Comas and MRIs

mhughes · Feb 13, 2006

A couple of questions to which I have no answers:

My current WIP is a fantasy with a large part taking place on earth. The main character has been banished from his world (where magic is norm) and sent to Earth. A side effect of the spell that sent him to us causes him to suffer amnesia. Aside from his name, he has no idea who he is or where he’s come from. On top of that, he enters a coma for eight months shortly after arriving.

First question – the doctors would want to do an MRI but he has a gold and diamond bracelet that cannot be removed by any means, even cutting it. Does that completely rule out MRIs?

Second question - how would our world handle someone suffering from amnesia and who spends months in a coma? He suffers no ill effects from the coma (yes, very rare but then again, he’s a bit of an out of towner). Physically he’s just fine and he learns languages without a problem. So he can operate like any other person. The down side is that he has no identification, no history, no driver’s license, etc. I’ve been struggling with how to tackle that.

My intention is to have him released into the world, but with some strict guidelines. One being seeing a psychiatrist every few weeks in an attempt to regain memory and make sure he’s stable (opens up a number of story lines). He’d also be limited in where he can travel (yet another story point). I want people to be suspicious of him, especially when folks start showing up to kill him.

Thanks much in advance.

ChaosTitan · Feb 13, 2006

I don't know about the MRI thing, but it seems to me that it *may* not make a difference. Does a married person have to remove a wedding ring before having one? Don't hospital bracelets have metal clasps/clinches?

For the coma aspect, it's likely that if the person is none violent, and seems to have all of his faculties about him, he would be released once he's deemed healthy. I imagine that Social Services would be called and get involved (which may give him an immediate link to someone in our world), especially since he has no identity, no home, no job, no money, etc...

mhughes · Feb 13, 2006

I think I might have answered part of my own question. Per the MRI Patient's Instructions at http://www.whidbeygen.org/services/MRI.htm:

Please remove watches, wallets, hairpins or barrettes. Gold jewelry and rings are okay, if not in the area of interest.

Glad I found that out. I was really hesitant to go out for my run tonight and dive in front of a car just to have an MRI done.

victoriastrauss · Feb 13, 2006

A question: who would be paying for all of this? Without insurance, his treatment options (especially after release) would be pretty limited, I should think.

- Victoria

dante-x · Feb 13, 2006

mhughes said:
A couple of questions to which I have no answers:

My current WIP is a fantasy with a large part taking place on earth. The main character has been banished from his world (where magic is norm) and sent to Earth. A side effect of the spell that sent him to us causes him to suffer amnesia. Aside from his name, he has no idea who he is or where he’s come from. On top of that, he enters a coma for eight months shortly after arriving.

First question – the doctors would want to do an MRI but he has a gold and diamond bracelet that cannot be removed by any means, even cutting it. Does that completely rule out MRIs?

Yeah the gold bracelet that can't be removed would remove the possibility of MRIs, the magnetic field is immensely powerful. It has to be powerful enough to allign all the desired atoms at specific axis in order to get an accurate reading when the atoms release a "pulse" by returning to their natural allignment - okay I have oversimplified it.

There have been fatalities in MRI machines - recalls discussion in upper year neuro about a kid was killed by a canister that was sucked in by the MRIs magnetic field. Depending on the time period of the piece, provided you can find a way to use MRI tech, you might want to consider fMRI. It would be more likely to be used as it gives a movie versus the MRIs snap shot picture. People with metalic staples and braces are a no go, last I checked. Haven't been in the lab for a couple years.

If you can't use MRI, you aren't completely out of luck.
-EEG, CAT (though would be ineffectual, unless the patient has structural anomolies in their brain),and PET might not be bad options, though not as effective, by themselves that is, as fMRI.

mhughes · Feb 13, 2006

victoriastrauss said:
A question: who would be paying for all of this? Without insurance, his treatment options (especially after release) would be pretty limited, I should think.

- Victoria

Quit injecting reality into my fantasy story! :tongue

But that is a valid question I didn't think about. I've done some Googling and not found a lot specific to this, just bickering about illegal immigrants. Might just make him a burden on the local tax payers, thus increasing resentment against him. But if anyone else has ideas, I'm very open to that.

DaveKuzminski · Feb 13, 2006

But don't you want it to have enough reality that it portrays an interesting contrast and better conflicts?

dante-x · Feb 13, 2006

mhughes said:
Quit injecting reality into my fantasy story!

