by Floyd Skloot
Suddenly her voice is in my head. “Earphones work?”
I force myself not to nod, and risk a shallow-breathed whisper. “Unless I’m having aural hallucinations.”
“Good. Now what kind of music do you like?”
Like most people, my head is often filled with music. Broadway, 1950s rock, the pop crooners, dance music. A random word can trigger a whole string of melody and lyrics, which explains why the song running through my brain now, triggered a moment ago by Molly saying “don’t move,” is once again Reel 2 Real’s 1994 hit “I Like to Move It.” It was a sticky song—an earworm—for me even before Beverly and I watched Julianne Hough and Apolo Anton Ono samba to it on Dancing with the Stars. I like to move it, move it. I like to move it, move it.
“Music?”
“Yeah, we can play music through your earphones. Helps distract you. Some of the scans can be a little noisy.”
A little noisy. I’ve had two brain MRIs before, twenty years ago, and remember feeling like I was stuck inside a jackhammer.
Without thinking, and overriding the crazed tune in my head, I tell Molly “the old standards.” That seems to confound her. There’s a click in my earphones, then silence, then another click.
“Name a singer you like.”
I didn’t think she’d know who Vaughn Monroe was. Or Matt Monro either. “Well, how about Michael Bublé?”
“That’ll work.”
She reminds me about the squeeze ball she handed me to use if I need help, and re-reminds me not to move. Then the table is sliding backward and I know enough to close my eyes so I won’t have to see the tiny space where I’ll be spending the next forty-five minutes. Molly’s view of me now: the pale blue paper shorts I’ve been issued, from which protrude my legs and feet held absolutely still.
Feeling Good
Google the phrase “MRI noise” and you find a range of descriptions: banging, beeping, buzzing, clanging, clicking, grinding, hammering, knocking, tapping, whirring. But the adjective preceding those descriptions is consistent: loud. And, for brain images, that loud noise is scant inches from your ears.
According to howstuffworks.com, an MRI’s noise is caused by “the rising electrical current in the wires of the gradient magnets being opposed by the main magnetic field. The stronger the main field, the louder the gradient noise.” Or, as the Boston Globe explains, “the fact that the strength of the magnet has to be changed over time and position means that all sorts of things move at least a bit in response to it, and that motion makes sound—that clanging noise.” As it scans to generate several sets of images, the MRI’s noise changes volume and intensity, producing a variety of decibel levels.
The Lancet, among the world’s leading independent general medical journals, says an MRI peaks at between 122 and 131 decibels. That’s just a little bit louder than a nearby thunderclap (120), or about the level of a jet at takeoff (130). Sometimes during a procedure the decibel level is between 90 and 100, or like lying beside a lawnmower (85–90), motorcycle (88), or farm tractor (98). As the National Institute on Deafness and Other Communication Disorders notes, “Regular exposure to sound over 100 dB of more than one minute risks permanent hearing loss.”
But I’m wearing earphones and, for distraction from the racket, will be listening to tunes. I’ve removed my gold and hematite earring so the magnets won’t rip my ear off. I have no pacemaker or artificial joints, so the procedure shouldn’t suck my heart or shoulder out of my body. Everything’s under control. As I settle into the machine’s isocenter and reposition the squeeze ball against my belly, the first scan begins. I’d call this one a snowmobile (105).
After a minute or two passes—did she forget the music?—and very faintly within the riot of sound surrounding me, I can hear music (decibel level of rustling leaves: 20, the threshold for “just audible”). That’s it? All I get is rustling leaves? A little volume in here, Moll. Is this worth squeezing the ball about? Then slowly, the volume comes up and there’s Michael Bublé singing that great old Broadway number “Feeling Good.”
Well, I had been feeling good, particularly for a man of sixty-one disabled since 1988 by a virus that had targeted his brain. I’d had a stable, healthy winter and first days of spring. Faulty balance was one aftermath of the viral attack that I no longer worried about. The way I’d been looking at it, I would never reclaim losses to my cognitive powers, memory, or abstract reasoning capacity, would never have a reliable immune system, but I’d learned how to live with what remained, and I was steady on my feet. It’s a new life / for me.
