On this blog, we frequently write about what it’s like to work for — or experience life at — Penn Medicine. What we don’t get the chance to write about very often is what it’s like to see the University of Pennsylvania Health System from the other side: as a patient, just trying to figure out what’s wrong and get better. Fortunately (well, not ‘fortunately,’ per se, but you get the idea), I’ve now got one such story to relate. This is the second of what it turns out will be three parts. You can find the first part here.
Prep Work (or: “You’re Gonna Be More Full of It than Usual”)
One of the ways I deal with anxiety is placing things into perspective. The first hill of that roller coaster looks terrifying? Plenty of folks have ridden it before and been just fine; you aren’t the first, you won’t be the last. Nervous about that cross-country flight? Flying’s the safest form of travel; millions of people do it daily. You get the idea.
I’ve always wondered — which is kind of silly, since I could just ask — if physicians sometimes feel like they have to walk a tightrope between two distinct patient experiences. On one hand, I imagine you want the patient to feel as if they are your only patient of the day. You want them to feel like they’re getting the most undivided and meticulous attention to detail possible. On the other hand, I imagine you also want the patient to know that this is not even remotely your first rodeo. Lots of folks have gone through this before. I’ve seen, like, eight of them already today. You’re going to be fine.
It’s a quandary that’s only minutes away from striking me yet again as I sit on a chair in an imaging suite at Penn Medicine University City, the well-fitting hospital gown doing its very best to keep me modest as I stare at the massive fluoroscope across the room. It looks like a big ‘C’ wrapped perpendicularly around a long table, with a camera sort of thing on the end of the ‘C’ that dangles overhead. There are several monitors attached to the whole contraption, which I’ll later use to snoop on my own bones.
An X-ray tech walks in and proceeds to ask me a few questions, including one I’m about to get very familiar with: “Do you have any sort of metal in your body? Implants, screws, rods, shunts, a pacemaker, anything?” I’m able to confidently say no. He asks again, this time rattling off an even longer list of metal objects that could find their way surgically or otherwise into the human body. I say no again — but less confidently, as I’m too busy thinking back on every dumb way I’ve ever hurt myself and wondering if maybe there’s any way I’ve forgotten, I dunno, a stray bullet or something. The tech seems satisfied and jots something down on his clipboard.
He then walks me, step by step, through what’s about to go down. He tells me about how I’m going to get up onto the table under the fluoroscope, have a sterile drape placed over a significant chunk of my torso and legs (“You need to make sure not to touch that,” he says, which I don’t even think twice about until a little bit later … but we’ll get there), and receive a small injection of lidocaine. Lidocaine, of course, is a numbing agent, which is of great importance because the step immediately following it involves a large needle being driven directly into the hip joint. Through that particularly invasive needle, I’m going to receive injections of radiographic and arthrographic contrast (two separate fluids). I’m told all of the prep for the procedure is actually much longer than the procedure itself.
They inject contrast fluid into the joint because more than a century of development and advancement of imaging technology still can’t really make up for the fact that joints like the hip and shoulder just don’t give up their secrets easily. Contrast fluid helps out by lighting up under a fluoroscope or MRI, making defects and whatnot far, far easier to spot.
“Your hip’s going to feel … full,” the tech says, the expression on his face something akin to, ‘I know, dude; I’m just telling you what I’ve heard.’ I nod. He continues. “It’ll be a day or two before the fluid is absorbed by your body, and then you should be back to normal. Just don’t do any running or anything strenuous on it in the meantime.”
I’m in the middle of putting aside the fact that being unable to do any running or anything strenuous on my hip even when it isn’t chock full o’ contrast is kinda what brought me here in the first place when one of the technicians who will be performing my MRI in a few minutes swings by.
“Really quick,” she says, “do you have any sort of metal in your body? Implants, screws, rods, shunts, a pacemaker, anything?”
Injections (or: I Guess We’re All Friends, Here)
As a musculoskeletal imaging fellow and the attending radiologist enter the room, the latter grabs the clipboard from before and begins to ask me a few of the same questions, as well as some new ones. He jots down my answers quickly, then looks up at me and begins walking me step by step through what’s about to go down. It’s then that I realize the reason I’m being walked through this procedure several times over isn’t so much about making sure I know what I’m consenting to so much as it is just making sure I don’t feel surprised by something and freak out while they’ve got a needle or two buried deep in my hip joint. Once again, I’m told the prep for the procedure is much longer than the procedure itself.
Once everything’s squared away and it’s clear I know what’s about to happen, I’m told to walk over to the table under that big ‘C’ arm and lay down. I do so, and rest my folded hands on my stomach. I’m a little nervous, but the team is moving like clockwork and making every single step as clear as possible along the way. It’s calming, which is good, because the next step involves pulling my gown to the side so they can sterilize the entire area of the joint.
I consider myself an easygoing guy, but it’s hard to maintain one’s chill when you’re one small shift of a hospital gown away from three complete strangers seeing, like, everything. The sterile drape that’s going to be placed over me is brought out of its packaging, and I’m told I can’t let my hands rest on my stomach anymore because they’d be in direct contact with the drape. I adjust, and they go about their business while I awkwardly try to figure out what I’m going to do with my hands. I end up folding them behind my head — the ultimate position of repose, which strikes me as entertaining given my sudden and notable lack of modesty. I chuckle to myself, and the tech checks in to make sure I’m doing okay.
“You alright?” he asks. “Nervous about the needles or anything?”
I tell him I’m not, and he relates a story from one time when a lady was undergoing this same procedure, saw the very first needle, leapt from the table and bolted. Their earlier repeated walkthroughs of the procedure make that much more sense. Lots of folks have gone through this before. You’re going to be fine.
The fellow holds up the first needle. “Lidocaine,” he says, making sure I understand we’re about to get underway. I nod, and he gets to it. I feel a slight pressure, and he pulls away with the needle before I even realize he’d pierced my skin. So far, so good.
“You’re numbed up, but you’re going to feel a bunch of pressure,” I’m told as the second needle comes into view. I guess there’s only so much we can expect lidocaine to do. I don’t really feel it when the needle enters, but I absolutely feel it when the needle gets close to the joint itself. “Pressure” is a good way to put it, if only because it’s tough to describe it otherwise. Take your pointer finger and push it hard — I mean hard — into your hip. Weird, right? It doesn’t hurt, but it certainly doesn’t feel good. That’s what it’s like.
The injection of the contrast fluids goes quickly and without incident, save for one injection having to be done twice because I have a tendon in an odd spot. I wish I could get more technical than that, but it was explained too quickly for me to fully understand what the issue was. Either way, it only meant an extra minute or so of everybody’s time.
The team grabs some radiographic images of the joint, which I stare at on the monitors. I’ve always been fascinated by X-rays of my own bones. I think people have a tendency to forget that everyone’s really just a walking skeleton wearing a meat coat.
I keep that particular thought to myself.
Just like that, the procedure’s over and I’m free to get up and walk over to a private waiting room while the MRI machine is readied. The hip does, in fact, feel “full.” It’s tough to explain. Nothing feels like it’s going to burst, and nothing’s all that painful — especially since the lidocaine’s still doing its thing — but there’s absolutely a sense of pressure within the joint that wasn’t there before. My first few steps are extremely tentative, but after that I’m moving only slightly slower than usual.
In the next room, I can hear one of the MRI technicians talking another patient through their last round of images. A few minutes of waiting and a huge, loud machine containing an enormously powerful magnet are all that stand between me and some answers.
Next month: The MRI experience, and finally some solid answers about what’s going on in my hip. It’ll be the last part. I promise.