It’s Monday morning, October 5, 2009 and I’m being shot up with gadolinium in my left arm as I lay strapped onto a sliding table the width of my shoulders and over seven feet long. I’m in the home stretch of a procedure that will eventually run for around 90 minutes. Having arrived here at 7:00 o’clock this morning and voluntarily submitted to this procedure, I’m in a room that reminds me of the sterile inside of a UFO as abductees describe it. Set to accommodate the huge white General Electric MRI machine, the temperature makes me feel chilly, dressed as I am in flannel one-size fits all open-front hospital gown and baggy pants. The long table I’m on is at the mouth of a tunnel that is three-feet in diameter. (Freud would have a field day.)
I began the day at 5:30 this morning, outside still dark with the temperature in the low 50s Fahrenheit. It’s the ideal coolness for my morning run that I’m delaying to drive to Stanford Medical Center in Palo Alto for an MRI of my heart my doctor has ordered. I have a heart muscle that has shown signs of wall thickening as a result of 30 years of daily running. Though this occurs in everyone who regularly exercises vigorously, doctors are looking at heart wall thickening as a possible cause of athletes, who appear perfectly normal, keeling over from heart failure. This can occur for a whole host of reasons: leaking heart valve, undetected heart damage from disease or injury or a genetic heart defect, among others. Considering the over-60,000 miles I’ve put on my heart over the years, I’m expecting this MRI angiography to eliminate all of these culprits.
The drive north from San Jose to Palo Alto retraces my commute in past years, having worked in offices at Waverly and Lytton and Emerson near Hamilton: North on Monterey Highway to just past East Alma Avenue, there a right turn and then left onto Third, north to East Reed Street and right for a block and right again on South Fourth Street and the on-ramp to Interstate 280. On 280 west for less than a quarter mile, a San Jose Police Cruiser merging into the lane just ahead of me as we both begin the 50-MPH right curve atop the elevated on-ramp from 280 to Highway 87, the Discovery Museum barely visible off to our right and on our left two separate lines of headlights streaming to confluence with us at the San Carlos Street off ramp from 87. Cars from the two left lanes wanting over to the right; most of the cars in our lane wanting over to the left to avoid having to exit the freeway. Finally, the police cruiser—on its way to the police garage on North San Pedro Street at the end of its shift—and I merge into the slow lane of 87 and begin the northward run to Highway 101. All of us spend our lives going somewhere, the stream of traffic on the main arteries a metaphor for the flow of blood racing through our veins.
The MRI procedure began with me getting out of my civilian clothes and donning hospital attire. I’m told to use the facilities before we begin because it will be a long time before I get another chance. I take the point. Pattering into the sterile room in white running socks, I’m struck by the size of the MRI machine, how white it is, and the size of the tunnel I will be rolled into. The attractive lady lab technician asks if I’m claustrophobic. I gulp, smile, and answer that I didn’t think so. As I lay on the table, my legs extending into the machine’s open mouth, she explains the drill I’ll be required to perform during the time I’m in the tunnel.
On her command, I’m to take in a breath, let it out and refrain from taking a breath until she says inhale—15 to 20 seconds tops, she says. She asks if I want a blanket and I quickly accept—I’m chilled by the air conditioning set to cool the equipment. After placing four electrodes on my chest in the general area of my heart, she straps me onto the table, wraps another sensor around by diaphragm—to monitor my breathing. Because the machine is imaging a moving object, instead of a relatively static one such as the brain or a knee joint, it needs to compensate for breathing and heart movement to create the 3-D image. The final apparatus is a curved plastic breastplate—I’m told it helps align the image—which she straps across my chest before we begin.
The drive north on Highway 101 from the Highway 87 on-ramp in San Jose to the Embarcadero Road exit in Palo Alto moved at the limit this morning, just before the full stream of northbound commuters floods the artery. Like my own arteries, the asphalt and concrete thoroughfare bearing the load of 101 traffic has deteriorated over the past 30 years, the analogy not lost on me as I travel toward the MRI that will reveal how well mine have fared over the same number of years.
One last thing, she says, stuffing my ears with plugs. You’ll need these as it gets noisy inside the machine. I’m not to be alarmed as it’s the sound the machine makes as it pulses a magnetic field through me to first align then flip the magnetic orientation of hydrogen atom protons in the water, comprising 75 percent of lean muscle in the heart. The protons’ rotation produces a miniscule magnetic flux that the MRI detects, thus creating a three-dimensional picture of the heart. Incidentally, these machines exert a magnetic force around 60,000 times the earth's own magnetic field effects—though nothing to be concerned about as magnetic flux produces no ill affects in tissue and cells.
A few seconds after she leaves the room, I hear her disembodied voice from speakers inside the dimly lit tunnel, that I now find myself in, and quickly close my eyes realizing I am going to freak if I keep them open. Just as I get my momentary panic under control and my breathing less labored, she asks if I’m comfortable and I say I am—liar, but I can’t admit to being a wimp. She says if I’m ready we would begin. I prepare for the sound and as soon as it starts that labored breathing returns. The sound is the shrill alarm of a truck backing up, but at a faster rate, two or three pulses a second it seems, and a different pitch. The sound reminds me of the staccato screeches accompanying the shower scene in “Psycho”—that rhythmic intensity but at a different pitch. I resist the flight response the sound invokes in me and will myself to relax. She’s no doubt aware of how I’m reacting to the machine. My breathing slowly becomes normal as I become accustomed to the sound.
When we begin the breathing drill, the tempo of the machine’s sound changes: same staccato beat, but slower. I count 15 to 16 repetitions as I hold my breath and wait for her to allow me to inhale again. Then she periodically changes the routine, telling me that the next time I must hold my breath longer and I count 20 repetitions before I breath again.
When I’m pulled out of the tunnel halfway through the procedure, I open my eyes and take in the bright light and expanded space of the larger room. She asks for my left arm for the gadolinium injection. According to Wikipedia, solutions of organic gadolinium—symbol Gd and atomic number 64 in the periodic table of the elements—are the most popular intravenous MRI contrast agents to enhance images. However, for anyone with impaired kidneys gadolinium side affects include hard, shiny, darkened skin that tightens and becomes extremely painful, joint inflexibility, loss of movement, yellow-colored eyes, painful joints, and lung, heart and organ damage. My kidneys are pretty healthy so I’m not concerned though I should have been informed rather than finding out from a google search.
Sliding back into the tunnel the second time was a piece of cake. I had become accustomed to the confined space. We finished the series of breathing drills and concluded with the same sequence of loud staccato pulses that began the procedure. And then like every event in life it’s over and I look forward to the prospect of caffeine, something I’d been denied for 24 hours before the procedure. As she removes my constraints and unhooks the electrodes, I ask her how long before the results are in and she says my doctor will have them within the week. I thank her for getting me through the process and return to claim my civilian clothes and start my day. It’s 9:00 o’clock on a beautiful October morn. What could be better than that?
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