WILD SURMISE
June 1987 #14
AN ALMOST ANONYMOUS INFORMAL NOTE
HAVING AN X-RAY WITHOUT RUINING YOUR DAY
Let us say you are about to have an x-ray study. It is a new experience. As with many new experiences, you wonder if you are going to get it right. You wonder whether you will get through it with dignity and aplomb. You wonder whether there is a hidden exit around somewhere that you can escape through without anybody knowing it.
One thing about an X-ray study is different from say rebuilding a carburetor or cooking French pasttyr unless you are being paid to do it, you probably can figure on tearing down just one carburetor or producing one pastry at a time. With X-rays, they are likely to run you through the whole gamut, not to say gauntlet. And given a normal amount of self esteem, you expect of yourself that you will manage ALL of the studies. Yet no one sets out to learn about ALL carburetors or ALL desserts at once.
One thing about an x-ray study that is the same as carburetors or cooking is that this is your own show. You aren't there because anybody told you you had to be, you are there because you have a complaint about the way you feel or what you can do. The whole point of the study is to accomplish your purpose rather than anybody else~s.
We will assume some mild complaint. 'Sense of impending doom," used to be popular. I don't think they admit patients to hospitals for that much nowadays, but say that's your problem. "Doc," you said. "I just feel somethin' bad's about to happen to me.." "Right," he boomed. 'We'll put you in the hospital and get X-rays.
Your first study is probably a chest film. On the way to the floor, your transporter rolls your wheelchair to the X-ray department, nods to the receptionist, and parks you near a door to a room with strange machinery inside.
Peering in, you see a number of things, three of which are critical. The x~ray tube itself can be recognized from its dominant central position. It is mounted so as to be somewhat mobile, has a special port for letting the rays out in only one direction, and has a couple cables leading to it that look about the size of fire hoses. It looks like pure business.
At the heart of the tube is a little wheel of tungsten built to spin very fast. Near the wheel is a little filament, much like the tungsten element in an ordinary light bulb, but not nearly so hot. These two elements are enclosed in an evacuated glass envelope. The envelope is surrounded by an oil bath to keep it cool and then by a metal shield. Most of what you see is the metal shield. The two cables deliver electricity say between sixty thousand and two hundred thousand volts. The electricity makes a spark jump from the filament to the tungsten wheel and where that spark strikes, the x-rays emerge. The reason the wheel spins is so as to spread out the area where the spark hits so that the spot doesn't get too hot.
Second thing you see is some kind of film holder. After the xrays have left the tungsten target, escaped through the port in the x-ray tube and gone through. the part of you being studied, they hit a sheet of film, where they make an image just like light shining on the film would. The film is held in a flat box between two layers of a fluorescent material called screens. The screens light up under the influence of the x-rays just as your television screen lights up under the influence of high speed electrons. The light from the screens adds to the image made by the x-rays themselves. In fact, most of the exposure of the film is made by light from the screens. For a chest film, the cassette that holds the film is put in a film holder against the wall. The height of the film can be adjusted. Behind the holder, usually, is an x-ray sensor that tells the control system enough rays have gone through the film.
Usually, the film holder will also incorporate a grid. Imagine, or remember, driving down a four lane road that is separated by a line of posts, the two northbound lanes are just east of the line of posts and the two southbound lanes just west. The posts are higher than the cars. The posts are about a foot thick and about a foot across. As you look ahead, you do not see any cars, only overlapping posts. But if you look at the cars that are going by, you can see them quite well. The posts only blur them slightly. You can imagine that at times, say at night, you can actually see the cars closest to you better with the posts than if they weren't there; the dazzling headlights of oncoming cars are blocked by the overlapping posts.
Design of an x-ray grid is somewhat more sophisticated. Instead of posts there are little strips of lead turned edge toward the beam. Sometimes the strips of lead are angled to match the diverging beam. Sometimes there will be a horizontal as well as a vertical set of lead strips. Sometimes there will be a little motor that jiggles the grid so the strips don~t cast an image on the film.
The purpose of the grid is to clean up an image. X-rays, like other forms of energy, are not readily destroyed. The may only be turned into other forms of energy. The most likely form, of course, is more x-rays. This secondary radiation will blur the irnage on the film. The grid helps to clean up the scatter.
The third thing you notice looking into the room, assuming there is nothing to distract you like a puddle of some nameless liquid or a sharp instrument, the third thing is the control panel. Tucked behind a redoubtable shielded wall, the wall pierced by a leaded glass window, the control panel contains a distressingly complicated array of dials, switches, buttons and knobs. It has the Gothic air of a suite of armor, complexity upon redundant complexity. Actually the control panel only does four things. It turns the current on in the x-ray tube. It turns the current off. It maintains a pre-set voltage and rate of electron flow while the current is on. It also heats up the filament in the x-ray tube and starts the rotor, the little tungsten wheel, spinning, but these are routine things, the same on every exposure. There may, however, be a choice of different filaments, one for high current flows and one for fine detail.
By this time, you have probably decided that you would rather be back behind that lead shield, and standing in front of the thing that looks like an early cannon. Dismiss the thought. You are safer out there in the room with the tube.
You see, the control panel is a lot more complex than the tube or the film. If something is going to go wrong, it is far more likely to go wrong at the control panel.
X-ray machinery is constantly breaking down. There was once the misconception that exposing a watch to x-rays would ruin it. We now know that the actual amount of energy in an x-ray beam is quite tiny. If you took the energy it takes to heat a cup of tea from room temperature to scalding, converted all that energy to xrays and exposed people with the same energy. You could kill off, 0, a fairly large city. Maybe Hiroshima. clearly, diagnostic xrays do not carry enough energy to stop a watch. oblivious to such arguments, x-ray machinery continues to break down.
nreakdowns can be dramatic. There was a case of a doctor working with an x-ray tube who allowed the tube to become overheated. (It was overheated by MAKING K-rays, not by the x-rays themselves.) The glass envelop melted. The hot cooling oil hit the super-hot spinning anode. The room vanished in an explosion and a cloud of brown smoke. There was a terrible silence until the patient spoke, "Did I do something wrong, Doc?" When the smoke cleared, the only casualties were the tube and the doctor's nerves.
There can be some dramatic failures at the control panel as well. A poorly maintained panel will occasionally emit an evil blue spark and the smell of ozone during an exposure. No doubt there is the risk of getting a shock from a control panel, but modern design minimizes that.
It is the undramatic failures that are common: a blown fuse, a stuck relay, a worn bit of metal, a switch pressed at the wrong time or left set in an unexpected position. These are problems that come to light at the control panel.
If you think about it, there is a lot of concern about exposure to x-rays, and rightly so. People get exposed to x-rays enough to get quite ill. It happens regularly. nut you must distinguish between diagnostic x-rays and therapeutic x-rays. Since the only problem you have is a sense of impending doom, you are in for strictly diagnostic x-rays. If they find a tumor, you may consider therapeutic x-rays at some time in the future. The xrays are the same, maybe a different voltage, but the dose is wuch different. If you need to decide about therapeutic x-rays, you may expect, nay insist on it, that someone sit down and talk to you about possible untoward results of radiation, and what this means to you in your case.
