Image courtesy of Wikimedia commons.
The first thing any self-respecting hospital does is disorient and demoralize you as much as possible while you’re still alive.
Feeling like a rat in a maze is an important first step for an outpatient procedure like an MRI. At Abington Hospital, the radiology registration desk is so far from the actual radiology procedure area that they give you a sheet with typed directions.
There was a beautiful fish tank in the MRI waiting area, but I didn’t have time admire it, or even finish filling in the lines on the intake form for every surgical procedure I have ever had. The hospital really wants to be sure about this before it sticks you in that tube.
“Have you ever had any surgeries on your head?” the staffer asked when I called to schedule the test.
“I’ve had my tonsils taken out,” I said.
She sighed. “Out of your head?”
“Well, my throat.”
Forgive me; I never learned where, for medical purposes, the definitive line between neck and head is — and if I recall, it was an Ear, Nose and Throat Specialist who recommended the tonsillectomy in question, so clearly I’m not the only one to lump the lymph nodes of the throat in with features of the head.
Last summer I wrote about a back injury and my troubled, nauseous relationship to narcotics. This week’s MRI was because a few weeks ago, I had another round of agonizing low-back spasms. I was stuck in bed for a week and fantasized a lot about death as a release from the pain, but went to the doctor when I improved enough to leave the house.
I hadn’t had an MRI since I was about ten years old. As a person who works to keep her heart-rate down in elevators, I had hoped never to go into another MRI, but at least I knew what to expect.
Once I was sufficiently disoriented from locating the MRI facility, the traditional systematic humiliation of the hospital gown followed, sharpened by the presence of another MRI patient (a middle-aged man, of course). A smiling blond tech showed us a row of lockers and handed him one hospital gown while I got two — an apparent concession to female modesty — and waved us to a pair of dressing rooms.
She told us both to take off everything but our underwear, shoes and socks. She moved away fast so I had to ask while the man was still there – could I keep my metal-free sports bra on?
I went into my cubicle, happy for the first time ever that it was -9 degrees outside and I was wearing four layers of clothing. I didn’t want to sit around next to a strange man with nothing but those infernal little hospital-gown ties holding us both together, hoping nothing was showing through the cracks. So I took a long time peeling off my jackets and fleeces and leggings, listening until the man had left his cubicle.
Once I was in the hospital gowns — one worn backward and one forward — I realized that
a) I had to walk into the waiting area in nothing but the gowns and my Timberland hiking boots.
b) I had not shaved my legs since before my injury.
But there was only one other person (albeit fully-clothed) in the waiting area, and she tactfully ignored me while I crossed my legs and bent over my clipboard. At least my bra had been cleared.
It was only a few minutes before a cheerful tech named Sue appeared to collect me, which was great, because the sooner I got done the sooner I could put clothes back on, but it was also terrible, because the prospect of the MRI tube made my guts clench.
Sue took my glasses and the world blurred, though I still clutched my newsmagazine like a talisman. Its staples set off the metal detector where I twirled around, step by step, in my Timberlands.
My old Timberlands. If you think they look good here, imagine them with a faded knee-length hospital gown.
“I see you’re claustrophobic,” she said with a sympathy that surprised me, after I had assured her one more time that no, I had never any pieces of metal removed from my eye, and no, there was no chance that I was pregnant. There was actually a box on the form for claustrophobia, but I hadn’t expected any mercy to come of it, given my usual experience with diagnostics.
I was surprised by how little the MRI chamber had changed from twenty years ago, from what I could see. Sue helped me untie my shoes (which takes me a long time on my own ever since my back went out), patiently helped me onto the stretcher, propped something high under my knees, and draped me with one of those no-nonsense hospital blankets that immediately begins to bake your own heat back at you. I even got a puffy pair of headphones and my choice of Pandora stations.
“Bet you didn’t get any music back when you were a kid!” Sue said.
With the plastic panic bulb secure in my hand, Sue asked if I was comfortable.
“As comfortable as I’m gonna get,” I said. “Go ahead and put me in.”
My bier began to slide head-first into the tube and I realized what a horrible idea the whole thing really was. The curved yellowy-tan plastic pressed down a few inches from my face. The tube was much smaller than I remembered.
I pressed my eyes closed so I wouldn’t see the tunnel sliding over me. You are bigger than you were at ten, that’s all, I told myself. The tube was not collapsing in on me like a Chamber of Doom booby trap.
“Alaina, are you all right?” I heard Sue’s voice from outside the tube.
“It’s very small in here,” I quavered. “It’s a bit scary.”
“Look backwards,” she said, “Look at the space right out here.”
I craned my eyeballs and saw her face framed by blessed, fluorescent-lit space less than a foot away.
When you’re in an MRI (magnetic resonance imaging) machine, you’re actually inside a giant super-conducting magnet made of vacuum-insulated, liquid-helium-bathed wire which, when you pass an electric current through it, has a magnetic field thousands of times more powerful than the earth’s own (now you know why you can never, ever wear any metal into an MRI machine).
