Room for a view: Scans

May ... MRI this morning, observing. A newborn baby with a mass blocking his nose. One tiny baby, with entourage of technicians, nurses, paramedics filling the room overlooking the MRI. An impatient, even imperious, entourage; when they want their questions answered, their questions must be answered. All the time the baby is inside, his heart rate traces green peaks on the monitor and the rough, quick little whisper of his breathing carries through the intercom. The scan ends, the table is drawn out, three people in blue slowly unwrap a tiny package in dustier blue. A nurse lifts the baby and holds him in outstretched hands, like a gem on a cushion, one hand cupping the little pink head. She carries him thus through the metal detector arch, seemingly oblivious to the scrambling behind her as the two others snatch up all the dangling tubing and wires before they snap taut. On the scans, the imminent end of another life. The tumour and the surgery and the radiation and the chemotherapy have hollowed out the left hemisphere. The tumour is a bright, thick, ragged edge around a great cavity. No level of scan, no single layer, is spared. The neurologist describes the patient as asphasic and crazy. The family, he says, is taking him around the continent, looking for a cure; he comes accompanied by MRIs and CTs from all over, recording the inexorable progression. Our neurologist thinks that the referring neurologist has prevaricated, has said maybe/maybe not, has not said finally that there is nothing else he can do. He himself would not touch this, not in a dominant hemisphere. So he will send this man home. Will he — will anyone — finally say to this family that it is time to stop? September ... I have been thinking off and on of two people I shall never meet. Should I put their names here — perhaps not — but I do not leave them nameless because I think of them that way. One a woman younger than myself, thrown from her car when side-rammed at 65 k/h, comatose (Glasgow Coma Score 4) with roving eyes and decerebrate posturing. The CT scan shows very little, in her head at least. She has a fractured first vertebra, umpteen spinous processes destroyed. The radiologist remarks on the inadequacy of the scan, which has the signature of one particular, indifferent technician. The head scan, with no visible abnormalities, does not account for the score, the eyes, the posturing. There is something bad and unseen in the brainstem: axonal damage. They can do nothing about a lesion they cannot see. The neurosurgeon will put a “bolt” in the vertebrae; there is a slight twist to his expression when he says this. If the big problem does not come right, then he will have done nothing to any avail. But in case the big problem does come right, then this will have been necessary. The other is a man only a little older than myself. Four years ago he fired a bullet into his frontal lobe, destroying eye and brain. On scan his glass eye is a shallow curve, mounted on an odd stalk. Wednesday night in the drunk tank he beat his head against the wall until the craniotomy plate shattered, arteries tore and his cranium filled with blood. On the pre-op scans, a glowing lens of epidural hematoma fills a third of one hemisphere. This story is told and retold. Doctors smile and shake their heads, not amused, a little awed, a little, necessarily, removed. They can say why bother; why not let him go. But they can say it because they know they will not do it. All they can do — for him, for all the failed suicides — is rebuild what they can rebuild. The exorcism of demons is beyond us. The infernal thing, though, is that we are wilfully letting it go further beyond us still, fostering this illusion of community care when community care is inadequate to nonexistant for the homeless mentally ill. Have I said before how very vulnerable skulls look, in cross section, the flesh and features effaced and only the thin bones or the thin skin or the thin fluid shell of the brain bright. No matter the age, there is always something fragile and infantile about the skull. A new word. Levelling. Learned it last week when the radiologists passed around an cerebral angiogram with a huge blot, a huge ink-bag of aneurysm, its image as large as the tip of my thumb. Was she still alive? She'd had a rebleed; the resident phoned upstairs to find out. “Is she still with us?” He put the phone down. “They're going to level her.” And then, to me, he explained, “Decrease the level of care until she dies.”

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