PET - A Chapter

Yesterday, I took the boys and Sophie to the Petersen Auto Museum, and after we'd wandered around and ooh'd and ahh'd over the fantastic vehicles, we went upstairs to the children's activity room. While the boys ran around, Sophie and I sat in front of a wire sculpture whose name I don't remember, but I was reminded of a very similar contraption that used to sit in the lobby of the waiting room at Columbia-Presbyterian Hospital in New York City. When I got home, I dug out the chapter of my dusty book-in-waiting and decided to publish it, here, for your consideration. It's a bit long for a blog post, but I'd love to know what you think.

PET SCAN

In the lobby of the hospital on Broadway, way uptown, is a giant contraption encased in Lucite. It’s so mesmerizing that even if you’re late for an appointment, you feel compelled to stand in front of it and watch for a few moments. The contraption isn’t electrical but rather mechanical, made up of a series of wire tunnels with levers and catapults. Many large balls travel through the whole thing in crazy patterns, completely fueled by the construction of it all, not any outside force. As they roll down hills, drop through holes and even make their way in what seems like an impossible upward climb, they make a clicking and clacking noise that lulls you into a kind of daze. Children stand with their noses pressed to the Lucite, quiet, their parents above them, both rapt at the continuous rolling movement of the balls. Nothing every really happens and it’s hard to figure out where and how the whole thing starts. There doesn’t seem to be an end, either, just an endless clicking loop for the balls to travel on forever.

   In January of 1996, we got a PET scan of Sophie’s brain. She was ten months old. The previous month when Dr. N recommended it, Sophie had already been on eight different antiepileptic drugs. PET is an acronym for Positron Emission Tomography. A website definition of the procedure says “positron emission tomography is a diagnostic examination that involves the acquisition of physiologic images based on the detection of radiation from the emission of positrons. Positrons are tiny particles emitted from a radioactive substance administered to the patient. The subsequent images of the body developed with this technique are used to evaluate a variety of diseases.” Dr. N said that since Sophie’s seizures hadn't been responsive to medical therapy, the PET scan of her brain might help to determine whether she would be a candidate for surgery.

   The technology was still very new and rarely done. I remember that there weren’t even that many actual machines in the state of New York. Fortunately for us, though, Columbia Presbyterian Hospital, the home of Dr. N, had one, so we made the appointment. Nowadays, you can get all your information about any procedure on the Internet, but in the dark end days of the last century, the only information came from your doctor. Initially, the procedure was denied by our insurance company, but I was armed with enough information to fight for it. With a lot of perseverance.

“Can I have your subscriber ID number?” the agent asked when I called one morning.

Click click clickety click, went the keyboard as he typed in the information.

“A procedure for which dependent?”

Click, click, clickety click.

“Child’s birthdate, please.”

Click, click, clickety click.

“Procedure name, please.”

Click, click, clickety, click.

“I’m sorry, ma’am, but we’re going to need some more information about this procedure before we can give you an approval to proceed.”

“Like what kind of information?” I answered, defensively, because by now I knew the insurance drill.

“Like if the procedure is medically necessary.”

Medically necessary? I’m thinking. Medically necessary? No. We just want to inject our nine month old baby girl with a radioactive substance to see her brain light up and then maybe have the opportunity to cut into it for fun. Just kind of experiment with a cool new procedure. We’re hoping that you’ll pay the five thousand dollars for it.

“You’ll have to get your physician to write a letter stating that the test is medically necessary,” the agent repeats.

I guess I swallowed and agreed because a month later we are scheduled to go into Columbia Pres for the test.

When we arrived at the medical center, we were taken to an examination room that housed the PET scanner, which has a hole in the middle and looks like a really huge doughnut. It’s white. The techs administering the scan told us that first they would open a vein in Sophie’s arm through which they would later inject the radioactive substance.

“Where is the substance?” I asked.

The tech pointed down to the floor and nodded toward what looked like a huge vacuum tube attached to the wall. Above the tube, near the ceiling was an enormous digital clock with bright red letters.

“The stuff is in the basement?” I asked again. The tech is busy with a metal tray. My husband has the baby and places her on her back on the examining table. She is about ten months old and chubby; her wrist is just a crease dividing the baby fat of her hand from her arm. It’s here that they’re going to find a vein.