Diagnostic x-rays are used in much lower doses. In fact, in recent years, there probably has not been a single case reported of a person dying or having any symptoms at all from x-rays received in the course of finding out what was wrong with him. That is a superb safety record. Compare railroads, ships, automobiles, bee stings, lighting, mad dogs, stray bullets. Look around and you will find people dying of them. nut diagnostic xrays? You just don't hear about it. They are treated with respect bordering on awe. X-rays used in diagnostic imaging, as currently used, are wonderfully safe.
On the other hand, there is such a thing as job stress. You hear about it all the time. People lose their jobs. They get divorces. They commit suicide. They resort to the use of drugs. They become totally miserable. A lot of this is due to stress, and a lot of stress comes from work. The job on an x-ray technologist is a high stress job. The fact that things don't always go perfectly is one of the causes. The safety record accomplished by these technologists is a monument to the care and attention they bring to bear, as well as the the highly predictable quality of the x-rays themselves.
So do not envy the person behind the control panel. Aside from the fact that you are the one with a sense of impending doom, the x-ray you are about to have taken is about as dangerous to him as it is to you.
About this time the technologist himself comes down the hall. Xray technologists come in two sexes. The females tend to be very small and the males tend to be very large. There are any number or exceptions, big boned women and skinny men, but the rule tends to be a mild exaggeration of the tendency for males to be bigger anyway. X-ray technology is very strenuous. The effort is ceaseless and the work must be very accurate. It seems that there are two different ways to get that kind of performance. A small person, who can move about quickly and effortlessly can handle the work by going as it were full throttle straight through the day. A big muscular person, can manage because his redundant strength makes any reasonable effort seem no effort. Like roughnecks on an oil rig, technologists have a wholesome look that comes of a high degree of physical fitness.
The technologist glances at your paperwork, reads "Sense of Impending Doom" without the slightest trace of emotion and asks with professional courtesy and friendliness that you stand facing the chest board, that film holder. He has you put the backs of your wrists on your hips and your chin on the top of the film holder~ He then has you roll your shoulders forward as far as you can to get your shoulder blades off your lungs, has you take a deep breath and hold it. The grid starts to jiggle and the rotor winds up. You can recognize the sound of an unlubricated bearing. That is because the inside of a modern x-ray tube is a hard vacuum. Lubricating oil would boil. So the rotating anode normally makes that characteristic metallic feathery sound your rootorcycles makes just before it burns out a bearing. There is an abrupt buzzing noise as a hundred thousand volts pours through the x-ray tube. And you will swear that you feel a slight burning sensation in your chest. Do not worry. That is normal hysteria. If people could really feel ionizing radiation, they wouldn~t get sun burned.
With a great crashing and clanging, the technologist changes cassettes, turns you sideways for the lateral view, and shouts over the noise of the grid and the rotor for you to take another breath. Another zap, and you are seated. Then you wait for one of two things to happen. Either somebody ought to tell you what the x-ray showed, or you ought to go to your room. For a little while, neither happens. But although you feel deserted for a few minutes, you are the center of a fluffy of activity-
First the technologist must develop your film In some institutions, this means that the film is transported automatically through a light-tight tunnel to where it is dropped into an automatic film processor. This is rare, even rarer than it was only a few years ago, and represents rather the high water mark of film technology. The low water mark of film technology was reached in, I think it was Egypt. There they had a man trained to hold x-ray films in his hand between his fingers, four to each hand. He would go into the darkroom, put the films between his fingers, dunk them in the developer for the proper length of time, lift them out and let them drain for a given length of time, step to the next tank, the stop bath, dunk the films, drain them, and so on to the fixer. At the end, he would bring them out and hand them in the sun to dry. The way he kept time, so they say, was to sing a song or chant at the top of his lungs, the song designed to last the right amount of time at each step. The reason he did it so loud was so that others, with a somewhat more sophisticated education, could monitor his speed from the outside so that he did not rush the song.
If you hear a loud chant being sung while your flirns are being developed, worry.
Most likely, your technologist will step into a darkroom, open the cassettes, take out your films, label them, put in in an automatic film processor, reload the cassettes, and then do some other chore while the automatic processor develops and dries your films. Presently he comes back, hangs your films on the light box and looks at them. He checks a number of things. Are these films of somebody's chest? Is it plausible that they are films of your chest? (A child~s chest is not the same as an adult's, nor a man 5 the same as a woman's.) Is your whole chest on each film? Is each film properly labeled and dated? were you straight enough when the film was taken? Taking a good deep breath? Holding still? Did you have any metal on that will make the film impossible to interpret properly? Is the film to light or too dark? And then, he will consider whether there is any disaster visible on the film, anything that will make a difference to you before you get up to your room.
If you have a lung collapsed, are drowning because of fluid in your lungs, or have a really terrible pneumonia, the technologist will try to bring this to somebody's attention promptly. He doesn~t really get paid to do that. He does it because he finds it easier to live with himself if he does. And over the years, there will be cases, not yours, or course, where a life will be saved because of his concern.
Having satisfied himself that the film is routine, he will park it where it can be put with any old films you may have had and then be set up for the radiologist to study and make a formal written report. Then the technologist comes to send you on your way.
Naturally frustrated by the delay, you are probably more caught up with your own problems than with the tech, but you may have noticed one other thing. X-ray technologists are remarkable gentle people.
Their gentleness does not come from some genial influence of being around x-rays, and certainly not from being around radiologists. Nor do the most sweet tempered children dream of growing up to be an x-ray technologist. The gentleness you are treated with was hammered out on the anvil of experience.
Think about it. The technologist spend no more than two or three minutes with you and no more than five or ten with the whole process of making your film. In a day he may do fifty studies. The next day, he may do fifty others. The nurse on you floor has maybe a dozen or so patients to look after for eight hours. The next day, he very probably has much the same dozen. He will be getting to know a much smaller number each day. If a patient is in pain, hurts when he is moved or is easily frightened, the nurse very likely will be told before dealing with the patient at all. The technologist has to be ready for anything.
Furthermore, when a person comes in with an injury, the x-ray may be the first clear proof that the person has a fracture. The doctor in the emergency room need only know that the arm has been hit very hard to know it needs to be x-rayed. After the x-ray has been taken, the arm may need to be manipulated to reduce the fracture, but the doctor who does that is armed with the information from the film.
But the x-ray technologist gets an arm (well, a person with an arm) that may or may not be fractured and has to position that arm for the film. Very often, after taking meticulous care to get good straight films, the technologist discovers a badly fractured bone. In the world of the technologist, everyone has fractures and very bad arthritis until they insist the contrary. It is quite frequent, particularly when examining the neck, to get a poorly positioned film without moving the patient and then check the film for gross abnormalities before going on to do the complete study.
For another thing, the technologist expects that every patient that comes under his care alive will leave alive. Nurses often cannot have such an expectation. The technologist can afford routinely to have somewhat more sensitive feelings, does not have to steel himself against the inevitable any more than ordinary mortals. To the technologist, as to the rest of us, all strangers are immortal.
