October 6, 2009 - Trapped in a enclosed space at Stanford Radiology MRI Lab for 90 minutes

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 or so they say.

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?

October 1, 2009 – Pain

Pain is primeval and integral to every life form on the planet, since life began. There is much to learn from Pain. Its wisdom is likewise as old as life itself. On Saturday night November 3rd, 2007 all the clocks in most of the United States fell back by an hour to return to standard time after an extended period of daylight savings time. Like most of my fellow citizens, I have come to regard this aggravating ritual as an unarguable fact of life. My biological clock like those in everyone else was suddenly out of step with the officially recognized time of the country. The entire nation was living under jet lag that would take a few days to sort itself out. In the meantime, our collective judgment was befuddled: car and pedestrian accidents would spike as would every other kind of calamity—near misses at airports, on the job mishaps, you get the idea.

The return to standard time meant one extra hour of sleep on Sunday morning November 4th, which I happily accepted. And it meant rising on Monday would be easier because my body really thought I should be waking and hour earlier. As expected, I awoke at 4:30 Monday morning and thankfully fell back to sleep for another hour. Roused by my alarm clock at 5:30, I dressed and started my morning jog, now with the morning rays of the sun illuminating the ridge of the Hayward Mountain Range east of San Jose much sooner in my run than the previous week. Last Friday I would be completing my run at the time I’m beginning it now.

Monday’s run went off without incident. However, Tuesday’s run at 5:30 started off badly. Unlike on Monday, San Jose was enshrouded in a blanket of fog that dropped visibility considerably. I could see less than a quarter mile in any direction and the streetlights had that balloon glow resulting from light colliding with water vapor as it seeks to escape its source. The fog also intensified the cold permeating my tee shirt and shorts blown by a persistent 25 to 30 mile an hour wind that pushed me along as I headed west on Branham Lane from Snell Avenue. It was right around 50 degrees Fahrenheit though the wind chill factor was considerably lower.

The exertion of running was staving off the cold for most of me but I had to continuously flex my fingers and move my neck side to side to force blood flow to my digits and to my ears to keep them from complaining of the cold. When I reached the Highway 87 overpass on Branham, the sun’s rays should have begun spilling over the crest of the Hayward Mountains, but the blanket of fog was concealing any advancing sunlight and keeping visibility down to a half mile at the most. As I crested the overpass, I lost the dual cones of headlights bursting from cars racing north beneath me on 87.

Fifteen minutes later I had ran from Pearl Avenue to Chynoweth Avenue after turning left off Branham at its intersection with Pearl. I was on the home stretch rejoining Branham at Vista Park Drive and heading toward Snell. Now, the wind that had been at my back was blowing against me increasing the chill factor of the fog. My sweat-soaked tee shirt had now lost any of its protection against the cold. My only source of warmth was now my sustained exertion: head swinging side-to-side, fingers on both hands continuously flexing.

Pain caught up with me at Mia Circle just after I had passed Kingpark Drive. Despite my exertion, the cold had numbed my fingers and begun to chill my arms and chest. I had increased my pace to escape its discomfort. There’s a round-leaf Eucalyptus tree at the corner of Mia Circle and Branham between the sidewalk and Branham Lane. Its roots have raised the sidewalk, something I knew as well as every other obstacle along the six-plus-miles of my morning circuit. However, for whatever reason: my jet lag still not caught up to official time—putting my timing off just enough to miscalculate the height of the raised concrete; my preoccupation with escaping the cold and/or the fog—obscuring my judgment just the small fraction needed for the concrete to ensnare my right foot long enough time to interrupt my forward motion... In any event, I found myself being propelled forward by a force not of my own making. My body flooded with adrenalin straining every muscle to slow my accelerating advance.

My left foot managed to get under me enough to keep me upright for an instant longer. In retrospect that exacerbated my plight because it allowed my forward momentum to gain force. Balanced on my left leg and my own accelerating weight making it impossible for my right foot to catch me from falling, I went crashing down, both knees contacting the cement first, followed by both hands—the heals of each taking the brunt of the impact. Then, the inertia of the fall was trying to flip me over my hands and knees—like a gym teacher trying to teach a reluctant student to do a summersault—my every muscle straining to resist. I watched helplessly as the contest played out between my body’s forward motion and the physical brake my muscles applied to halt its advance. In the end the latter lost and my forehead staining backward to avoid the collision kissed the concrete with a light thud, breaking the skin between the bridge of my nose and my right eye.

I could see the entire sequence in slow motion, like a car braking and almost managing to stop before finally colliding with the rear bumper of the car in front. The endorphin rush kept me insulated from sensation for just enough time for me to get to my feet, reclaim my unbroken glasses thrown free of the collision, appraise the damage: bleeding silver-dollar size raspberries on both knees and right hand where the torn skin hung loose from a hinge near my wrist. The only damage to my left hand was gouged out quarter-inch-square patches of skin on the knuckles just above the fingernails. The gouge on my left pinky finger was the deepest and it leaked blood in a slow steady stream reappearing shortly after I wiped it clean. A similar deep gouge on my right thumb also kept seeping blood. The bump on my head complained the least. It bled slightly at first then stopped.

Realizing I had dodged a more dangerous bullet, I slowly resumed my run home, testing my legs by walking a couple of steps before easing into a slow lope then moving to a sustained run. As soon as I increased the pace, all the insulation from the pain and cold the endorphin rush afforded during the fall had vanished. Now I was completely aware of the pain in my knees and in my right ribcage. But the pain and cold in my digits—refusing to move as I tried to clench each fist—created the greatest discomfort of all. Hurt and in flight all I could think of was getting home and tending to my wounds. And that concern only lengthened the apparent time it was taking for me to complete the final mile of my run.

When I finally arrive back at home, my hands were so unresponsive that I had a difficult time grasping my door key, getting it into the lock, and turning the tumblers to allow me into the warmth inside. Once inside and in the bathroom, I turned on the hot water faucet full blast impatient for the feel of warm water to thaw my frigid fingers. As the water warmed I lathered both hands washing away the dirt and dried blood from each open wound, pain screaming from each one—the large opening on my right hand shrieking loudest—warm soapy pink water coloring the white porcelain wash basin. Blotting both hands dry with paper towels, I sterilized my Swiss Army Knife scissors in alcohol and cut away the loose skin hanging from the large open wound on my right hand, wrapped bandages around the deep wounds on my right thumb and left pinky finger that refused to stop bleedings. All the others including the large one on my right hand had stopped bleeding and had started sweating a clear liquid tinged pink by small amounts of oozing blood.

In the shower I used my left hand to clean the small wound on my forehead and the two round skin avulsions on my knees both crying out in pain from the soap and my rigorous scrubbing. The entire morning routine took nearly an hour to complete but in the end, I had replaced the water soaked bandages from the two wounds still bleeding with clean ones and place a large square patch bandages on the skin avulsion on my right hand and two knees. I noticed a slightly darkened patch beneath the skin of my right hand filling the area to the right of my palm’s Mars line to the base of the thumb. The hand was sore and had little gripping strength.

In the aftermath of the fall, I took a perverse satisfaction in knowing that I had survived the mishap with only superficial wounds that would scab over in a day or two and be gone within a week. I was also reassured that my survival instincts were still sufficiently intact to protect me from a fate far worse. And Pain once again reminded me of what it means to be living creature having to cope with the vagaries of nature and the world around me.