“Actually, yes. It’s sort of in the basement. It’s radioactive and made in a machine downstairs called a cyclotron. When we’re ready for it, we’ll let them know and they’ll send it up.”

While the tech is explaining this amazing technology, he is also busy patting the fat on Sophie’s little arm. He’s actually almost slapping her, trying to find a vein. There’s a rubber band on her upper arm and she is starting to fret. She’s used to needle sticks as the neurologist is always trying to get a blood level of whatever drug she’s on, but some people are better at it than others and this guy doesn’t appear to be one of them. I move over to the table and squeeze myself next to Michael who I always accuse of being too passive when it comes to blood sticks. He steps away because he knows me.

“I think you’d better try somewhere else,” I say.

The tech’s lips are tightly closed, and he releases the rubber band and puts it on her other arm and then starts slapping that wrist. He sticks the needle in, a moment when I always (ashamedly) wince and turn away, my body steeling itself for the scream. And Sophie screams, so I turn back or open my eyes and the tech is basically rolling the needle around under her skin. He hasn’t gotten it. I let a few seconds go by.

“Stop,” I say, “try somewhere else, please.” I’m bent over Sophie, trying to soothe her. She’s stopped screaming but is impatient lying down. I want to give her a break and ask for a second.

The tech says that we have to get going and starts working on the veins in her feet, then her ankles. Each time he does the slapping and then the stick and then the rolling and probing. At the seventh stick, I shout, “STOP!” Michael’s hand is on my back and he’s looking at me warningly because he knows that I’m about to explode. Which I do.

“YOU’VE GOT TO GET SOMEONE ELSE IN HERE TO DO THIS RIGHT NOW,” I shout. “It’s not as if this is a life or death situation.” I’m crying, now, enraged and holding Sophie in my arms. Michael still has his hand on my back.

The tech isn’t apologetic, just sweaty and bothered, but he goes to the telephone and asks someone to come up and help him. When the nurse arrives we find out that she’s from the NICU, used to sticking preemies and “good at it.”

We lay Sophie down again and the nurse gets the needle in the vein on the first try. We’re ready for the radioactive substance. The tech places the call to the folks in the “basement,” and when the big red clock clicks over by a couple of seconds, we hear this tremendous “whoosh” and watch him put on some enormous gray gloves and walk over toward the tube. There’s a door in the tube, a panel and it opens and the tech reaches in with his space gloves and pulls out a huge needle. It’s not actually all needle; it’s a regular sized needle attached to a syringe that is encased in some kind of protective material. So the tech gets this radioactive substance at a precise moment, protected by the casing on the syringe as well as his enormous gloves, but he moves over toward the examining table and injects the stuff immediately into Sophie’s vein. The tiny vein in the crease of her right elbow.

The radioactive substance is attached to a natural body compound, usually glucose but sometimes water or ammonia, and once this is administered to the patient, the radioactivity localizes in the appropriate areas of the body and is detected by the PET scanner. It takes from 30 to 45 minutes for the substance to travel through the body and accumulate in the tissue that is being studied, and after that time, the scanning begins. When Sophie is slid into the doughnut hole, she has been sedated. She is in there for a little less than an hour. Within the machine are many rings of detectors that record the emission of energy from the radioactive substance. The detectors permit an image of the brain to be obtained which is displayed on a monitor of a nearby computer. The images show alterations in biochemical processes.

I could hold up the copies of those images in my hand and peer in wonder at the inside workings of Sophie’s mysterious brain. There were spots there that were sort of blue, lit up, I suppose, from the radioactive substance. I wondered at the absurdity of it all, the juxtaposition of nuclear medicine and the incredibly primitive way in which the stuff was administered. Whatever was happening in the “basement” in that cyclotron had the power to travel through the veins and light up targeted tissue. But to get there, we still had to open the vein with a needle, a sharp point had to puncture vulnerable flesh. Couldn’t there be some kind of advancement in the administration of a nuclear material? It wasn’t the nuclear medicine that scared me that morning, strangely. I was undone by the seven needle sticks, the bumbling idiocy of it and my own helplessness.

The PET scan of Sophie’s brain was inconclusive. It showed “activity” on both sides of her brain and it was determined that she probably wasn’t a candidate for surgery. We were left hanging, again, in the unknown. People always say that it’s good to “rule things out.” So far, I have found that to be incredibly frustrating.