On your way at last, hoping for a good meal, you leave the x-ray department and your film~ If it is early enough in the day, perhaps the film will be examined and a formal report made, typed and signed and placed on your chart by morning. When you arrive on the floor, you find your good meal was a mirage. You have left the x-ray department, but the department has not left you. It extends it withered fingers into your life in the form of standing orders. No solid food for your liquids and laxatives. Perhaps forced fluids. Perhaps you will have one of the modern twenty four hour bowel preparations and may eat tonight after all. But we will assume liquids and laxatives.
At this point you are saying to yourself, something terrible was about to happen to me."
"See? I told you"
The next day they send you down for your abdominal and pelvic sonogram, your IvP and liver scan. No breakfast. Food would utake your gall bladder contract, making it harder to see, and fill your bowel with gas, making problerrs both for the sonograms and the Ivp. The sonograrn comes first.
There is a kind of crystal that changes shape when an electric charge is put across it. The effect is caused by the fact that the charges within the crystal are fixed an a certain pattern. When a charge is put across the crystal, the positive charges within try to move one way and the negative the other. For certain crystals, the warps the overall crystal itself. Similarly, and this is the clever part, if you take such a crystal and place a force on it, say squeeze it in a vice, it will produce a tiny voltage. Lots of things in physics tend to be reversible like that.
Electricity is very easy to control. If you take the proper crystal and give it an abrupt shock with a voltage change, the crystal will create a tiny shock wave of sound. This shock wave is able to travel through the body. when the wave bounces off something, and returns to the crystal, the resulting voltage change can be 'neasured. The time it took for the wave to travel out and back tells you how deep the structure is that the wave bounced off. with a little electronic and mechanical gimmickry, it is possible to build a machine that sends in a large number of Waves at different angles in a fraction of a second. It then makes a picture on a monitor screen that shows the shape of things inside. By renewing the picture a few times a second, the machine is able to show an image in real time of what is below the crystal, the transducer they call it. At any instant, the image can be frozen and recorded on film.
It is not a bad experience. You lie on your back while the technologist, probably not the one that took your chest film, runs the transducer over your abdomen. Except for the firm pressure of the transducer, there is no sensation at all. The technologist will, however, use a gel to give good contact between the transducer and your skin. With luck the gel won't be very cold. It has to be used, because the sound wave cannot jump through air to get from the transducer to our skin and back, just as it can~t jump across gas in your bowel. The study is a good one. Safe. painless. Cheap as such things go- It is particularly good at picking up gall stone, cysts on the kidneys and enlargement of the aorta.
The pelvic sonogram is not without sensation. In order to see well in the pelvis, the technologist must have a full bladder. It acts like sonic window with which to see pelvic organs. If you have been taking plenty of fluids, your bladder may be full already. Otherwise, it may need to be necessary to put a thin catheter into your bladder. Today, however, the technologist has another trick. You are sent for your IVP.
IVP (eye-vee-pee) once stood for "intra-veinous pyelogram." The study is now so sophisticated that the name is not really accurate. The study shows more than the collecting system of the kidney, as the word pyelogram should suqgest. However, long tradition keeps the old name in use. It has the advantage that it is not likely to be confused with anything else medical.
Before the study, someone will probably present you with a form to sign. A glance shows you that it has such words as "death" or "fatal" or "lethal." You think that this is precisely the kind of problem you were hoping to avoid in the first place. Even when someone undertakes to reassure you, you notice that they aren't saying things like, "Only kidding."
Indeed, the contrast agents used for this kind of study are not without risk. An airplane ride is not without risk either. You don't hear them saying things like "drown" or "burn up" when they are introducing you to the safety equipment. The just talk about life vests and fast ways out of the machine.
So get someone to explain what kind of risks are involved. They will probably mention a fall in blood pressure or difficulty breathing as being high on the worry list. Feel free to ask questions. Particularly feel free to ask the question, "And what are you going to do about it if I do have a problem?" The airline is courteous enough to let you know what their disaster plan is. No reason the x-ray people can t. It doesn't really matter how they answer the question, of course. You'll have got them thinking about it.
The consent understood and signed, the technologist takes a film of your abdomen. This my be called a scout film, a RUB for "kidney, ureters, bladder," or a flat plate. This last term dates back to the time when abdomen examinations were done using a real glass plate rather than film. The plate was able to hold a thicker photographic emulsion than film, making the plate more sensitive to the low output of the x-ray tubes of the day. The scout film lets the technologist be sure what technique to use in filming you. It also lets the radiologist know whether you have any tiny stones in your kidneys that might later be obscured by contrast material.
Quite likely the technologist will also obtain a tomogram scout. Imagine you are taking a photograph of a running child. The child is running southwards and passing west of you. Between you and the child, as well as beyond the child, are shrubs with few leaves, you see the child somewhat obscured. However, as you take the picture, with a moderately long exposure time, perhaps a sixtieth of a second, you swing the camera to follow the child. when you look at the finished photograph, assuming you have the rock steady hands of an expert sharpshooter, you see the child quite clearly, his face and body. His legs are blurred, and so are the bushes in front of him and behind him. The final picture is sharper than reality was at any instant.
The tornogram does something similar. The x-ray tube swings past above you while the mechanically linked film cassette holder trundles along in the opposite direction under the surface of the table you are lying on. The result is a sharply detailed layer, with things above and below that layer blurted. It would be awfully nice of you to hold still during the exposure, because the technologist will have a very hard time trying to distinguish between the kind 0£ blur that moving or breathing produce and the kind of blur that the machine produces if the level of the selected layer is chosen wrong.
Next the technologist prepares to inject the contrast material. He may call it a "dye." In fact, it is colorless. Unlike a real dye, which reacts with the thing it is dying, the contrast material is very inert. Furthermore, the word "dye" sounds far too much like "die." The contrast contains iodine, which stops xrays just like lead does. Raw iodine would be ferociously poisonous, of course. The contrast material has the iodine bound in a very inert, almost always harmless compound. The kidneys will concentrate it and excrete it.
Imagine you had an invisible post office you wanted to examine. You could see the post office by spraying it with visible paint, but you would be little wiser about how the post office worked. Far better would be to mail a lot of visible letters at the post office. Then you could see how the letters were being handled. Whether any were being tossed in a heap never to be touched again. Whether there were large parts of the post office that never passed any letters through. Whether the office worked day and night or only a couple hours in the morning. Similarly, the IVP follows how the contrast material is handled from the time it is injected until the bladder empties.
The technologist or radiologist puts a needle into your vein. There are certain traditions about puncturing veins. The person doing the vein puncture is supposed to mutter, "Small veins," or "Fragile veins,,' or "Veins roll," or "Spasm," or somehow imply that any failure on the first pass is your own fault. Otherwise he is pretty sure to appear a fool. On the other hand, if you are very jumpy and likely to jerk your arm away, spoiling a perfectly good needle placement, the vein puncturer may remark, "Don't worry. I know what I'm doing. I always get it on the first try." Do not mistake this for reassurance. Everyone knows that a remark like that is a prelude to disaster. what he is doing is hoping to paralyze you with fear, as you lie there imagining your arm turning slowly to hamburger meat.