Non-helium resistive magnets, incredibly heavy permanent magnets with a small but constant magnetic field, and three lesser-powered gradient magnets which create a variable magnetic field focused on a certain part of the body also lend a hand. The magnetized body tube causes a huge “magnetic moment” in your hydrogen atoms (let’s just say that since we’re mostly water, there are a lot of those), taking them out of their customary random spin and lining them up, meaning an equal number of hydrogen protons point to your toes and to your head. But for every million or so obedient hydrogen atoms, a few, for whatever reason, just keep on spinning.
Now, radio frequency (RF) coils poised close to your injured body part send in RF pulses that only affect hydrogen. That pulse makes those still-spinning atoms “resonate,” or spin at a particular frequency in a new direction, apart from the MRI’s magnetic field. While this happens, the gradient magnets are quickly flipped on and off, changing the main magnetic field in the body part (“slice,” yum) your doctor wants to look at. When the RF pulse ends, the affected hydrogen protons respond to the MRI’s magnetic field again and give up the energy they took from the pulses. The coils are waiting to transmit this energy to the MRI’s computer.
A formula that is surely beyond me, called the Fourier transform, turns the affected protons’ signal from mathematical data into an image of your insides, because each of your body’s tissues offers a slightly different signal.
Image courtesy of Wikimedia Commons.
Ah, you see? Magnetic. Resonance. Imaging. Here is the resource that helped teach me.
MRIs are magical. But they have a few drawbacks — one being that each second of a 25-minute MRI session costs approximately $8.7 billion, so insurance companies are often loathe to authorize them. Another is that all those thumping magnets make a lot of noise that no music can cancel out. A third is that the small space required to make the images sends most people’s autonomic nervous system off a cliff: we evolve for millions of years looking down from trees and striding the open plains, and then some genius doctor decides to diagnose our ills by trapping us in a 24-inch tube. It doesn’t help that you have to keep absolutely still for each five-minute segment of the test.
If you’ve never had to get an MRI, imagine that you’re in a plastic coffin on the roof of a house having a Dubstep dance party so loud that the neighbors are about to call the police.
MRI inventor Raymond Vahan Damadian also failed to address what is now known as Confined Space Itch Syndrome (CSIS), which is especially dangerous to claustrophobic patients like me.
As Sue’s voice in my headphones checked one more time that I was ok, and the machine’s grinding thumps began to reverberate through my spine, a terrible itch crawled like a worm down my right ear canal. Even though my eyes were closed, I knew that even if I was allowed to bring my hand up to scratch my ear, there was no room to do so.
Quicker than the Missouri in flood, cortisol gushed from my eyeballs to my ankles and my heart began to pound.
I remembered an old meditation technique and concentrated on the breath whooshing in through my nose and out through my nose and in again. I imagined that I was lying in a large room. The CSIS intensified, with the itch moving from my nose and then to my left big toe and then back to my ear. Woken by the stress, my low back began to throb.
As soon as the first segment of the test was done and I could hear the music again, a commercial for Turbo Tax came on my Pandora station.
Come on, Abington Health. You’re probably charging upwards of $1,000 for this 25-minute MRI. You can’t spring for a $4/month ad-free Pandora subscription?
Because tell me what could be worse than lying in an MRI tube with an un-scratch-able itch in your ear while you’re reminded that it’s almost time to file your taxes.
“Are you ok in there, Alaina?”
“Yea-a-ah.” I tried to keep my voice from shaking.
As the next round of thumping began I forced my mind over to my notes for the magazine feature I was writing this week. I scanned them in my mind’s eye, looking for the lede.
After about half a day, Sue’s voice in the headset informed me that the first ten minutes were already done; there were only fifteen minutes left of the test.
Ordinarily I don’t think I’m a very imaginative person. I am the only writer (possibly the only person) in the world who is not working on a novel. But I concentrated on the idea that the tube is not there. I was just lying in a room with my eyes closed, my body vibrating with a terrible phump-phump-phump-phump-phump.
Finally, the RF pulse released my hydrogen protons for the last time. The little traitors never even knew what was happening to them. As the body slab began to slide back out of the tube, I felt like a five-year-old coming down the stairs on Christmas morning. Every itch disappeared and my heart pumped with joy. I was so grateful I would have waltzed to the bus stop in my gown and Timberlands.
Walking me back to my locker, Sue asked if I knew my way out of the hospital.
Of course, I said. Do you know how many times my grandparents have been admitted?
Before I got completely lost trying to find my way from the dressing area to the nearest hallway, I stopped in the dressing room’s bathroom to pee in total darkness because the only switch I could find from the light of the hallway was labeled “EMERGENCY.”
My doctor called less than 24 hours later. Yes, there is a herniated disc. But my lumbar spasms are probably from muscle strain and a bad sacroiliac joint. Physical therapy will help.
Besides the slow, painful work of recovery, the MRI left me with two lingering concerns. A close friend, texting with me after the procedure, helped to dispel my fears on the first.
“You’re a blond,” she pointed out: My unshaved legs couldn’t have been that bad.
There may be no help for the second worry. Twenty-five minutes is a long time and the body lives to betray us. Can the Fourier transform tell if you farted in the tube?
Now that I survived the MRI I will continue to write. Visit the homepage to subscribe if you want to know what happens next.