Obsessed (5 page)

“Does it delay the onset of the disease?” I asked.

“Delay? Prevent? That's what we're trying to find out.” He gave a wry smile. “That's why the research is so important. If we can identify patients early, confirm the diagnosis with a functional MRI, treat it aggressively, we may even have what amounts to a cure. Hold out some hope to families suffering through the nightmare of this disease.”

There was a light tap at the door. Emily stuck her head in. “Ready when you are.”

Shands offered me his hand and we shook. “Nice meeting you.” He held on and put his other hand on my forearm. “By the way, if you're interested in having your brain scanned, we're always looking to add normals to our library. The only way data makes sense is when we can do comparisons to an overall population.”

I grinned. “Me? Get an MRI?” I couldn't help the enthusiasm. It sounded pretty neat. Wouldn't hurt to have the experience, I told myself—that way I'd be in a better position to advise my own patients about what it was like.

Shands knew just how to seal the deal.

“Sure,” he said. “Why not? We'll even give you a souvenir image for your wall.”

I wondered what my mother would think if I installed a light box in my living room and displayed a scan of my own brain. I'm sure she wouldn't find it nearly as charming as the crayon drawing of an eight-year-old.

“Talk to Dr. Ryan about it before you leave,” Shands said. “She'll schedule you.”

“I
SN'T HE
amazing? His work is completely original,” Emily said as we headed back into the central area. I suspected Shands inspired this kind of hero worship in many of the young researchers who came to work in his shadow. “And he's so dedicated—beyond anything I've ever experienced.”

I followed her into another hallway. We passed the open door to a small room filled with person-sized dewars marked
LIQUID HELIUM
. I assumed they used cryogenic gas to cool the coils through which electrical currents passed to create the magnetic field. There were also a few smaller tanks marked
OXYGEN
, one of them set on a narrow handcart with wheels. In the hall were a pair of yellow sawhorses and more warning signs:
CAUTION
and
NO METALLIC OBJECTS BEYOND THIS POINT
.

Sitting on one of the sawhorses was what looked like a flattened hockey puck. Emily picked it up. “You don't mind if I just check to be sure you haven't got anything on you that'll be attracted to the magnet?” When I looked puzzled, she added, “This is our test magnet. We use it to check anything metallic before it goes into the scan room—and we double-check people, too.”

“Sure,” I said, and held my arms out like I was at the airport about to get wanded.

As she ran the magnet up and down each side of my body, then front and back, she said, “I love working here. The excitement of being at the edge of what's possible. Imagine, the third most commonly diagnosed dementia, and we're going to cure it?” Emily's cheeks had turned pink. “The hard part is working with patients who are dying. Seems like you just get the chance to know them and they're gone.”

That was one of the hallmarks of Lewy body dementia—death came more quickly than with Alzheimer's.

Emily put the magnet back on the sawhorse. Across the hall I noticed a door marked
PRIVATE
.

“What's in there?” I asked.

“That's Bluebeard's chamber,” Emily said, giving me a wink. “Honestly, I don't know what's in there. It's the only lock with a different combination from the other ones in the lab.” I noticed the keypad lock on the doorknob. “Only senior staff gets to go in there.”

As she moved on I tried the door, like a little kid unable to resist. It wouldn't budge.

I followed Emily to a heavy metal door that was propped open. I assumed it was part of the shield Shands said protected the scan room. Beyond, in a large bright room, Mr. Black was lying on a narrow table attached to a massive white cube that was the MRI scanner.

“Just a few minutes more,” Emily told Mr. Black.

Then she led me through a door connecting the scan room to another room. “This is our control room.”

The overhead lights in this room were off. In the half-light, computer monitors and wall-mounted light boxes glowed. Through a wide window in the connecting wall to the scan room we could see Mr. Black on the table, and directly beyond him, into the horizontal tube that ran through the magnet from front to back. No wonder some patients freaked, unable to tolerate having to remain motionless in such tight quarters.

Emily sat me at a monitor by the window. “We'll be able to watch from here.” To one side, there was a control panel with an array of buttons.

I heard someone cough and looked around. “That was Mr. Black,” Emily explained, indicating a speaker mounted in the console. “We'll be able to hear everything that goes on in there.”