But that is a valid question I didn't think about. I've done some Googling and not found a lot specific to this, just bickering about illegal immigrants. Might just make him a burden on the local tax payers, thus increasing resentment against him. But if anyone else has ideas, I'm very open to that.

I agree with Dave, in terms of limiting the fantasy to the elements. However, there might be some ways of getting free funding for this amnesic. If he had undergone testing that confirmed his amnesia, and yet it remained a neurological mystery, there is a chance that neurologists would agree to use their juicy university grants to fund his therapy in exchange for permission to inevasively study him. We use to recruit people from all across north america when we found some funky confirmed disorders. You might want to think about the conditions, coincidences or social networks to make that viable though.

mhughes · Feb 13, 2006

dante-x said:
I agree with Dave, in terms of limiting the fantasy to the elements. However, there might be some ways of getting free funding for this amnesic. If he had undergone testing that confirmed his amnesia, and yet it remained a neurological mystery, there is a chance that neurologists would agree to use their juicy university grants to fund his therapy in exchange for permission to inevasively study him. We use to recruit people from all across north america when we found some funky confirmed disorders. You might want to think about the conditions, coincidences or social networks to make that viable though.

My smiley face joke apparently didn't work. Sorry about that.

In any case, I do agree with all of you. Not being in the medical field, there's quite a bit I don't know. I've got some questions into my sister in law who is a doctor but she's family practice so we're not sure how much she'll know about this situation. I think dante-x might have given me the answer though.

The story takes place in a fictional town based on the one I live in. It also just happens to be about one hour from the Mayo Clinic in Rochester, Minnesota. The nursing students at the local college spend a semester up there. There's even a shuttle that runs between here and Rochester since so many people in town work at Mayo. It wouldn't be a stretch at all to have the MC heading up there once or twice a week for testing, etc. Thank ye.

MattW · Feb 13, 2006

Having been to a hospital recently, I notcied signs all over saying that critical care will not be denied to anyone who is in need, regardless of insurance or ability to pay.

How "critical" amnesia is is debatable, but I'm sure enough doctors would take interest to make sure the patient was thoroughly studied and examined.

The bracelet would just add more fuel to the fire for any inquisitive doctors.

DaveKuzminski · Feb 13, 2006

Plus imagine the problems encountered before he regains consciousness where thieves tried to cut the bracelet off or even tried to amputate his hand. You could have a lot of side issues to choose from that might let you inject interesting elements later such as meeting up with one of those would-be thieves later as either another opponent or a new ally.

DaveKuzminski · Feb 13, 2006

Yeah, and if it was from a writer's world, it could be a semi-coma.

Sorry, couldn't resist that one.

dante-x · Feb 13, 2006

lol, this post deletion thing is making things confusing heh.

Originally responded to a post, and the post was deleted as I hit submit.. so I went to delete my response and dave responded. ER.. kind of made an abortion of the flow of conversation there.

But to repost:

Yeah it is rare. That is in part moderated by the cause the of the coma. But as mhughes' MC is from a different world, a magical world at that, it might have a different biology or it might be a "magical" coma.

Shadow_Ferret · Feb 13, 2006

I don't know that medical care would be withheld from someone who needed it. The person would just be saddled with this monsterous bill they wouldn't be able to pay off.

And as far as metal in MRI's, I've heard that if you have a tatoo they might not even do it for fear there is metal oxides in the ink. That's how powerful these things are.

BlueBadger · Feb 13, 2006

Regarding payment ... luckily, I'm Canadian, so if I ever found myself in that kind of situation, at least it'd be paid for. XD But my husband (American) suggests that there are churches and charities out there that sometimes offer help for people in sticky health situations...I know your character just arrived on earth, but who knows, maybe it'd make for an interesting chain of events later on in the story.

TheIT · Feb 13, 2006

Does it have to be an MRI? What about a CAT scan? Does that use the same technology?

Who found your MC and took him to the hospital in the first place? Perhaps whoever found him has some interest in paying for his healthcare, like he appeared in the middle of a road and the person who nearly ran him over thinks he's guilty of causing the coma. Does your MC appear to be human? If he has some sort of non-human or fantastic characteristics, that might be enough to have a university be interested in him for research.

You said he learns languages easily, which implies when he wakes up he's speaking a non-earth language. Who teaches him, and how would they react to him speaking a completely unknown language? If he ends up in the hands of a university or a government, they'll have major security concerns about letting him loose without knowing where he came from.