Till that early spring morning in 2009. Blossom on a tree / You know how I feel. I’d spent a weekend at the Oregon coast, where I’d caught a cold, but I was starting to feel better, was driftin’ on by. But then I folded back the sheets on the morning of March 27, got out of bed, and found the world whirling counterclockwise. It also felt as though I’d been pushed or tripped by a ghost lurking beside the bed. But even when I was on all fours, the vertigo didn’t stop. I made it back into bed and, showing keen analytical insight, told Beverly “something’s wrong.”
In about three hours, we were at my internist’s office. After diagnosing BPPV, he said, “We don’t really know what triggers it. Might be viral, might be weather related, might be age, trauma. Did you hit your head?”
“Not that I remember.”
He laughed, then shrugged and said, “I see a lot of BPPV in the spring.”
It was a reasonable diagnosis, certainly the most likely explanation for my symptoms and their sudden onset. BPPV is the most common cause of vertigo. But as the projected two-month duration was ending, and none of the remedies we tried were working, I finally admitted what I’d been thinking about: the diagnosis was likely to have been incorrect. After all, my vertigo wasn’t paroxysmal, since it didn’t come and go, but remained constant no matter what I did. Or didn’t do. Sometimes I might be awhirl, sometimes everything around me was awhirl, and sometimes nothing whirled but I was so light-headed that I seemed to be floating away. So if it wasn’t paroxysmal, and it didn’t have anything to do with position, and it wasn’t only vertigo, and it no longer felt benign, maybe it wasn’t benign paroxysmal positional vertigo after all. My doctor agreed it was time to see a balance specialist.
And this old world is a new world. That’s right, focus on the music. Thinking about the diagnostic journey is making me restless. “Feeling Good” is a song I remember from the Broadway show The Roar of the Greasepaint—The Smell of the Crowd, which I saw when I was eighteen. It was all about getting the Man to Share the Power, Freedom for the Worker. Very sixties. Who was in that? British guy, actor/singer, was on all the talk shows. Married to what’s-her-name. Wait, wait, Joan Collins. Anthony Newley! I’m pleased to nail the actor’s name, under the circumstances, and then I get a bonus: I remember that he cowrote the songs. Even if Newley gave us the saccharine “Candy Man” and “Talk to the Animals,” and all the angst of “Who Can I Turn To?” and “What Kind of Fool Am I?” he did manage to write “Feeling Good.” Reedy-voiced, charming, emotional Anthony Newley. Music is performing its magic on me here, triggering memories and releasing feelings. I’m getting relaxed, feeling good—great idea to have this piped in music—but I’m also having trouble keeping still as Michael Bublé gets the song swinging toward its conclusion. Oh freedom is mine! How weird to hear a celebration of freedom while transfixed and caged inside a horizontal tube. What I want at this instant, almost irresistibly, is to snap my fingers or shake my jazz hands. According to Oliver Sacks in his 2007 book Musicophilia, “Listening to music is not just auditory and emotional, it is motoric as well. ‘We listen to music with our muscles,’ as Nietzsche wrote. We keep time to music, involuntarily.” So of course I can’t help needing to move. Dance music in an MRI. I wonder if just wiggling my toes a little will violate Molly’s command.
Sway
The MRI machine is named Tim, after its Total Imaging Matrix technology. This, according to the manufacturer,
Siemens, provides “advanced image detail and speed, scanning flexibility, and power.” But Tim is a real loudmouth, so I can’t at first identify the new song that’s playing.
Oh, it’s “Sway,” Pablo Beltrán Ruiz’s great mambo from 1953. I’ve loved this song and known Norman Gimbel’s English lyrics since I was a kid with dreams of being a crooner. But hold on, this isn’t Michael Bublé’s version. Pipe down, Tim. The combination of being dizzy, being inundated with CLANGING HAMMERING I THINK WE’RE AT THE POWER-SAW LEVEL (110) noise, trying to concentrate on identifying the singer while not responding to the music, and feeling confused, makes me suddenly queasy. If the nausea gets any worse, I may have to squeeze the ball and get out of here.