The contrast is injected. Cold icy fingers crawl up your arm toward your heart. Suddenly you are flushed all over. An odd metallic taste arises from inside your tongue. A wave of nausea hits your stomach. The technologist sees the panic in your eyes. He has sworn by his father's sword and his mother's brow that he will sweep into action if you are in trouble. Now he will tear the syringe of adrenaline down where it is taped to the wall. Now he will break open the "crash cart" and start taking out all sorts of arcane medicines and glittering metal instruments. Now he will whirl like a ballet dancer and slap the blue button on the wall that will summon the cardiac arrest team, young men sprinting down the halls, shouting and waving strange devices~ Instead, the technologist hands you a green plastic puke basin. With a sense of anti-climax, not to say betrayal, you fight down the nausea and keep your dignity.
They didn't tell you about that. Didn't want to plant the expectation of nausea in your mind. But it is a perfectly natural thing. Happens to lots of people. The reason is that the contrast material is very concentrated. It feels cold going up your arm just because it is cooler than your blood. Once it gets into your circulation, it causes the little blood vessels in your skin to open up. That makes your skin warm up, although it makes the inside of you actually cool off a little. It may make you turn pink for a little while. And the concentration of material also tickles a little vomit center in the base of your brain.
In the days of old sailing ships, they used to do that to new hands. If the new sailor complained of sea sickness, the old hands would suggest drinking a pint of warm salt water. That usually made him so sick at the stomach that he never complained about anything or trusted anybody again. You'd feel just the same if they injected concentrated salt water in your veins. It's also another reason why they don't let you eat a big meal just before your study.
Films are taken, both an early film to make sure both kidneys start to work at the same time (a narrowed artery to one kidney may cause that kidney to function slower, that's a curable cause of high blood pressure, and a kidney blocked by a stone may also begin to function a little late) and late films to see that they drain well. Tomograms give the radiologist a chance to see the effects of a tumor, if there is one there and it is big enough.
Soon you notice another effect of anything concentrated getting into your blood stream. Your bladder fills quickly.
Instead of letting you void like a civilized human being, they send you back to ultra-sound for your pelvic sonogram. You are ready to assure them that your bladder is now quite full, thank you. After the inevitable wait while someone with more pressing problems gets their sonogram, you are back with the ultra-sound technologist. This time the technologist studies your pelvic organs bearing down firmly with the transducer right over, yes, your full bladder.
After an eternity or so, they send you back to the x-ray area to finish your IVP. You see why the whole area is called "x-ray." "Imaging department" is a somewhat more modern term, including ultra-sound, nuclear medicine and magnetic imaging along with x-ray studies. Frequently these studies are dovetailed, like your IVP and your sonograms. If they are not actually fitted together while they are being done, at least someone must be able to put the studies side by side. Suppose your abdomen sonogram shows a large cyst on a kidney but the IVP is normal. Someone has to decide which study is the more persuasive. Ideally, this should happen as the study is being done.
The doctor who is ordering your tests, of course, will see that your tests are done in a rational and orderly way. If he were to get a sonogram report that said, "Suspect stone in left kidney. Suggest IVP, "he would order," IVP: Confirm or exclude stone is left kidney seen by sonograrn." The IVP report might then conclude, "Vascular calcification but no stone in left kidney." Of course, your doctor might just order "IVP" and the IVP report wind up, "Normal." Whereupon the two doctors might have a telephone conversation, the cordiality of which would depend on their breeding and relative lack of sleep.
Back up at the x-ray end of the hall, they let you into the bathroom remarking, "we'll get a film to see how your bladder empties." You suppress the urge to say, "Why don't you just come in and watch?" for fear they will.
Perhaps they run you upstairs for a quick lunch of liquids, a diet you are becoming familiar with, and then take you down to the imaging department at the nuclear medicine end of the hall for your liver scan. The liver scan, they assure you, is completely safe. There is no side effect to be expected or any sensation from the isotope. Your mind is saying, "They thought Cbernobyl was safe, too."
The technologist goes into a little room where a tiny laboratory is concealed behind lead bricks. There he does a little chemistry. Radioactive molybdenum is kept in a little cylinder called a "cow." The molybdenum is chemically bound inside the cylinder. However, when the moly undergoes radioactive decay, it becomes technetium 99M. This decays to technetium 99, which is a stable element. In the decay, the technetium gives off a single gamma ray which has the same energy of the strongest radiation from an x-ray tube running at about seventy thousand volts. That's right in the diagnostic range. If the gamma ray is released from inside you, a large portion will get out without interacting with you at all.
They will use a dose of about five millicuries, which is enough to give off about two hundred million gamma rays a second. That sounds like a lot over a few hours, but it is reckoned to be very safe. Like diagnostic x-rays, diagnostic radioactive isotopes have not been implicated in causing any known disease for many years, if ever. If it has happened, nobody knows about it.
Hot technetium is recovered from the cow (or generator each morning. For your liver scan, the technetium is attached chemically to a colloid of sulfur. They inject the radioactive particles in a vein using a tiny needle. No odd taste or sensation at all this time. You notice with gratitude the meticulous care with which the job is done. That is so the technologist is sure he is not spilling radioactive isotope all over you. Or all over himself.
After your liver and spleen have had time to filter out the tiny particles, they put you on a table top and aim the gamma camera at you. The gamma camera looks a little like an old fashioned mortar, a kind of cannon with a barrel thicker than its length. It is mounted on a crane that lets it go up and down as well as turn at different angles. Listening to the electric motor that drives the crane, or watching the technologist push the camera around, you get the idea that the camera is about as heavy as a mortar, too.
The reason for the weight of the camera is shielding, lead casing that keeps stray background radiation from swamping the image that is being made. That such precaution is needed should give you a feel for just how little extra radiation you are getting, say the extra radiation you would get from moving to the top floor of your building for six months, or taking a commercial jet across the ocean. The camera is not shooting at you; you are shooting at the camera.
On the very front of the camera is a grid, again to clean up scatter. Right behind the grid is a large disc of sodium iodide crystal. Any gamma ray that makes it past the grid produces a little flash of light in the crystal. The flash is detected by an array of photo cells. A computer rejects all flashes that are the wrong strength for the isotope, "flashes~ that are seen by only one photo cell (electrical static from within the cells), and the computer calculates for the remaining flashes just where the photon hit the crystal. Over five or ten minutes, the computer builds up a speckly little picture of the isotope in front of the camera.
The reason for going through all this, indeed the only reason the imaging department exists at all, is because of one of the most profound and subtle concepts in medicine. The concept is: A disease is in a place. Don't laugh. It is not as obvious as it seems. Again: A disease can be located in three dimensions. It has a top, a bottom, a left and a right; it may be very oddly shaped, may even be discontinuous - many little islands of disease -, but it is located somewhere, and other places it is not.
