We just need to look inside your head

You never know what you might find.

Photo by Accuray on Unsplash

Nobody here is happy.

I’ve just walked into the waiting room for magnetic resonance imaging at the M Health Fairview University of Minnesota Medical Center, and the feeling is very familiar even though I don’t visit that often.

You are looking in the wrong place, in general, if you are looking for joy in a massive medical center. But the MRI lab has a specific feel.

An MRI means something is possibly wrong with you, but you aren’t quite sure what (if anything) it is. Maybe it’s nothing. Maybe it’s everything. Maybe it’s somewhere in between.

It’s a place of anxiety and tension. It’s hard to feel happy at all when you are feeling those things.

I’m at the front of the check-in line now, still shivering after walking inside at 8 a.m. on one of the coldest days of the year. It is minus-17 and more like minus-40 with the wind chill.

Schools have been canceled all around Minnesota because of the cold, but I have been bragging to people that our district already had Tuesday off as part of a four-day Presidents’ Day weekend.

I’m a disgraced Hollywood star lashing out. You can’t cancel me, I already canceled myself.

I’m not sure why this is so important; it simply means my wife and I have pre-planned for this disruption to our usual weekday schedule, knowing that our three kids will be home instead of at school.

They will be attending Camp Netflix for a few hours while I am at this appointment — OK, three appointments according to MyChart — and my wife is at home trying to work.

My attention snaps back to the woman checking me in, who has to deal with anxious and unhappy people in a nonstop stream. She is not smiling, either, as she informs me that I need to prepay for all the work that is about to be done, an exciting new wrinkle in our nation’s evolving healthcare system.

Insurance covers a lot of it, but there is nothing quite like knowing how many hundreds of dollars it won’t cover even before I climb into an unpleasant machine to learn how I’m doing.

She also hands me a tablet with all the familiar pre-examination questions that must be answered ahead of time.

I’m paying attention to all this more than usual, for some reason.

I keep clicking the “no” box to every question. Shunts? Implants? Metal from accidental gunshots? I make it all the way through without a single “yes,” even to the question about whether the MRI machine makes me feel claustrophobic.

It used to, but I’m used to it by now.

I don’t even have a piercing. What sort of uninteresting, privileged life have I led so far that I don’t have any secrets to reveal here?

I’m called back not long after I finish filling out the form, and the anxiety rises.

“We just need to look inside your head,” the medical professional says somewhere between cheerfully and matter-of-factly. “And today we’re doing your thoracic spine, too, it looks like.”

This is correct. I’m here for my checkup for Multiple Sclerosis, which I was diagnosed with in 2014. For the first several years thereafter, I had a brain MRI every year. A few years ago, my doctor said we could start going to an every-other-year schedule for MRIs, provided I was feeling OK, and just do a one-on-one visit during the off years.

That relative breeze was last year.

But this year he wanted to repeat both of the tests that were done more than a decade ago that confirmed my diagnosis, when the lesions found on both my brain and the middle of my spinal column explained the mental and physical symptoms I was experiencing.

The tests are just for surveillance and knowledge, nothing more. I had been feeling generally good, but two tests meant two chances to find out something was wrong or at least lurking.

I was shown into the familiar small changing room, given the familiar instructions and then left alone so I could put on my giant pair of drawstring pants and gown that theoretically would close in the back if that was where my arms and thumbs were also located.

I sat down just outside the room, waiting to be fetched to bring back to the MRI room, getting anxious every time I heard footsteps.

I heard a conversation down the hall as another patient went into another room, the familiar question of what music they wanted to hear during the test.

The patient, a woman, remarked that it didn’t matter and that she would just listen to whatever the previous person had listened to — which blew my mind, as it often does when I encounter people who seem to have no opinion about music.

“That would be the Red Hot Chili Peppers,” she was told, and she chuckled that she hadn’t heard their music for a long time. I imagined that the patient who picked the Chili Peppers was probably around my age, a strange comfort.

I started to give serious thought to what music I would pick this time, wondering if maybe I should counterintuitively pick something that I hate since you can barely hear it through earplugs and the loud sounds inside the MRI tube.

