Essay, EMG

EMG or Why I Am NOT A Doctor

by M. RAE LEE



I know I have nerve damage. I see the scene in my mind over and over
again: being stopped on the road, a huge truck coming at me in the rear
view mirror unable to stop, the glass on the rear window shattering.
Tautly strapped into the front seat of the car during that second of
impact, reverberating back and forth, like a pine tree during a hurricane,
my nerves stretched and being torn loose from their hinges, the bone
and muscle, my shoulder blade like a dock ripped from its moorings during
a storm. This, being rear ended, happens twice within two years.

"Scapula winging," is what my internist calls it examining
my right shoulder blade which sticks out like a beached dock. That's
why my neck and right shoulder always ache at the slightest activity.
Her diagnosis is nerve palsy and to find out for certain I need to be
tested.

As I sit in the EMG exam room at OHSU waiting to see my ninth different
doctor since my accidents six and seven years ago, I look at the bookcase
and see many books on nerves. I pull out a tall thin volume, the CIBA
book on nerves. The technician peeks in and says, "If you had to
pick one book, that's the best." The pictures are color paintings
done by a doctor. The CIBA series are the Leonardo of medical illustration
books--classics. I turn to a cross section of the neck that looks like
the inside of a phone cable, with wires of different colors, red for
the arteries, blue for veins, grayish for the tendons and pink muscles.
The nerves are white. It makes sense thinking about it. People who are
nervous and frightened are "white with fear." The nerves are
everywhere and vary greatly in width and length and have potato shaped
sacs at the ends.

I asked my orthopedist Dr. Buuke, "Exactly what do nerves do?"
He seems surprised by the question. Everyone knows what nerves are.
My association is with the dentist who deadens them with novocaine and
then says, I think sadistically, as he put the drill on my tooth, "Can
you feel this?" Or with my grandmother who liked to say before
she had a blackberry wine cordial, that she is all nerved up. But what
do these experiences have to do with my aching shoulder?

Dr. Buuke says, "They send impulses from the brain to the muscles."
I try to imagine why my nerves aren't sending the necessary messages
to my shoulder muscles. I see split ends like hair, and sometimes frayed,
thin, stretched rope like things. I see nerves cut as with a knife.
Are mine frayed, stretched or cut? I think about this as I do my physical
therapy.

Dr. Crawford interrupts my reading. She is a neurology resident at OHSU
and is going to do the preliminary exam. She is tall and big and has
long, straight hair pulled back in a gold clasp. She is dressed seasonal,
wearing mustard checked pants, a white blouse and red cardigan though
it is a warm September day. She slumps over slightly as she writes down
my history on a clipboard across from me. I talk about the accidents
briefly. Since she is the ninth doctor I've seen since my accidents,
I tell my history fast. She, like the other doctors, is not interested
in the details of it. The doctors are interested in the here and now.
In their tests, their procedures, their perceptions. I would never make
a doctor; I am too interested in history, in motivation, causation,
the link between pathology and psychology.

I am reminded of the author Annie Dillard who lived in my home town
of Bellingham in the seventies. Later I saw her at a book signing and
I asked her how she liked Bellingham. She said, "I hated it there."
Several years later she wrote a book on Bellingham called The Living.
Then she said how she loved Bellingham. Writers, I conclude don't like
the living experience as much as they like writing about the living
eperience.

Dr. Crawford points me to the exam table next to a computer with other
gadgets attached to it. She puts little wire leashes around my fingers.
She sends little jolts of increasing electrical force and charts the
response of my nerves on a graph on the computer screen. "This
computer costs $15,000.00."

I tell her about my fear of electricity. Once, when I was a child,
I used an electric scrubber on water from the garden hose on the front
porch of our house. I moved the scrubber to the front lawn and remember
standing in the water being shocked and unable to let go of the scrubber.
It frightened me.