Remember the last time you had a cold. It seemed that the whole world had gone wrong. General misery was the obvious problem. You hurt all over. Taking thought, you would agree that your nose and throat were worst hit, but nothing felt really good. It was a tremendous problem of abstraction for someone to say, "The disease is in the nose and throat.; the muscle aches and general misery are incidental."
As recently as the early AIDS epidemic, the concept was alinost lost sight of. It became evident the homosexual men were dying of unusual diseases, generally harmless to a person whose imrnune system was intact. Ideas flashed around of germs and poisons. But there was also an undercurrent of suspicion that it was somehow poor mental state, unwholesome emotions, wrong ideas, bad thinking that was at fault. Now we know, we say, "Virus located in the DNA of certain lymph cells." It is now a true "disease" rather than a "syndrome" and might well be called AIDD or some anagrarn.
AIDS is, of course, a very severe test of the concept that a disease lies in a place. In a manner of speaking, AIDS could also be called, "flad information." Once the virus has got into the DNA, it is pure information just as rnuch as the rest of the host DNA. In this case, however, it is intQrmaticn destructive of the very context within which the information itself can exist. That is very close to "wrong ideas."
Your liver scan is based on the fact that normal liver (and spleen) will take up stuff like sulphur colloid. It filters it out of the blood stream. The liver, of course, does a lot of other things. But with sulphur col~oid, the liver just filters it out and holds it. When they have scanned your liver from several different directions, the radiologist will look the scans over and decide if there is a place or places in your liver that are not taking up the isotope. They would be abnormal areas, needing further study or at least better understanding. The liver is thus a "cold spot scan;" it looks for areas where the isotope should be but isn't. obviously, it is hard to spot a cold area in a sea of hot area.
For this reason, occasionally nuclear medicine tomograms are done. The camera is swung automatically in an arc around the person being studied. The computer than does some computations, taking into account the location of the camera as well as the location of each photon in a crystal. In the end, the computer is able to present sectional images, just like the tomograms in an IVP. This may make it easier to see cold spots since there is not a hot layer in front of and behind each one. You might be able to see the holes in a lump of Swiss cheese by holding the lump up to the light, but slicing the cheese is much more effective. It is a good trick, but not as good a trick as you would think. The liver scan is "photon limited." Just enough isotope is used to make a picture in a reasonable length of time without too much graininess. In order to get many pictures, it will either take longer (called taking it out on the patient), or the pictures will be too grainy for confident interpretation (also called taking it out on the patient). Don't feel too bad if they don't do tomograms, but occasionally they are a big help.
While you are lying under the massive camera, you are probably wondering, "I wonder what the last time was they dropped that on somebody?" They didn't. Nuclear medicine technologists are very careful. It comes from working around radioactivity. If a fraction of a drop of isotope gets loose and gets in front of the camera, whether on the patient's clothing or the technologist's hand, the instrument will register it as a plume of light on the monitor screen. The camera never blinks. The technologist learns not to drop things.
Upstairs you go for a night of liquid diet and laxatives.
Some sleepless hours later you are brought back down to the radiology department. They prepare you for your barium enema. First they put you in a gown. Then they put you on an x-ray table and take a KUB film of your abdomen. while the film is developing, you look around morosely and notice an IV pole with a number of enema bags hanging from it. Each bag is filled with a white liquid. You decide they are planning to use one bag for each patient rather than using them all on you.
Presently the technologist returns, announces that your scout film is adequate and undertakes to insert the enema tip. You have probably had an enema at some time or other. You still feel quite undignified at having a plastic tube put up your rear. The technologist inflates a little balloon that helps you hold the tip in but makes it feel like you are about to loose it, then goes for the radiologist. Ideally, he leaves someone to keep you company while he is gone. This does not always happen.
This may be the low point of your whole adventure. Alone in a dark room lying on a hard table top surrounded by strange machinery with a balloon up your tail. Above you is the fluoroscope, a strange contraption that consists of an x-ray tube under the table, and above you a grid, behind which is a protective sheet of plastic, behind which is a screen of fluorescent material, behind which his a sheet of x-ray proof glass, behind which is a snooper scope for intensifying the image, behind which is a television camera for looking at the snooper scope. Also attached is one or more devices for filming the image that the x-ray makes on the fluorescent screen. There is a television monitor in the room that lets one look at what the television camera sees. The whole thing looks for all the world like a hydraulic press, like they used in the old version of the movie THE FLY. Its design prevents it from falling on you, but it does not prevent you from thinking about it. Like the third rail on a subway, the disagreeable thoughts it encourages outweigh its actual threat.
By now, you are wondering if you have been forgotten. My suggestion is to start shouting, "I confess! I'm a heretic. Manichacism forever. I have fasted for days. I have not procreated since I can remember. The world is an evil place."
After all, you may have fallen into the bands of the Spanish JquisAtion. In that case they will only continue to torture you until you do confess. Might as well get it over with. The inquisition was capable of torturing people for up to three days. You are only on day two.
Presently the radiologist arrives. He greets you, says, Sense of Impending Doom, eh?" to make sure he knows why you are getting the study, and then asks you to roll up toward your left.
This you are not about to do.
Last time you rolled to the left they put the enema tip in you-
Who knows what will happen this time.
"Roll up part way onto your left side," he said in a sliqhtly raised voice, as if he thinks you may be hard of hearing.
You slide toward the left side of the table. He drags you back away from the edge. The reason for this diversion is that in most people the sigmoid colon runs from the left lower quadrant of the abdomen generally posteriorly and inferiorly toward the right, with a couple loops on the way. The radiologist is about to fill your colon backwards. The first thing he will see is the rectum, then the sigmoid. Later, after a lot of loops fill, he may not have a good view of the sigmoid because other loops will cover it. So he wants you to start out turned slightly toward the left to give him the best view of the sigmoid. If you start out that way, it will mean that you can spend the shortest time possible with your colon full.
You will have the impulse to ask things like: how long will this take? Do my K-rays show anything? Does your mother know what you do for a living? If you are lucky, he will not be drawn into conversation.
The radiologist tends to be less fit than the technologist. He spends wore of his life sitting stock still in a chair looking at films or reading. On the other hand, he will often have to sling heavy machinery around just like the technologist. The result is that, unless he is possessed of tremendous physical vitality, he will be a scrawny little runt. Nervous tension, physical strain and lack of sleep have burned his flesh away.
You will notice that he tends to talk~very fast. Repose in motion is not a skill he learns. Nor is composure. He is trying to think of too many things at the same time. You will notice another thing about his voice. He tends to talk in an artificially lowered tone, as if he were trying to sound like an airline pilot. (Pilots wrote the book on repose in motion.)
For the pilot, it is a professional skill. You expect that people under stress start talking in a high pitched excited voice. In fact, under stress, the voice tends to get lower and sadder. People who are really scared speak in slow tragic tones. Since the pilot does not want to communicate fear to his passengers, he speaks in deep tones routinely, so you get accustomed to it.
The radiologist speaks in a low tone so he can be heard. As people lose their hearing with advancing years, they tend to lose the high frequency sounds before the low frequency sounds. If you are talking to a deaf person, do not raise your voice to a higher key. That will only put more of your voice outside his range. Drop your voice, loud all right, but with a low pitch. It may not be good for your throat, but it lets you be heard.