A lot of times I pick Radiohead, but I settle on Nirvana. I know that I will know every song and can fill in the gaps over the sounds of three different emergency exit alarms blaring inside a washing machine blasted by a jackhammer, also known as an MRI.

And I know that every Nirvana song is from the before times — before my diagnosis, before I had ever crawled into one of these tubes for them to get a look at my head.

I hear footsteps, they grow louder, and this time they are for me. I’m walked back to the familiar room, spare and white with the giant tube in the middle.

I’m given the familiar instructions and reminded that they will be coming back at some point to insert a needle in one arm to fill my body with contrast dye — a substance that will help reveal any new disease activity.

They tell me I can keep my shoes on, which is a new one. In the past, the shoes have come off and they have reminded me multiple times to be careful not to slip on the floor when the procedure is done.

I wonder what sort of mishap caused this policy change.

Two technicians help put in earplugs, then the headphones. Brackets on each side of my head slide into place, looser than a vise but tighter than, say, pretty much anything else.

Then they slide me into the tube.

The procedure hasn’t even started yet when I develop an itch just below my left eye.

But I remain still, remembering the most basic rule of an MRI: don’t move. The “strong magnetic field created by the MRI scanner causes the atoms in your body to align in the same direction,” and if you move it can mess up this process.

If you mess up the image, you have to do the scan again, and if you have to do it again that means even longer in the tube. So I stay still and hope it goes away.

I try to focus not on the itch but on the music, which I can hear clearly before the imaging begins.

But then the machine whirs into motion.

Now I can barely hear “Scentless Apprentice.” It sounds like an ape shrieking over someone playing disorganized bongos.

I close my eyes and search my memory for the drums. I think about how I might write about all of this later. My mind stubbornly returns to check on the itching sensation, but enough time has passed.

It’s gone.

Somewhere between 30 and 60 minutes pass — I’m never sure exactly how long I’m in the tube, only that whenever they tell me how much time is left the last 8 or 10 minutes feel like 20 — and it’s done. I think the needle went in about two-thirds of the way through, but again my concept of time is warped.

The technicians return to the room, pull me out of the tube and advise me to get up slowly. You learn nothing about the results from them; they are only there to take the pictures.

One of them walks with me down a hallway and says, “Now let’s get you back,” and I’m temporarily disoriented enough to think this means we still have to do my thoracic spine and she’s taking me to a different machine.

To my relief, we arrive at the lockers where my stuff is stored. The atoms and magnets have done their jobs. I get dressed and prepare to ascend a couple levels for an appointment with my neurologist.

He is going to tell me exactly what the pictures mean.

I check in for that appointment and take a seat. I’m a little early, since the MRI time is padded, and I start scrolling my phone and taking care of a few tasks that had been piling up: a gymnastics registration for my daughter; a bill that needs to be paid; research for something I want to write about.

I’m reading The New York Times on my phone when I’m called back. A nurse takes all my vital signs, and I’m told the numbers generally look fine but that my blood pressure is a little higher than normal.

I decide that information is decidedly not good for my blood pressure.

But then I also remember that about 45 seconds before he put the cuff on my arm I had been reading about a recent airplane calamity. (No, not that one or that one, but this one).

I wish there was a way they could sneak up on you in the wild, maybe while you are calmly eating a sandwich on the patio, to take your blood pressure instead of while you are nervously doomscrolling in a brightly lit room waiting for medical results.

Nonetheless, after he leaves the room but before the doctor arrives, I Google “foods that help lower your blood pressure.” I also remember that it is Taco Tuesday. Maybe I should refine my search: “Foods that help lower your blood pressure starting tomorrow.”

My neurologist knocks and enters. I’ve seen him roughly a dozen times in the past, and we have an easy rapport. He’s probably the ideal doctor for me: Obviously brilliant but able to explain things easily; willing to give you optimism without delivering false hope; and an eternal Minnesota sports fan.