It’s Dino! I recognize the soused-sounding baritone of Dean Martin and remember trying to imitate it as a thirteen-year-old boy. I’d wanted to learn the sexy song’s lyrics so I could add it to my repertoire for when my voice finished changing. Molly, this is a mambo, for God’s sake, and you want me not to move. What are you doing to me?
I try to settle down but, as the current scan intensifies, the table starts vibrating. Tim, you’re not on the beat here. Surely this happens all the time, isn’t a sign of impending catastrophe, and doesn’t count against the Don’t Move commandment. Like a lazy ocean hugs the shore / Hold me close, sway me more. I feel trapped between the urge to move with the song’s rhythm and resistance to random movement from the table’s vibration.
But it’s better than being in the Omniax System chair, where in early June I was spun upside down and sideways by the famous neurotologist, who then diagnosed me with endolymphatic hydrops instead of BPPV. It had taken me two weeks to get an appointment at his balance clinic, and I had to pay for all costs myself because he wouldn’t accept Medicare patients, but I’d looked forward to gaining clarity about what was wrong with me.
The Omniax looks like a futuristic (and expensive) carnival ride, or a device for training astronauts to endure zero-gravity. Inside an open, circular metal frame, there’s a high-backed seat festooned with straps. Harnessed like a fighter pilot in a cockpit, wearing a goggle-tipped headset equipped with infrared cameras, I was swiveled, twirled, somersaulted, and backflipped through full circles across several planes. I was also shifted sideways and suddenly upright, dangled, rotated. Through those maneuvers, the cameras revealed that I had none of benign paroxysmal positional vertigo’s characteristic nystagmus, the jerky involuntary eye movements caused when ear rocks get shaken up by movement of the head. Therefore I had a definitive un-diagnosis: not BPPV. And was now dizzier than I imagined possible. When we sway I go weak.
What followed were two days of tests spaced a week apart. I stood on floors that were suddenly tilted or jerked in different directions, and challenged to maintain equilibrium. My eyes and ears were tested with flashing lights and weird head movements, with blowing air and pure tones. Electrodes were stuck deep into my ears to record brain stem response to sounds, and onto my forehead and neck to test the inner ear’s response to clicks and short bursts of sound when I turned my head.
According to his report, the neurotologist found my acoustic reflexes “suggestive of diffuse cochlear disease.” My eyes didn’t work—separately or together—as head position changed: “The patient drops visual acuity five lines when moving his head to the left and three lines when moving his head to the right (both abnormal).” I showed “a marked vestibular deficit type of postural dyscontrol with somatosensory dependence” and my ability to adapt to movement underfoot was “impaired.” In other words, technology and medical science confirmed that I WAS DIZZY. My balance system was measurably a mess, and I wasn’t making it up.
To the expert, it was a result of endolymphatic hydrops, a vestibular disorder caused by abnormal fluctuations in the fluid of the inner ear. Those fluids, normally maintained at constant volume and chemical consistency, keep the sensory cells that control balance functioning properly. Something had caused the volume and composition of my fluids to change.
“By far the most likely cause of his hydrops,” he wrote, “is a viral endolabyrinthitis.” He thought that either a reactivation of the virus that had damaged my brain twenty years earlier or a reactivation of the chicken pox virus I’d caught in 2002 were the likeliest culprits.
With a prescription for powerful antiviral drugs, a book about dietary management of hydrops, and a plan for months of vestibular rehabilitation in hand, I went home and called my internist for a follow-up appointment. I was not about to take Valtrex without his approval. And besides, what did he think of this diagnosis and treatment plan?
He smiled as soon as I uttered the first two syllables of endolymphatic, so I stopped talking, handed him the prescription, and tried not to move my head as he talked. It wasn’t surprising that a specialist who sees so many patients with one particular disease would diagnose me as having that disease. My internist had done the same thing with me earlier, finding a different and even more common balance disorder. But I didn’t have the full range of symptoms for endolymphatic hydrops: no sense of pressure or fullness in the ears, no ringing or roaring sounds, no hearing loss. And my dizziness and vertigo didn’t vary the way they would if my problem were based on inner ear fluid fluctuations. They were always present.