The radiologist also faces the two problems that the technologist does; he must make himself heard over the sound of machinery, and he must make himself understood by a person who cannot see him and cannot get clues from eye contact, gesture and lips. So when a skinny guy with a frantic growl comes into the room, you can be pretty sure it is the radiologist.
The pace of the radiologist is different, from that of the technologist. When the technologist asks you to hold your breath, he said, "Take a big breath ... in through your mouth ... now, ho-o-o-o-old it Click. He makes the exposure. That is because he is used to setting up a situation and recording it. He wants to give you time to respond. The radiologist will be using the fluoroscope. He is able to see what he wants a picture of, and he wants to~record it before it goes away. He is apt to say, "Don't breath" Click. You don't have to take a breath. In fact, if you try to, you will probably spoil his film. This, of course, only makes him more frantic.
When your colon fills up, you gotta go right away. At least thates what your colon tells you. when it really means is that you COULD go right away. The moment the barium starts to run in, your colon says, "Let's go." Alas, you have to ignore it until the end of the study. Of course, it should not be painful. If anything hurts, you should let it be known at once; it might be important. Hut generally, the experience is like being stuck on a bus with no bathroom and a mild case of the trots. The experience does not seem so miserable afterwards as it does at the time.
Frequently, instead of using just barium, they will use barium and air. The barium, like IVP contrast material, works by stopping xrays. Unfortunately, the colon is so big that so much barium may be in it that the x-rays can't get through at all. In that case, a film may show the edge of the colon be not the middle part. By coating the colon with barium and filling it with air, certain details may be easier to see. Crucial details may also be harder to see. Also, it takes a good deal of rolling around to get that colon will coated and well filled. You may not be feeling up to all that effort.
After your barium enema, they send you to the toilet to empty your colon and then they take a last film. After all the films have been gone over and judged adequate, they let you 90. often, they may have to reschedule you for a repeat barium enema if the colon was not clean enough.
In your case, we assume that your colon was clean and that it ernptied so well that they are able to do more tests the same day. So they send you to the CAT scan room.
The CAT or CT scan is a computerized x-ray study. Today they are going to study your head and abdomen. After qetting a notion why you are there. sense of impending doom, they have you sit down ano start to drink a dilute barium mixture. This will help the scanner avoid mistakinq a normal loop of bowel for an abnorwal mass. Anything that has bariurr or air in it will be deemed bowel unless there is a reason to think otherwise.
A quart of so of barium later, they introduce you to the machine. The CAT scanner is a great big round thing with a hole in the middle. They put you on a sort of a tray that goes through the hole. It all looks so much like a guillotine it isn't funny. The tray slides you head first into the whole. With relief you find there is no basket on the other side.
You will lie on the tray for quite a while as the tray moves in and out and the machine does it's work. First they will scan your head. Then they will scan your abdomen. Then they will give you intravenous contrast material, the same as with an IVP. Then they will scan your head and abdomen all over again.
The scanner is actually just a super tomogram machine. Around the hole they slide you through is a moving frame. The frame holds an x-ray tube and an array of little sodium iodide crystals, each with its own photo cell. The frame, hidden behind the plastic shroud you see, rotates around the hole. A computer picks up the output from the photo cells and reconstructs an image of what is in the plane of the hole. By sliding you through and taking many images, the computer is able to reconstruct a rough three dimensional image of what you look like to the x-rays.
Although the image is a little rough, seeing details only down to about a thirty second of an inch, it has excellent contrast resolution. It is able to distinguish between things that are oflly slightly different from each other. That is because the computer does not simply blur the information it is trying to remove mechanically; the computer actually subtracts out the unwanted inforration mathematically. The computer, of course, is actually in a different room. You will probably not see it at all.
The whole process is painless, and safe except for the contrast material. Tedium, as often as not, is the worst of it. They ask you to lie still for quite a while.
After the CT scan, they take you for your marmogram. (Assuming you are a woman.) This is a screening procedure most commonly used for overtly healthy people such as yourself. It is a way of picking up carcinoma of the breast at a very early stage.
They send you to the mammography suite where the relevant history, sense of impending doom, is again obtained. You may wonder why nobody ever talks to each other around here. They always want to get the story straight from you. That is because you are the star. Besides, it is a big help for them to know they are doing the right test on the right person.
The mammogram machine uses a special low energy tube with an molybdenum anode and a special compression device. They sit you up and prop your breast on a little plastic platform. They then compress it firmly with another little plastic piece. The low energy tube needs all the help it can get in getting the beam through the tissue. On the other hand, the contrast it can produce and the detail it can resolve are excellent.
Two or three views of each breast are about standard. After that, quite likely the radiologist (usually one you haven't met before) will come in briefly to ask you once again about any complaints and to examine you himself. He does this so as to give himself the best chance to do the best job of reading your study. Do not panic. Just the fact that he walks into the room doesn't mean you have cancer. When you ask him whether your films show cancer, he will be a little evasive. That is because he is not through looking at the films. He's checking you so he can read the films better, and he doesn't want to say the films are normal until he is sure. Bad luck, don't you know.
After lunch, some solid food for the first time in ages, they take you back to the nuclear medicine department for your thyroid scan. The thyroid scan was one of the first radioactive isotope studies to be developed. The thyroid concentrates iodine as part of its normal function. Radioactive iodine isotopes are available. Newly available 1123 has a conveniently short half life and useful gamma ray energy. They give you the isotope and take images of your thyroid. They also estimate the functional state of your thyroid by seeing how much of the iodine dose the gland manages to accumulate at two hours and at twenty four hours.
Between the injection and images and your two hour thyroid scan, they take you back to ultra-sound. This time they will study your carotid arteries, the great arteries in your neck that supply blood to the front part of your brain. The base of the brain is supplied by vertebral arteries that run up a the back of your neck. The vertebral arteries are well protected by little bridges of bone. You would not be able to put pressure on vertebral arteries without using a meat axe. And it is the vertebral arteries that supply the part of your brain that keep you awake. Cats don~t have carotid arteries; they live off their vertebrals and an artery we don't generally have called the trigeminal artery.
It seems most unlikely that a person, at least a young person who was resisting, could be rendered unconscious by pressure on his carotid arteries. The carotids just don't supply the part of the brain that can do that. Squeezing a person's neck is quite dangerous, but mostly because it may keep him from breathing or block his jugular veins, which run right along side the carotids. There aren't any vertebral veins of any consequence. If you block the jugulars, it will cause pressure to back up into the brain, cause edema and tiny little hemorrhages. That can make him unconscious very quickly. A pilot is able to endure far more force doing a loop that makes the blood run away from his head than a loop that keeps blood from running away from his head.
Arteries get atherosclerosis. Cholesterol piles up in the inner lining, which eventually shells out, spilling its contents while the wall beneath begins to calcify. The end result is narrowed or blocked blood vessels and little blood vessels getting plugged. No part of the body (except the surface of the cornea of the eye) can live without blood supply. You dontt want this to happen to your brain, of course.