A short, heavyset man in a white lab coat slunk into the room. He had thinning hair, glasses, and the pale, unhealthy look of someone who didn't see daylight often. A folded newspaper was tucked under his arm.

“Hey, Lenny,” Emily said. “This is Dr. Leonard Philbrick, the real expert on this stuff. Lenny, this is Dr. Peter Zak. I work with him at the Pearce.”

Philbrick gave me the once-over through thick lenses. “Shands say he was okay in here?” he asked, his voice high-pitched. Sweat stains were just visible under the arms of his lab coat.

“Uh-huh. I was just about to explain how all this works,” Emily said. “But you're much more eloquent—”

Philbrick seemed to take the flattery as his due. “It's not complicated.” He set down the newspaper and slid a well-chewed pencil into his pocket. “You know how a functional MRI works?”

“Sure,” I said. “I get the general idea.” I knew that in a regular MRI of the brain, the scanner took picture after picture, slice after slice. In a functional MRI the same thing happened, only much more quickly so you got a series of images of the brain. Somehow, with the help of a computer, the images got assembled to show changes in the brain over time.

Philbrick said, “Then you know that the data shows us where blood supply increases during mental activity. Our experiments generate huge amounts of information quickly. It used to take days to process the data into a high-rez three-D image.”

He avoided eye contact, his gaze darting around the room as he talked.

“Our scanner is one of the most powerful in the country. We use helium to cool the superconducting magnet coils. The system holds almost a thousand liters of liquid helium.” I wondered if that explained the thickness of the cube walls.

“Our scanner records data from the brain and transmits it via high-speed network to a Cray T3E in there”—he indicated a glass wall through which I could see a massive black multisection cabinet with a jaunty red racing stripe—“which converts the raw data into three-D images, compensates for head movement, and identifies the level of activity in different areas of the brain. From the T3E the data travels here where we can watch what areas of the brain light up. Functional imaging in real time,” he said, his voice caressing the words.

Philbrick kneaded his hands together. “We've already got one of the largest libraries of brain scans in the country.”

I could imagine him poring over the data bank, Midas counting his gold.

“It's the first comprehensive collection of MRIs of patients with Lewy body dementia,” Emily added. “Plus lots of normals for comparison. Mine's in there. So's Lenny's. Lenny modified the controls so we can even do it ourselves. Just push a button and the program takes care of everything. Slides you in, administers the test, slides you out. It's pretty amazing to see your own brain working.”

I could relate to the “amazing” part. But I wasn't too keen to slide myself into that narrow tube without knowing that someone could haul me out if something went wrong. “Dr. Shands said you could set me up for a scan.”

“Sure. I'll do it before you leave.”

“You staying late?” Philbrick asked Emily, squinting at his watch.

“Dr. Shands is letting me use the scanner for a research project.” She blinked at him. “Oh, gosh, Lenny.” She put her hand on his shoulder. “I'm sorry. I forgot we were going grab a bite later. You want to hang around? We can—”

Philbrick's mouth turned down, pinched at the edges as his eyes darted at me and away. “Not a problem,” he said. “I can't make it tonight anyway.”

“Lenny's worked for Dr. Shands for ages,” Emily said brightly.

I couldn't read Philbrick's look. “Yes,” he said. “I've collaborated with Dr. Shands for more than ten years.” There was a big difference between “worked for” and “collaborated with.”

“Of course, that's what I meant.” Emily gave a nervous laugh.

“Though it's Dr. Ryan here who scored a credit on his latest paper. Quite a coup. Took me three years to do that.” His words were addressed to the computer monitor.

“Thanks.” Emily was glowing. “It just got accepted in the
Journal of Neuroimaging.
Real snappy title. ‘Neurocognitive Correlates of Lewy Body Dementia.' I did the neuropsych testing and wrote up the methodology.”

Philbrick hung his lab coat on a hook and grabbed a rumpled raincoat. “Make sure you get someone to walk you to your car later.” He addressed the warning to his own shoulder.

“Don't forget this,” I said, picking up the newspaper he'd left on the table. It had been folded over to the obituaries.

He grabbed it and left, leaving behind a slightly sour smell.

