Day 1: Familiar
The promised mega-blizzard turned out to be nothing more than a wimpy winter storm, leaving the city with half a foot of slushy snow. I like winter storms, now that I live in a place where they don’t happen often. (It helps that I don’t have a car.) Snow — even the slushy kind — reminds me of my childhood in small-town central Maine, waiting by the radio for the 92 Moose DJs to announce school closures. I like having an excuse to dig out my old heavy boots and the earflap hat I bought when I went up to Greenville to volunteer at a sled-dog race. It’s silly, maybe, but snow and ice is a comfort zone.
When I got off the train in midtown, a damp, icy substance was falling — wintry mix, they call it, which is a fantastic term, because it is ridiculously vague and precise at the same time. The sidewalks were less crowded than usual. At the corners, piled-up embankments led to brown puddles, and pedestrians picked their way over them to reach the crosswalks. I was grateful for my boots.
My TMS doctor’s office is a small suite of rooms that smells very, very good. There is a diffuser of some sort in the waiting area, and an Air Wick plug-in in the bathroom. In the treatment room, the doctor’s assistant — a chipper Australian woman— handed me a lavender-scented stress-relief ball. “It’s really popular with the patients,” she said.
The assistant (I’ll call her Sophie) had me sit in a large semi-reclined chair, the kind you might find in a dentist’s office. It faced a flat-screen television and a desk that held a computer, a clipboard and a plastic model of a brain. She fussed with the headrest for several minutes, and I was about to tell her not to worry, I’d be fine with whatever, but then she explained that a) it’s important to get my skull in the right place and keep it there, and b) each treatment lasts nearly 40 minutes, so you need to find a position you can hold. Next, she dialed a hard brace against the right side of my head, a few inches above my ear. The final step was attaching strips of tape to my head and forehead, fastening them to the back of the chair. All of this was to keep me from moving.
Once I was in position, the doctor (I’ll call him Dr. Levine) came in. Sophie handed me a pair of disposable foam earplugs, because, she said, the TMS machine’s clicking can be loud. Our first order of business was to locate the part of my brain that controls my right thumb. This is because science has determined that the root of all depression lies in that region, which is why babies suck their thumbs for comfort. Lol, no, you look for the right-thumb brain region because it’s easy to tell when you’ve zapped it with a current: the right thumb twitches. And the section of the prefrontal cortex that TMS targets lies on the same plane, so as soon as you know what machine position makes the right thumb twitch, you can move it forward a few inches and land in the ideal spot. It’s very technical and scientific, but nevertheless, it’s all predicated on Sophie standing there with a clipboard to determine what twitched: wrist, fingers or thumb.
At this point, I suppose I was anxious. Nobody wants to think too much about physical things happening to the brain, to the actual squishy bits you’ve never seen except in plastic models. By the time Dr. Levine positioned the coil by my left ear, my palms were getting sweaty. He explained that I’d hear some sounds, and then I’d feel something like a sharp tap against my head. Was I ready? My mouth was dry, but I couldn’t nod, so I squeaked something that I hoped was affirmative-sounding.
The machine made some sounds, and then I felt… what was it? Not pain, exactly, but not far from it. More of a snap than a tap. Perhaps the most disconcerting thing was that I couldn’t tell whether the sensation was happening outside or inside my skull. My fingers twitched. Snap. My thumb jerked. Snap. Fingers again. I was aware of my hand moving, but none of it made sense: I wasn’t trying to move a muscle. I hadn’t even thought about moving. Snap.
All of a sudden, the edges of my vision went dark and sparkly. “I don’t feel well,” I said. “I think I’m going to faint.” Dr. Levine and Sophie pulled the coil and brace away from my head.
“It’s fine, you’re fine, just lie back,” Dr. Levine said. His voice sounded like it was coming from a long distance away. Sophie ran to get me a cup of water. I knew exactly what was happening: vasovagal syncope. It happened when I was in high school and tried on a pair of contact lenses at my optometrist’s office. It happens every other time I get my blood drawn. It happens at the gynecologist’s office. It happened once on a crowded train on my way to work, because the novel I was reading contained a description of a medical procedure.
It took about fifteen minutes for me to stop feeling dizzy and pukey. I apologized repeatedly, which is what I do in these situations, because as soon as the initial passing-out feeling goes away, it is replaced with an overwhelming sense of embarrassment. “Don’t apologize,” Dr. Levine said. “You were anxious. It’s an involuntary reaction.”
“I can’t do this,” I said. I knew I sounded like a panicked little kid, and I didn’t care. “I can’t keep going. Does this mean I can’t do this?” Fuck, I mean, fuck. Of course. Why would this be simple? Why would it just work? The magnet was my last best chance, and my stupid fucking brain was going to make me pass out instead of cooperating while getting zapped, because OF COURSE, of course. Fuck fuck fuck fuck.
