films, but I will be a good patient and wait until the results are downloaded to my electronic medical records. The purpose of today's MRI with contrast was to see why my tinnitus has changed. Of course, they are looking for tumors. I don't suspect they will find an underlying reason; we rarely do, but we have to check anyway. Like most clinicians, I handle some of my own medical care, but I let other professionals work up my tinnitus. Tinnitus is as frustrating for the patients as it is for the clinicians trying to solve it. I become just another one of their patients - a little sarcastic at times, with a few outbursts of humor, occasionally inappropriate, but at least I am not a whiner.

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