This scenario is reminding me of a short lived series from the 70's called "The Phoenix", and also Heinlein's Stranger in a Strange Land. Maybe those might give you some ideas.

mhughes · Feb 13, 2006

MRI was the first thing that came to my mind. I'm going to be checking some of those other options tonight so I can get a better idea of them. The short of it is that there is nothing wrong with him they can find. It was a spell that did this to him.

He is 100% human except for the fact he's covered in scars (in his world, he uses blood for magic). The person who found him rents out part of her house for him to live in. I had always determined he was going to emerge from his coma with no muscle atrophy/weakness. Something pretty unheard of I guess in long comas. So there will definetly be interest in him.

Ever since the research aspect appeared (which I hadn't thought of), it opened up a number of story lines. I just have to develop them properly.

dante-x · Feb 13, 2006

TheIT said:
Does it have to be an MRI? What about a CAT scan? Does that use the same technology?

CAT wouldn't present the same problems that an fMRI/MRI would. CAT's like a 3-d x-ray, and doesn't produce the magnetic field. So no problem with the gold bracelet. Not nearly as effective as fMRIs which, while more expensive, are becoming more common. Yeah probably best just going with the CAT if you are stuck with the gold bracelet.

Maybe even look into using a PET, which I think would probably be used in conjunction with the CAT in this case.

But then again, not too sure what level of detail you are looking to go into with this aspect. You might even be able to get away with just grabbing a pamphlet on each of the three from your local hospital.

Shwebb · Feb 13, 2006

MRI might be okay. MRI's, as far as I understand, are problems with magnetic metals only. They are essentially very powerful magnets. As long as you are dealing with non-magnetic metals, it's definitely feasible.

I have surgical staples and had an MRI, and there were no problems--I'm assuming that my staples weren't magnetic. Oh, here's a tip: don't carry credit cards while you have an MRI. I forgot the one in my pocket, and it completely erased the info contained in the strip.

If his watch doesn't contain magnetic components, you hopefully won't have a problem with it. If it does, it could conceivably rip off his hand, I'd think, from the force of the magnet

On Mythbusters, they addressed the tattoo issue--the tattoos would have to have a large magnetic metal component to cause any problem; they subjected one of their workers with tattoos to an MRI and she had no problems.

Probably your best bet would be to call your local hospital, ask to speak to the radiology department, and see if someone will answer your questions. Get the answers from the horse's mouth.

Mac H. · Feb 13, 2006

First question – the doctors would want to do an MRI but he has a gold and diamond bracelet that cannot be removed by any means, even cutting it. Does that completely rule out MRIs?

People are correct in saying that non-ferrous metals such as Gold is OK.

The problem is that the doctors have a patient with a bracelet of an UNKNOWN metal. It is clearly not gold, because it can't be cut. In this age of lawsuits, what would they do?

They could test it with a magnet, but if I were a doctor I'd hate to risk my professional indemnity insurance on a half-arsed test that I made up myself.

(Also, doctors have done a LOT of damage to patients based on their partial knowledge of how medical technology works. In one famous case a doctor burned a boy's penis entirely off because he decided to use a fancy new electrocautorising tool to do a simple circumcision - and he had no concept of how electrocautorising actually worked. Those kind of accidents mean that doctors should NEVER use their own knowledge when using medical technology. To put it bluntly, they aren't as knowledgeable as they think they are. Sorry - I'm an engineer who designs medical equipment. End of rant.)

At the very least, it is a dilemma which could give another source of conflict in the novel.

fallenangelwriter · Feb 13, 2006

his treatment could be payed for by a mysterious benefactor....

Sage · Feb 13, 2006

Is there any way that you can jump into the novel after the coma, MRI, etc. Just start w/ the guy trying to figure out what to do now that he's alone w/ only the knowledge of his name. This way, as he's figuring out who he is & what abilities he has, so is the audience.

Of course, this might not work w/ the way you envision the book, but it would be a quick way of avoiding all that medical information that you don't know & keep the readers in suspense.

You could also jump from the other world to the guy adjusting, w/ only a short description of his stay in the hospital. A little jarring to the reader, but they'll figure it out quickly.

mhughes · Feb 14, 2006

That's pretty close to it. First chapter has him being found face down in a river surrounded by ice in July, not a common occurance in Iowa. Second chapter starts two years later and has him talking to a psychiatrist who is giving some of this information.

Still working on a few of those details

But thankfully this thread has done a lot to help me out.

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