Anyone who has been pregnant knows that it is not a great idea to lie rigidly flat and still on your back for 40 minutes whilst your concave bump blocks your eye line as you lean forward. I had had an MRI scan a few years earlier and found it claustrophobic, but time limited and manageable. The ingredients were different then. This time round I was not wholly encased in the chamber but my head and neck were surrounded in layers and layers of casings like a 1940’s deep sea diver. The radiologist handed me headphones, a panic button which I held in my sweaty right palm, and a sort of periscope to see her with. Of the music options on offer, I made an idiotic choice, but no matter - the beauty of the MRI scan is that the music is completely inaudible except for the brief respites in between scans when all you can hear is the sound of your own pulse anyway. Actually in my case I wasn’t sure if it was my pulse or Monty’s – it sounded a hell of lot quicker than the ultrasound had measured it the day before, and I couldn’t distract myself from it for a moment.
‘Is everything OK’ asked the radiologist: “Just 3 scans left – 2 short ones of 3 mins, and 1 long one of 7 minutes and then it will all be over”.
“OK” I replied.
Of course I wasn’t ‘OK’, but I was entirely focused on the finish line and didn’t want anything to delay its arrival. My left leg had just fallen off its position on the bed and since my core muscles were incapable of pulling it back again, I tried to find some kind of meditative psychic state that might coach it upwards and back again. But I couldn’t move it an inch. Maybe I would have been able to if I’d been to any of my pre-natal yoga classes. I would decline the periscope device for the subsequent MRI 2 weeks later, as all it did was focus my thoughts and eyes on the submarine lump in front of me. I had signed the disclaimers before entering the room - something about a theoretical risk to the hearing of the 4 month foetus, and I’m not sure the intense anxiety was doing my blood pressure much good either. As I lay strewn, I thought of all the amazing technological advances that had happened in the last few decades and wondered how on earth nobody had come up with a way to reduce the decibel levels of the MRI. I braced myself once again before the pneumatic drill sound of the MRI gripped my vibrating body in a noise deafening envelope, pummelling of all my senses at once.
Finally it was over and the female radiologist approached me to take off the casings around my head and help me up. Once up right, I felt a dull sensation in my back, and slid off the bed, stumbling to the floor. The radiologist’s assistant swiftly came to my side and supported me with an arm under my shoulder to usher me back to the waiting room. I felt so sorry for the next patient who saw my useless legs shuffling on the floor incapable of coordination. I think I was suffering some kind of temporary paralysis that I would also repeat the next time. It was probably the combination of lying flat and the intense anxiety level that I had never physically felt so acutely before. But save for the inevitable migraine that the MRI had induced, I got over it all very quickly, and was up and walking a few minutes later and back to work that afternoon.
Parkside hospital is ruthlessly efficient at every appointment and every step. The following afternoon I am sat behind the Endocrinologist’s desk being reassured that the tumour identified in my pituitary gland is fairly microscopic and will likely be treated very easily with tablets post breast feeding. He is not at all concerned and I agree to monthly blood tests and follow ups to monitor the hormone balance. So no dramatic surgery required after all and I almost feel a sense of anti-climax. Unfortunately that is not the end of the £150 consultation. Despite reporting on the scans so quickly overnight, the radiologist, with her remarkable diligence has picked up some shadowing on a view of my neck in 1 of the 18 scan views taken. This specific scan sits on the Doctor’s desk, circled in red pen.
“Here you can see shadowing in the artery in your neck. You need to get this checked out with our neurologist here” said the Endo Dr as he brought me to my feet and escorted me swiftly to reception to get an appointment with Dr Al-Memar. I agreed to an appointment offered by the receptionist the following week, but the Endocrinologist questioned if there wasn’t an appointment available that same day. I’m offered 7pm, but decline as Alex is working away and I can’t quickly think of a babysitting option. It’s only as I drive home that I reflect on the apparent urgency that the Doctor was encouraging.
