By Amanda Ramirez, ARMRIT

CLC student 1710A, MRI Graduate Class of 2019

We enter the classroom, bright eyed and full of eagerness to learn of the explorations of our future chosen careers. While we sit comfortably, (for the most part), in our well-lit educational environment, notebooks blank and our pens waiting to start filling the pages with unknown and new information. The instructor really doesn’t share with you the reality, the fears, and the hard work that goes into the long six months that lay await for us. These six months are called, “Externship”. Sure, the studying, testing, group sessions, and labs may seem to be slow (I speak from experience), but the real-world externship is a whole other ball game. No one really tells you all there is to know of the day-to-day work of the student extern – that is left to the imagination, right? Well here is my story as a former Casa Loma College MRI student.

First day of extern! I was excited and very nervous when I entered the doors to what would be my “home” for the next six to eight months. Walking in, I had my Clinical Handbook from my Cross-Sectional course, all of the notes I knew I needed, and of course, my lunch and a freshly brewed coffee. Not knowing what awaited me around the corner to the MR desk, I took a deep breath and let out a slow sigh. Then I met my Clinical Supervisor (CS)! He seemed very hard and emotionless. He showed me the “ropes” and the lay of “the land”. I was introduced to the PSR’s (very important to meet and get along with, they are essential to the facility running smoothly, and orders being put in properly), the site manager, and other techs from different modalities (again important that you get familiar with and respect them as well). My CS explained to me that having a professional relationship with ALL facility staff will prove beneficial later on (I’ll get to that in a bit). As my first day came to an end (I was there for the tour, my official start date was the following Monday), I felt more at ease and yet, still very nervous.

The first week of extern went rather smooth and seemed to go by very quickly as I observed and shadowed my CS. Week two came and it was completely different. I met with my CS first thing in the morning, again shadowing him, and was handed a list of expected “duties” that would need to be completed by me and approved by my CS before the end of each day. I told him I thought this was childish and felt as though he was using me as “free labor”. He looked at me and stated very sternly, “These are not chores, nor should you feel like a child. This is a list of tasks that a GREAT Tech completes before the end of each day. Completing these tasks will help keep you from running behind first thing into your shift, and helps the next Tech coming onto duty. Keep in mind, work smarter not harder!” That being said, I began to read through the checklist. The list included:

  • Check linens (blankets, sheets, towels, pillowcases
  • Fill Ear plug bin
  • Empty soiled linen bags
  • Restock gowns in changing rooms
  • Leave trash bins outside of MR room for housekeeping
  • Wipe down Tech desk, disinfect contacted surfaces
  • Put all patient documents in shredding bin to avoid HIPPA violations

(I carry this list to every site I work at as a reminder of what I WANT to have done before the next day. It has kept me on time every morning before I see my first patient).

During the first month of my externship I was taught some of the most important tasks of an MRI Technologist – most which I have continued to do as a professional MRI Technologist.

Things I learned during the first month:

  • How to properly screen a patient;
  • How to check patient orders and scheduled appointments using eRad and RIS;
  • How to draw contrast – students don’t get to stick the patients;
  • Checking inventory and so forth;
  • Clocking in through Trajecys.
  • MR Room:
    • Ensure all coils were in their proper place and disinfected (even though you are to disinfect after every use);
    • Wipe down the bore and table;
    • Check the schedule for the day to make sure there was enough contrast drawn for the patients that were scheduled, WWO (with and without);
    • Check my linens and patient gowns.

Over the next six months, this became routine and habit and has stuck with me now that I am a Tech and on my own.

The Not So Glamorous Side to MRI

I remember my first traumatic case like it was yesterday. This was only day two of extern. The patient had fallen 60 feet from a palm tree and landed on his head. The patient had waited four weeks before getting an MRI. The patient was immobile, could not speak and did not comprehend anything we asked – let alone the process of the exam. The patient laid there, lifeless, as my CS and I had to physically move him and lay him on the MR table. While sliding the brain coil over his head, his eyes locked onto mine. This sent chills down my spine. As I sat down and began my scan, running the 3-Plane Localizer first, I noticed a large black void in his left temporal lobe. I stopped, went and checked him again to verify no visible surgery had been performed. I then asked his wife if he had a history of working with metal, and she stated, no. I ran the calibration, and followed with my T1SagFLAIR. Again, I saw the voiding. I continued with the sequences prescribed, SagT2, Ax (there were a few different ones conducted), DWI and lastly the Coronal. After the last sequence, I noticed that the patient had significant hemorrhaging. I became nervous and called for my CS to verify what I was seeing and the severity of his condition. We then contacted the on-duty Radiologist. She confirmed our finding and called for the patient to be admitted.

About two months ago, I saw this same patient come in, but he was so different that I barely recognized him. He was there on his own, and he was walking, talking and coherent. Because of the MRI, he stated, “we saved his life”.

I had another patient that had complaints of abdominal pain and heavy bleeding. The patient was scheduled for an Abdomen-Pelvis. Long story short, this patient was diagnosed with a uterine tumor, measuring 13 inches protruding up into her abdomen. I scanned her for pre-operative purposes and also scanned her post-op. Again, between pre-op and post-op she was so different.

Every patient is different. Every patient reacts to their scan differently. I have had several patients refuse the exam due to claustrophobia. And, there are those patients that we need to take a few extra minutes with. There were times with my pediatric patients that I stood in the room while the exam was being performed by my CS. And times I actually sat on the MR table after scanning a patient because they were in tears fearful of the findings. I have also talked with patients that refused the exam, as they simply needed someone to talk to. We are not just Techs; we are so much more. We perform tasks to help those that need further evaluation for proper diagnosing – sometimes it even saves a life.

I know that my experiences may differ from other Tech’s experiences because, just like patients, we Techs are all different. But perhaps hearing or reading about another student’s experience might encourage you and keep you moving forward. I have gone on for a few paragraphs now, and, I will bring this to an end with some advice I wish a student had passed on to me …

  • TOSS out your notes.
  • Ask ALOT of questions!
  • Grunt work is small but vital to the bigger picture of what you’re doing for others.
  • Without the patients’ we HAVE no job.
  • Be grateful for the opportunity and exposure before entering the field.
  • Be open minded and understanding to ALL patient’s needs, fears, and most of all keep your humility and keep heart.