“Of course you can do it,” Dr. Levine said.
We decided to take a break, during which time Sophie plied me with water and kept up a stream of pleasant chatter. This was her first real winter, she said. She’d never seen snow before. In Australia, the severe weather is heat. The beaches get so hot in the summer that people, mostly tourists who didn’t know better, sometimes wind up in hospitals with burns because they try to walk barefoot on the sand.
Dr. Levine came back in and asked if I was ready to continue with the mapping. I said I was. I guessed I was. “The good news is, your body just dumped a whole lot of adrenaline into your system all at once,” he said. “You probably don’t have much left.” He began to position my head and the machine. “You see it with medical students. I remember the first time I saw a really bloody surgery in school. I’d been so excited for it, but then we got there, and I remember the feeling of blood on my hand, it was such an alien thing, and I felt faint. You get used to it.”
“Okay,” I said.
The machine snapped. My fingers twitched. Snap, twitch, snap, twitch, snap, twitch. Sophie made notes on her clipboard. I tried to focus on the stress ball in my left hand. After a little while, Dr. Levine was satisfied that he’d found a position that isolated my thumb response. He tested it again. Snap. My thumb jerked. He entered the information in the machine. The last step was to determine current intensity: different brains require different amounts of stimulation. Dr. Levine explained that the machine would run through an algorithm that delivered twenty pulses of different intensity, and Sophie would watch my hand to see when it twitched. Then the machine would take the average of all the levels that resulted in movement, and that would set my treatment level.
I draped my hand over a foam prop and waited. Snap. Twitch. Snap. Nothing. Snap. Twitch. Snap. Twitch. Snap. Nothing. Snap. Twitch. It was kind of fascinating, now that I wasn’t on the verge of blacking out. “Right before you started to feel sick, I was going to do my line,” Dr. Levine said. “We see the first muscle response, and I say, Good news! Your brain works!”
When the mapping was complete, and all my positions and levels were programmed into the machine, it was time for the first actual treatment. I was exhausted, and sweat had stuck my shirt to my back, but I figured I’d come too far to stop now.
“Now, the treatment is a little different from the mapping process,” Dr. Levine said. “You’ll hear a chime, and then the machine will deliver ten pulses per second for four seconds. Then nothing for twenty-six seconds, and then it repeats. In other words, forty pulses in rapid succession, a break, and then it repeats, and it does that sequence twice per minute. Okay? Ready?”
Maybe? “Sure,” I said.
A pause, a chime, and then- brpbrpbrpbrpbrpbrpbrp. I could feel it inside my left eye socket. As with the mapping, it hurt, but it wasn’t really pain. “It’s like a woodpecker in my head,” I said.
Sophie laughed. “You’re the third person who’s described it that way.”
“You okay?” Dr. Levine asked.
“Sure,” I said.
And so I sat there for the next 37 minutes, the machine emitting its rat-a-tat zaps in four-second increments. Sophie kept me company — I’m not sure if that’s standard procedure, or if they were just afraid I might have another vasovagal episode. She turned on the TV, opened the Netflix app and gave me the remote, but I was too busy anticipating the end of the 26-second pauses to concentrate. Finally I turned on an episode of “Master of None,” since Sophie seemed convinced that watching something would help me relax. Brpbrpbrpbrpbrpbrpbrp. Aziz Ansari was plating pasta. Had ten seconds elapsed? Fifteen? Twenty? More? The machine chimed. Brpbrpbrpbrpbrpbrp.
“I can see you waiting for it,” Sophie said. “Your eyes keep looking to the left.”
“I keep thinking I’ll see something moving toward me.”
“You won’t.”
“Yeah, I know, it’s just weird.”
Chime. Brpbrpbrpbrpbrpbrpbrpbrpbrp. People talking on the TV. Silence. Chime. Brpbrpbrpbrpbrpbrpbrp.
“Let’s go up with the intensity a little,” Sophie said. She tapped a button on the machine. “We’re not at full treatment intensity yet. Let’s see how you do at 90 percent.”
Chime. Brpbrpbrpbrpbrpbrpbrp. The woodpecker had gotten stronger. My left eyebrow spasmed. “That’s ninety percent?” I asked. “So it has to go ten percent higher?”
“Actually, full treatment strength is 120 percent.” Chime. Brpbrpbrpbrpbrpbrpbrp.
“So 30 percent more than this?”
“Yep. But your nerves adjust after a few days. By next week you’ll hardly notice it.”
Chime. Brpbrpbrpbrpbrpbrpbrpbrp. I winced. “I find that hard to believe.”
She smiled brightly. “Trust me. I’ve had patients fall asleep in the chair during treatments. You just have to get used to it.”
“Okay,” I said. “Okay.”