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“Mrs Orme, please sit down here. Now may I firstly remark on what a large and beautiful brain you have. Look at the image on the screen - it is just as it should be. The brain is a beautiful thing”
I am immediately disarmed and charmed by his warm smile and upturned moustache.
Dr Al Memar looks like an Egyptian Hercule Poirot, he is thoughtful, well considered and generally running late. We discuss my migraines for about 20 minutes, which is a huge relief as I had neurotically pushed for such a discussion with an expert for many years, only to never be taken seriously. He draws a diagram to share with Alex:
“It is important that your partner understands the physiology behind the migraine, the recovery cycle and all the potential causes. It can be just as hard for your partner as it is for you to understand and manage”.
This guy is brilliant I think. Better still he says that after the baby is born I should return to see him, and he will prescribe some fantastic high strength new drugs that will ensure the headache never gets to the debilitating stage.
Reassured and fairly relaxed, we finally turn our focus to the shadowing on the MRI and I ask what it could be.
“Good Question” says Poirot. “It looks like you have some kind of obstruction in the ‘right carotid artery’. The two main arteries that supply blood to your brain are in the right and left side of your neck, known as ‘carotid’ arteries.” Again he is drawing. “Your right carotid artery of course supplies the right hand side of the brain which actually controls the left hand side of your body. I believe that the shadowing is a large body tumour (benign), an aneurysm, or actually nothing at all”
“How could it be nothing at all”, I ask.
He responded with the explanation that it could just be a misleading scan showing a multitude of cross sectional vessels overlaid on top of each other to appear like an obstruction. At this stage, our Poirot is leaning towards the ‘something and nothing’ diagnosis as I had confirmed that I don’t faint or black out. However, he explains that we must explore further and he arranges for me to go to a hospital in Cheam, Surrey to see a ‘Dr Clifton’ the following Tuesday. Normally the Neurologist would have arranged a so called ‘angiogram’ and CAT scan which would be conclusive quickly, but the angiogram consists of injecting a radioactive dye into the vascular system which is of course a no-no for a an expectant mother. So he admits that getting a confirmed diagnosis will be tricky, but he conjures up the image of Dr Clifton’s magical neuro-radiology powers. “Clifton is thee expert in the Country and I need his judgement on this”. So Dr Clifton will study my neck with ultrasound equipment, much like the baby is monitored. It is an entirely non-invasive risk free technique. Poirot also assures me that he will not request another MRI until I am at least 6 months pregnant, as he is not comfortable with the risks another scan might present at this stage.
I call my Dad after the appointment and read out the radiologist’s description of the obstruction – 3cm in diameter, ‘ovoid’ in shape and situated at the bifurcation of the right carotid artery’. Dad makes some enquiries and later that day calls me back to say that the thinking is that it is most likely a ‘benign body tumour’ if anything at all.
“More exciting than the prolactinoma, but not a particularly exciting diagnosis, Sophie.”
He explains that a surgeon will need to remove it at some point but points out that the neck is a brilliant healer. “You’ll hardly even have a scar. It could be nothing, as the neurologist says, but it’s unlikely to be an aneurysm as they are so rare.” I felt that the inference was that an aneurysm might tip the scale into the exciting zone.
Once again I appreciated my parents’ fast track medical opinion and network, and more than that my Dad’s vocabulary. I could work with “not particularly exciting” – it brought my hypochondriac thinking back down to earth. The phrase reminded of when I called my Dad up when I was endlessly waiting at A&E to get my cheek bone x-rayed after a lacrosse tackle to my face. Dad had asked me to describe the pain over the phone. “Would you say the pain is exquisite” Dad had asked. I paused at the unexpected adjective, and had to conclude that ‘no – it wasn’t exquisite as such.” So Dad confirmed it couldn’t be broken and I should get myself home, which I did. “No, not broken apparently” I’d reply the next week to my colleagues when I sported my distorted purple right cheekbone.