Atherosclerosis happens to anyone who lives long enough. It happens faster in the presence of high blood pressure, smoking, diabetes, high blood cholesterol, the kind of anabolic steroids some athletes use and the wrong combination of genes. Diet and body weight may also have some influence. One of the characteristic places atherosclerosis strikes is the carotid arteries. There is a big artery on each side called the common carotid, which comes up from the chest. In the neck, each common carotid divides into an external carotid that feeds the face and neck and an internal carotid that feeds the brain. Flow through the external carotid is highly pulsatile. Blood flow through the internal is more nearly constant.
It is interesting to ponder why the blood flow through the internal carotid should be smooth. It is probably because of the skull. As a pulse wave comes up from the heart, the skull does not allow the brain to enlarge abruptly to accommodate the flow. Pressure rises inside the skull, but not flow rate. As the pulse wave passes, intracranial pressure drops, resistance drops, and flow keeps going on. At the point where the common carotid divides, obviously the vessel walls are subject to extreme stresses, dealing with mismatched flow profiles into the branches. It is right at the division of the common carotid that atherosclerosis tends to strike.
Possibly removing the skull would reduce the rate of progression of disease at this point. It is simpler, however, just to keep an eye on the carotids and repair them if they become too narrow.
The ultra-sound technologist places a probe over your neck and gets an image of you carotid arteries, much as was done during your abdomen sonogram. The next thing the technologist does is throw a switch and put the machine into Doppler mode. Now the machine listens, not for the intensity of the returning echo but to the pitch of the returning echo. If the pitch coming back is not the same as the pitch going out, something - blood in an artery - is moving and causing the difference. A careful analysis of the pitch of the returning echo makes it possible to estimate the speed of the moving blood as well as whether it is turbulent from going through a narrowed bit.
The procedure is painless. The machine makes lots of odd little sounds on its speaker is it picks up the variation in pitch of the returning echo. Generally a whoosh whoosh is good but a growl or a hiss is bad.
You go back for your two hour thyroid scan and then back upstairs for another night of liquids and laxatives.
Early the next morning, right after missing breakfast, you are taken back to the radiology department. First you will have an upper CI series. This is a study of your stomach and the first part of your small intestine.
There are as many different ways to do an upper CI series as there are radiologists. In this day and age, it is so common for doctors to look into the stomach with an endoscope that the upper CI (stands for gastro intestinal) has fallen into relative disuse. As with the barium enema, there is an air contrast version. What you are going to get is the classical study.
After the scout film, to make sure all the barium from yesterday is gone, the fluoroscopic table is stood on end. It is the same table you were on for your barium enema yesterday. There is a little foot rest at one end for you to stand on. You stand there until the radiologist scurries in and greets you (Msense of impending doom" "yes yes"), holds the fluoroscope over your heart, turns the machine on, fixes his eyes on the television screen and says, "Turn toward me. I'
At this point, you are within your rights just to turn your head toward him. He then explains that it is your body he is interested, not your head, and if you would be so good as to turn your body at an angle, you can do what you want to with your head. Eyes on the television, he then has you turn toward the left. He is checking for calcifications in your coronary arteries in your heart. It's not that you are more likely to have coronary disease than anyone else, it's just that as long as he has the machine there, he might as well check for you. If there are a lot of calcifications, he will be able to see them.
While you are still standing, you are handed a cup of barium. You think, "Isn't this the same stuff you ran up my ~ yesterday?"
Of course it is. Barium, or rather a water suspension of barium sulfate powder. It is very inert. Non fattening. Doesn't cause pimples or cancer. Not habit forming. Maybe constipating. Remember constipation? That was before they put you on days of laxatives. For the upper CI, the barium is somewhat denser than for the barium enema. It is also flavored, perhaps like strawberries. Of course it isn~t real strawberry, just a mush of coloring agents, flavoring agents, smoothing agents and preservatives, just like everything else you eat.
He has you take a mouthful of barium in your mouth. when he can see it on his screen be has you swallow, and then he watches it as it goes down to your stomach. That gives him a look at your esophagus. Of course, this isn't a formal study of the esophagus, but as long as he has the machine on, he might as well check for you. Carcinoma of the esophagus is notorious for not producing any symptoms unti~ it is far advanced. Naybe, just once before he diesr the radiologist will stumble across an asymptomatic early esophageal carcinoma and save somebody's life. He'll try, anyway. After a second swallow, he will look at your stomach, compressing it to fill out all the folds. Then he will ask you to finish the cup.
At this point, you are within your rights to ask incredulously, "The whole thing?" To which he will probably answer, 'All right. You don't have to swallow the whole cup. Just drink the barium out of it and then gnaw the wax out of the little paper curl ...
He pauses as he detects in your eye the evil light that means you are about to pour it over his head.
The cup down, he gives you a sip of water to wash the barium out of your esophagus. Then he tilts the table down flat. Once more he rolls you toward your left, so as to get a glimpse of the duodenal bulb. That is the first inch of small bowel. It is the most common place for ulcers to form.
Then he rolls you toward the right and gives you another sip of water. This is to make sure that what goes down stays down. If you eat while reclining on your right elbow, like the ancient Romans did, it gives your stomach the hardest job holding food down. The Romans would have been better reclining on the left elbow, so as to have the right arm free and not to throw up. On the other hand, the Romans apparently rather enjoyed throwing up. Takes all kinds of make an empire.
Speaking of throwing up, you are not likely to vomit the barium. It is so heavy that it stays down. This is a little celebrated discovery that was actually made by a cardiologist. He was the same cardiologist who introduced transmitting EKG's from ambulance to hospital by radio, the way they do on TV.
The radiologist then rolls you over into the ever popular RAO position. That means "right anterior oblique," meaning an oblique position with the front right part of you body close to the x-ray film, which ought to be under the table. In this case, it is the x-ray tube that is under the table but never mind. The RAO position is th9 position you put your fraternity brother in if be has gotten sle;epy after a long night of partying and generously cheering other people up. With his face down, he won't choke if he vomits. You see, apparently undergraduates, like the Romans, find throwing up a congenial experience. of course he may wake up with his right arm numb and paralyzed, but at least he will wake up.
When the radiologist is done, the technologist will take a few routine films and let you go. Unless your doctor has ordered a complete small bowel study, in which case you may have to hang around for another three or four hours, getting films every twenty or thirty minutes.
Between small bowel films, they take you back to nuclear medicine to finish your thyroid scan and inject you for you bone scan. Some years ago, they discovered that technetium labeled detergent was incorporated into growing bone. It later turned out that it wasn't just any detergent, but a particular box car load that worked well. By the time they discovered this, the box car had gone the way of dishwashers the country over. Other detergents didn't work. So other agents have been discovered.
The principle is the same, though. They inject you with a radioactive agent that is incorporated by growing bone. Almost any injury to bone will result in an attempt at repair. The repair incorporates more radioactivity than normal bone. The abnormal area turns up, usually, as a 0hot spot." It is easier to read than a "cold spot" scan. It does involve lying on a table while the camera slowly sweeps over and inspects you.