So he called his friend, a neurologist who specializes in balance problems. I could get in to see him four days later, June 30. At our first meeting, he watched me approach, my head held rigidly, my shoulders hunched, my hand gripping the cane, and nodded. “You look like a dizzy man.”
It’s happening again. Thinking about how hard it’s been to find out what’s wrong with me, and why, is making me more agitated. But what’s a person to think about during an MRI that might finally reveal the truth. Even if it’s a truth I’m not eager to know, such as a tumor or stroke in the brain stem, as the neurologist casually mentioned. “Let’s have a look,” he said, patting me on the shoulder, “so we can rule things out.”
Sing to me, Dino. I need you now. He might be able to hear the sounds of violins but right now I’m hearing sounds that remind me of the subways of my Brooklyn childhood (88 dB). The train of doom. I realize I’m much more comfortable fighting the immediate battle against mambo-inspired movement than thinking about the diagnostic herky-jerk I’ve been doing since March 27. Come on, Dino, sway me smooth, sway me now.
They Can’t Take That Away from Me
About a half hour through the MRI, I make a mistake. As the silence after the end of Tony Bennett’s “I Left My Heart in San Francisco” extends, and another scan (mild, maybe only an 80-decibel garbage disposal) winds down, Molly clicks back on and says, “How you doing in there?” I react to her sudden presence by opening my eyes, something I didn’t want to do.
The immediate view is of a small rectangular mirror mounted inside the cage over my face. It can’t be more than two or three inches away, and is angled so I can see into that part of the room framed by the tube’s opening but nearly blocked by my toes. There’s nothing to see but a glimpse of white wall. I know that Molly and another technician are in a room there, watching me through a window just above my view. Peripheral vision lets me see that the sides of the tube are even closer than I imagined. I shut my eyes.
“I’m okay.”
“One more scan, then we’ll pull you out and inject dye for the last images. Hang on.”
The procedure has seemed to go on for hours, yet I’m surprised to hear that it’s almost over already. Time has both stood still and flown by. Past and present have folded together too. It’s as though the rearranging of magnetic fields in here has shattered the familiar bounds of time. Which is another way of saying that there’s so much we don’t know about the workings of the human brain. Not just the experience of time, but also—and obviously—the experience of space, the intricacies of identifying where the body is and how it maintains equilibrium. Neurology knows the basics, and the way much of the wiring operates, but there are substantial mysteries remaining, especiall
y when the system malfunctions and the customary explanations fail.
The next scan begins with a few gentle clanks and pings, as though Tim is clearing his throat. I tune him out. Immersed in the mix of music and noise, with my eyes shut, I’ve been turned deeply inward during much of the MRI, dwelling in the past rather than the present, following the flow of memory. The songs I heard triggered associations, shifted mood, loosened imagination. They took me away from here. And for a while they counteracted the great feelings of loss, dislocation, and disorientation that accompany both long-term illness and the kind of sudden, life-changing episode embodied by my vertigo. Despite the discomfort and annoyance of the MRI procedure, I was having a pretty good time here.
These thoughts, as one of my favorite Gershwin songs starts playing within a ruckus rising to maybe the 75-decibel level of a dishwasher next to my ears, feel revelatory. They remind me of how much I retain despite the things that are wrong with me, how sustained I am by music, by Beverly and the love we share, by friendship. No, no—they can’t take that away from me.
From the moment I lost my balance, Beverly has been a kind of spirit level showing me the way to find steadiness despite what was happening inside my brain. As Frank Sinatra sings the way your smile just beams I remember looking up at Beverly’s smile so many times during our futile repetitions of The Epley Maneuver. From my position, though her smile was shaped like a frown, I saw such tenderness that it made me cry. Which made her worry that I was losing hope. Just the opposite. The way you’ve changed my life!