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My iPhone map led me pretty quickly to St Andrew’s hospital in Cheam. It is no Parkside, with no Times in the waiting room or offer of a Twinning’s tea. I’m quickly called in by the nurse into Dr Clifton’s room where I sit in a dentist like chair waiting for the Dr to return.
“He should be here in a minute”, the nurse says again 30 mins later. We’ve covered all the usual small talk by now – ‘No – I don’t know if it’s a boy or girl’. Yes – I already have a 3 year old who’s a bit naughty to be honest’. ‘I’m actually only just over 4 months pregnant, and no it’s apparently not twins’.
When Dr Clifton arrives, he nonchalantly turns on his machine and bangs the large computer element until it resonates and hums into life. He introduces himself and picks up the Dove like deodorant stick of the ultrasound instrument on a chord and starts rolling it back and forth along the right side of my neck. It sounds very much like the heartbeat of Monty, only slower. After about 10 minutes of rolling and listening to the rhythm of the blood flow I relax and my mind is transported back to my aeronautical engineering studies at University. I’m back at Wills Hall at Bristol and my Z block corridor mates are amusingly doing impressions of Northern Ben who has come through the toilet block corridor from X block.
“Sophie can you help me with my fluids homework”.
Ben’s from Rotherham and very much proud of it, his ‘can you help me with me fluids’ line had sounded much like the Yorkshire boy’s accent in that old milk Acrington Stanley who are they? advert:
“Surrrrphyyyyy, what makes a liiight, light?” “Electricity of course”
And of course the ‘help with me fluids’ phrase also induces some fresher’s year puerile giggling.
The point is that as the ultrasound roller ball travelled up my neck, Dr Clifton was comparing the sound and speed of the blood flow as it navigated around the ovoid obstruction on the right side with the normal direct blood flow expected on the left hand side of my neck. I couldn’t see the information on the screen, but I could hear the difference, and pictured the blood travelling around the object, just like I could see diagrams of distorted air flow around an aerofoil shape in my mind’s eye – creating the lift force responsible for the wonderful concept of flight.
So I had achieved a far better Zen like calm in that room for the 40 minute scan than I had with the MRI, but the repeated rubbing and sensation of feeling the lump had invoked a hideous nerve ending headache which started on the right side of my face and travelled across it to my left ear in sickening fashion that would stay with me for the next 4 days. I have not even tried to touch my neck or locate the lump since that day.
“Can you find anything there” I asked Dr Clifton.
“Yes, most definitely” The Dr replied. I’ll send my report to Dr Al-memar by the morning.
I wouldn’t get to sleep that night ahead of a boisterous Barnaby bundling into our room at 6am the next morning full of 3 year old chatter and questions. I’d looked up images online of tumours and aneurysms at the fork in the carotid artery, and realised that whatever the lump was, it would be wrapped snuggly in a bundle of nerve endings. I thought of my migraines in a different light, and felt nauseous and quite awful at work that day.
On Thursday I would return to see the Egyptian Hercule who was not his cheerful self. Despite his previous comments about MRI risks before 6 months, he would march me back to the x ray department and request a same day MRI. Calls would be placed to St George’s hospital arranging for the right people to attend the MRI that lunch time. With the time I had, I took myself home to grab a sandwich and my laptop and try to call Alex unsuccessfully at work. For me, Dr Clifton was heavily leaning towards the diagnosis of an aneurysm in his report and hence a step up in perceived risk and urgency. I called my old Z block Bristol Uni friend – Felicity, who would likely be at home with her kids in Wimbledon, and asked her to find a way to join me back at Parkside in an hour. I didn’t really fill her in except to say that I needed an MRI at Parkside that lunch time and it hadn’t gone well when I had one 2 weeks earlier. Felic is an old friend, and without needing further explanation, she juggled what she needed to and arrived one hour later with a sleeping Ciara in the pram, ready to hold my hand through whatever it was I was I about to embark on.
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The post ‘Cornwall Heals’ will follow when it has written itself shortly, no contractions pending.
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