“Lenny was with Dr. Shands and Dr. Pullaski at Harvard,” Emily said. “He helped set up this place. Got the designers to remove an entire floor so the magnets wouldn't affect the other building tenants. Lenny knows more than anyone about this technology but he stays behind the scenes pretty much. He's not so weird, once you get used to him.”

“He walks you to your car?”

Emily smiled. “He's a sweetheart.”

Emily picked up two fist-sized pink rubber balls from the table and unhooked a pair of high-tech goggles and a set of headphones from the wall. “The system makes quite a racket during a scan. These muffle the noise,” she said indicating the headphones. “Plus I can communicate with him through them.”

“You playing stoop ball in there?” I asked.

Emily laughed, looking down at the rubber balls. “No. I'm going to give them to Mr. Black. You'll see. He'll use them during the test.”

“Mr. Black, can you hear me?” Emily said, addressing the question to the microphone in the control room.

From inside the scanner, Mr. Black answered that he could. Emily turned up the volume so we could hear him better.

“Get ready now. I'm going to start the scan. You'll hear noises. That's perfectly normal. I'd like you to just lie there. Relax.” Emily put her hand over the microphone. “First we take a baseline.”

Now the machine was making loud, rhythmic, buzzing sounds. The window in a corner of the screen flickered and an image started to materialize. Instead of slice after slice of brain, an integrated, three-dimensional image of a brain hovered in front of me. It blurred and came back into focus. Mr. Black must have moved.

We sat there in silence for about a minute. Then Emily leaned into the microphone. “Mr. Black?”

Now the machine was making thumping sounds along with the buzzing. It was the kind of noise you'd expect in the bowels of a manufacturing plant. What we saw was amazing. There were pulses of yellow in the bluish green on either side near the temples, and immediately more pulses closer to the center as Mr. Black heard, then processed what he'd heard.

Emily began what seemed like a test routine. She asked Mr. Black to open and close his eyes, say his name, his mother's maiden name. She logged the time at which she made each request. I watched, fascinated, as different areas of the brain were activated, pulsing in a spectrum from green to yellow to orange. It was like watching a supersonic pinball game. I wanted to slow it down.

The door to the control room opened and a woman stepped in. She was an imposing presence with her stylishly cut short black hair streaked with gray and her dark eyes, eyebrows nearly meeting over her nose. She had on a lab coat, and an ID tag hung from her neck. “Dr. Ryan? I didn't realize you were using the scanner.”

“Mr. Black, I'm going to pause the scan for just a moment,” Emily said into the microphone. She pressed a button and the scanner fell silent. “Yes, I'm working with a patient,” she said with her hand covering the microphone.

“I can see that. Who gave you permission?”

“Dr. Shands said it was okay.”

“And we don't allow visitors.” The woman's nostrils quivered as she eyed Emily, then me.

“Dr. Pullaski, this is Dr. Peter Zak. He runs the Neuropsychiatric Unit at the Pearce.”

I could feel Dr. Pullaski lower her hackles.
The Pearce
bestowed an instant patina of legitimacy on anyone associated with it.

I stood and offered my hand, told her how I'd heard such wonderful things about University Medical Imaging and how I was grateful to have a chance to see their amazing system in action. She gave me a thin smile. This was not a woman to be patronized.

“And where is Dr. Shands?” she asked.

“He's around.” Emily waved her hand distractedly. “Somewhere. I'm sorry. I thought you knew.”

“I'm sure you did,” Dr. Pullaski said. Then she wheeled around and left.

“That,” Emily breathed the word, “was Dr. Estelle Pullaski, the executive director. She and Dr. Shands are like this.” She held up two fingers. “She runs this place, right down to the last latex glove and hypodermic syringe. She's always got a bug up her ass about something. I mean, the system was going to be idle anyway.”

Emily removed her hand from the microphone. “Mr. Black, we're going to start again.” She pressed a button on a control panel and the system started up again. “Now I'm going to show you some pictures.”

To me she explained, “Those goggles I gave him? We project images from here onto the insides of the lenses.”

A window had opened up on the monitor screen showing a photograph of a bouquet of flowers. Emily noted the time. Then she pressed the button again. Now the picture changed to a person's arm. She went on, changing the images and marking the times on the test protocol. With each change in the image, there were subtle but perceptible changes in Mr. Black's brain. But it was all happening too fast to make any sense to me.