I ask her why she chose neurology as a specialty. "The short answer,"
she says, "is because I like sleuthing." I see her looking
at her screens of my responses, fixing one on top of the other, trying
to establish a pattern. I think of her mentally wandering through the
billions of white nerves, arteries, veins, in the body--when she can't
see the color coded strands as you can in the book, trying to decode
the electric impulses and trying to see which nerve has a tear, which
is frayed, or "pitched" as she says. It seems more complicated
that trying to locate a missing messenger on a bicycle in New York city
during rush hour. Or a missing child on a milk bottle lost somewhere
in the United States.

"The second reason," she says starting a new finger making
little black s's to mark spots on my wrist, and taping a probe, "is
that during my rotation I got sick of self-inflicted illnesses."
I am thinking of a recent article on young people who stab, bite or
cut themselves but she says as if she reads my mind, "I mean the
people who smoke, or alcoholics, drugs addicts, things like that. It
was so depressing. I liked neurology because I deal with innocents."

I think of Jennifer, a two year old girl out in the waiting room. Her
mother and doctor are worried because Jennifer, instead of developing
is going backwards, regressing. She is an innocent. I wonder about myself,
I suddenly feel guilty. I think of all the ways I could have avoided
my rear end collisions. Keeping more of a distance, not letting trucks
drive behind me, not driving at all.

Thinking of Jennifer and the pain I am undergoing, I ask if some patients
can be anesthetized and she says they can but that Dr. So, who is her
mentor and my soon-to-be tenth doctor, prefers to use his charm, which
"is enormous," she adds. Dr. So will come in later to perform
the EMG.

I tell Dr. Crawford about my work as a writer and about my screenplay
on Mina Hubbard, a woman who was the first explorer of interior Labrador
in 1905. She succeeded I tell her, when her husband failed (and actually
starved to death when he got lost.) She makes a joke about men never
asking for directions, and not stopping at gas stations. I laugh. Do
neurologists stop to ask? She says, not on this next test. It's a solo.
Dr. So is a genius at this and she is going to watch him do it.

Dr. Crawford leaves and I am waiting for Dr. So, I turn to my book
again of the nerves. If the body were a road map, the arteries would
be interstates, and the highways veins, the muscles city streets, but
the nerves would be the back country winding roads. The impossible side
streets. If the neurologist can't see the color coded strands, how do
they detect damage? Through sound, Dr. Crawford explains. They probe
the muscle and nerve with needles and listen through computer simulated
sound of the electromagnetic waves.

Dr. So, comes in. He is a compact Chinese man in his forties and he
is a navigator, an explorer of the nervous system. The Maestro of the
orchestra of the body. The nerve test, the electromyography is so complicated
it makes the stethoscope look like a single drum. Dr. So must listen
to harps, and brass, and strings and reeds. He must conduct in 12 tone,
in 5/4 jump time and still think at the same time at what is wrong.
And when he probes the needle in, it is live--there is no recording
possible of this, not on the hard drive, on disc or CD. He interprets
on the spot. It is an art.

I hear the sounds somewhat like scratching, somewhat like 12 tone John
Cage, not percussion, but perhaps a violin being plucked. I feel the
probe a long needle on my nerve and I exert my muscle, pushing on his
arm, as he says to do. I hear the amplitude rise the harder I push.
Probing rhomboid, trapezius, and finally he stops.

I think of Murry Sidlin at the Portland Symphony Orchestra, smiling
at the end of a good performance. "I did well, then?" I say,
wondering if my violin is in tune, if I missed notes.

"Normal," he says. "Everything is normal."

After he leaves Dr. Crawford tells me, "This is a very difficult
test to read."

"What are they looking for?"

She says, a normal nerve will go blip, tat....and level off. Whereas
a damaged nerve will go blip, tat tat tat and keep tatting.

I thank Dr. Crawford and she leaves. I put my blouse back on and put
the nerve book back on the shelf. I realize there is one more reason
I will never be a doctor. Imagination. Looking at the nerve running
up my neck one last time, I realize my pain is not the torn, frayed
nerve after all. But knowing me, I'm sure I'll think of something else.