He sits down and asks how I’ve been doing. I give him the standard (and true) answer: generally pretty good, even if winter seems to bring an uptick in minor existing symptoms of MS for me. A few muscle cramps. Fatigue that comes on more quickly. Occasional feelings of brain fog. But I also mention this:

“I’m also getting older. I’m 48 now, not 37 like I was when I was first here. Sometimes I don’t know what’s MS and what’s just ‘getting older.’”

My doctor, a little older than me, chuckles and agrees. Then he gets down to business and opens up two sets of images on his computer: results from today’s brain MRI and the results from the one I had two years ago.

I lean in close, watching as he scrolls through various cross-sections and slices of my brain. I’m obviously not the expert here, but my anxiety fuels me to search for things:

What I want to see and what I don’t want to see.

I’ve been through this enough times to know that medium and large white blobs are bad. Those are lesions — areas that have been damaged by my immune system quite stupidly (OK, they usually say mistakenly) attacking nerve fibers, which is what happens with MS.

Those attacks can cause problems with vision, memory and coordination, among other things. Enough of them over time can have a significant impact on healthspan and a small but measured impact on lifespan.

My doctor is gliding through the images. There are a handful of small lesions, but he compares them to the images from two years ago and notes that none of them are new. He returns to one spot that does look new, but it’s so small that he dismisses it as an “artifact” and not a lesion.

We repeat the same process with the images of my thoracic spine, which had multiple lesions on it when I was diagnosed in 2014. He tells me that attacks on the spine tend to produce more obvious physical symptoms, which is why the spine requires less surveillance than the brain, but that it’s a good idea to check it periodically.

He is looking for parts of my spinal cord that are damaged in a way that the scans will reveal, but again there is nothing.

“This is actually a really nice image,” he says, adding a few seconds later: “You’re my easiest patient.”

I beam like the overachiever that I am, having just been awarded a gold star.

I feel relief and exhale. This has been how our visits have gone for a decade, and yet it’s still a surprise every time.

I feel the usual guilt of a survivor, wondering why I have been spared (so far) any of the worst effects of MS when many others have not.

I know some of it is within my control: I dutifully take shots three times a week to slow the disease’s progression. I try to eat well, including a gluten-free diet that seems to help me avoid the inflammation that can trigger attacks. I get a lot of exercise. I try to sleep well and manage my stress, areas that have incrementally improved in the last few years as our children graduated from being babies or toddlers to school-age.

I know some of it is privilege: Being able to afford care, being near world-class facilities and doctors, being able to choose to live in a way that benefits my health.

And I know some of it is just luck, the sometimes cruel and sometimes forgiving whim of a lifetime in this world.

My doctor performs a quick physical exam to test my strength and balance. I dutifully touch my outstretched finger to his, then back to my nose, over and over, among other things.

We make an appointment for this time next year, no MRI needed. I remember to schedule it for the week after Presidents Day, when our kids might actually be in school, assuming it isn’t 40 below with the wind chill again.

I text my wife: “All done. MRIs were clean,” a whole lot of anxiety reduced to a few calm words.

Then I head to the elevator and wait along a woman wearing a clinic badge. We both jab our fingers at the down button, and I notice the elevator in the far corner has opened a few seconds before she does. I walk toward it and she twists around, still unable to locate the open door. I hold the elevator and she scrambles in, while we share a laugh.

The doors are about to close but then they open once more. Two more women walk in: One is the calm friend and one is a patient who is sobbing. She can’t stop crying, and she’s apologizing.

I can’t tell if her pain is immediate or ever-present; if it’s physical or emotional.

But it hurts all the same.

The doors open, and I’m stilling thinking about her as I walk out to my car, blasted by cold air, trying to tell myself that the air temperature (now minus-7) doesn’t feel so bad.

It’s all relative.

I turn the key and start listening again to the audiobook version of “Calypso,” a collection of David Sedaris essays that mainly deal with family, middle-age and mortality.

There are laugh-out-loud moments, but the essay I have just finished is about his father, 91 at the time, softening in his twilight years.

That one is bittersweet.

I think about my own life, how my young kids tease me not just about already being old but relentlessly mention how old I will be when they are certain ages.

What will it be like to be 91, I wonder?

I used to think I would never know, but now I’m not so sure.