As with the mamogram, the radiologist is likely to come in and look at you before he tries to read your thyroid scan. Thyroids are very variable, and if there is a lump in yours, he needs to know about it and no fooling. Somebody else's sketch isn't enough. He may even want to put a little marker over an area he in interested in and do a scan with the marker in place to help him orient himself to the scan.
Small bowel, thyroid scan and bone scan done, you have a quick lunch and the go out for your NMR scan.
Magnetic Resonance, so called, is one of the newest, most exciting, and most expensive techniques in medical imaging. The principle is that you are put between two powerful magnets. They force the hydrogen nuclei in you body to become oriented with the magnetic field. Then a radio signal is sent in, altering the orientation of those nuclei. As they return to their original orientation, they give off a tiny radio signal of their own. By sending in complex signals, warping the basic magnetic field, and listening to the time, frequency and rate of decay of the return signal, the MR scanner is able to create a three dimensional map that records the location of the nuclei as well as information about the microscopic environment of the nuclei. A hydrogen atom in water is going to act different from a hydrogen atom in fat.
The Np scanner is frequently located in a different building. It is very sensitive to changes in the magnetic field outside itself. When you see it, it looks like the mother of all CAT scanners. It is so big that when they put you in the tunnel you wonder if you are ever going to get out. The magnetic field is so strong that the people who work around the machine cannot carry credit cards. They would be erased.
There is a small, but real, risk that a stray piece of metal may be snatched into the magnet while you are in it. If it hit You, it could really hurt. However, the people who work at the facility kno~~ of the risk and are at great pains to be sure nobody is going to toss a screwdriver into the room.
There is a small risk that if you have metal inside you, say a surgical clip on a delicate blood vessel in your brain, that the magnetic field could twist the clip. They will ask you if there is any chance you have metal in you.
Aside from that, the study is quite safe. It may raise your temperature a degree or so because of the energy from the radio waves. But a one degree fever for twenty minutes will not harm you. The magnetic field itself is not known to be able to to harm to tissue directly. There is no ionizing radiation to worry about. There is no need to use contrast agents that carry any risk at all. Generally magnetic resonance imaging is the kind of safe, sophisticated procedure you would expect from modern medicine. Your only sensation is the sound of the antenna that sends and receives the radio waves. The shifting of the main magnetic field makes the coil go slap, slap, slap against the side of the tunnel. It's not much noisier than an ordinary x-ray filming device in action.
That night, your physician comes by your room. He flips through your chart and says with satisfaction, "There is a mass on your chest film. The CAT scan shows a mass in your pancreas. The mammogram shows a suspicious area in one breast and your carotid arteries have been condemned as a health hazard."
"That doesn't seem possible," you say. It isn't, or at least not very likely, but we will go quickly through some more invasive procedures you may hear about some day.
Your doctor schedules you to have a needle biopsy of the lung, a needle biopsy of the pancreas and needle localization of the breast mass the next day to be followed by an arteriogram some time in the future.
The next morning, you go down to x-ray for your lung biopsy. The radiologist explains that he intends to put a needle into the lesion he can see on your chest film. He explains that the needle may puncture a blood vessel in your lung that may make you cough up blood for a bit. He explains that the needle can cause an air leak so that the surgeons would need to put a chest tube in to draw off the air so you can breathe. He points out that a chest tube is no fun, but if they operate to make the diagnosis, you will get a chest tube for sure. There are also the usual warnings that infection or just about anything else could happen but probably won't.
Next he explains that the pancreas biopsy will be done the same way, only using the CAT scanner to guide the needle. He says not to worry, that although the needle he is going to use is quite long, it isn't very wide. Yep. Long, sure enough. But nooo it's not so wide, not wide at all. In fact, it~s a very very narrow shiny needle, even if it is kind of long. You wonder whether this is supposed to make you feel better or worse.
Next morning, they take you to the fluoroscopy room, where the radiologist puts a needle into your chest, draws back with a syringe, and then helps the pathologist make a couple slides. You are lucky. No air leak. The procedure doesn't take long.
Next you go off to the CAT scanner, where they take a couple pictures for orientation and that long needle is put into the area they were worried about. Again, the pathologist makes a slide or two.
Then you (assuming you are a woman) go to the mammograin room. A film is taken for orientation. Then the radiologist puts a needle where he thinks you may have a tumor. He passes a thin hooked wire down the needle into the area of the lesion, and removes the needle. Then he asks the technologist to take a film with the hooked wire in place. The surgeon, meanwhile, is waiting to operate. He will use the hooked wire to guide him to the area in question. If it turns out to be nothing, the surgeon can get away with doing as little as possible.
The films no longer show the lesion. The radiologist calls the surgeon and explains that it must have been a cyst, a little collection of fluid of no consequence, and it is now gone. Then he comes in and breaks the good news to you. Just a cyst. No problem. of course there is the matter of getting that wire out again. The solution is a modicum of brute force. Still, it's better than finding out the same thing with an operation.
Some day hooked wires that can be withdrawn easily will be available. Some day. But it will still be an imperfect world.
That night your doctor comes by and explains that your lung biopsy turned up a little fluid collection and your pancreas biopsy is negative. The thing the CAT scan showed didn't show up on the magnetic resonance scan, and with a negative biopsy, there is no reason to pursue it further. These modern machines can be misleading, no doubt about it. You are scheduled for your arterioqram the next day to look at your carotid arteries.
Early the next day, the radiologist comes up to your room to talk about your arteriogram. Although you have no symptoms, the Doppler study of your carotids suggested severe narrowing. In order to be sure, be proposes to take a long thin plastic tube, about the diameter of the ink well inside a ball point pen or less, and put it in your fernoral artery. Then he will slide the tube up through your arteries to your neck, where he will inject contrast material and get films of the carotid arteries.
He does it later that day. The whole study takes about an hour. First he numbs up the area in your groin where the femoral artery is with local anesthetic, just like the dentist, and then he sticks a needle into the artery. when he 9ets good back flow of blood from the needle, he threads a little flexible wire through the needle and well up into the aorta, the big artery that runs down the middle of your body- Then he pulls the needle out, slides the needle to the other end of the wire and takes it off. Then he puts the catheter, the plastic tube, onto the wire and threads is up to where it reaches the skin. with a little nudging and twisting, he gets the catheter into the artery, takes the wire out, cleans it, flushes the catheter with clean saline, and then advances the catheter up the aorta and so into a common carotid artery.
When the contrast material is injected, it feels very hot for several seconds. That is simply because of its concentration. Salt water of the same concentration would feel the same way, just like when you get salt in a cut. Modern contrast agents hang more iodine atoms on a single molecule, and thus do not need to be so concentrated. They don~t hurt as much. Anyway, the hot feeling goes away in a few seconds.
The risks of the study include reaction to the contrast, as usual. Also, if the blood leaks through the hole the radiologist has put in your fernoral artery, you can get a really hefty bruise. The problem everyone worries about is blocking off a blood vessel. clot can form on the outside of the catheter, but that is not generally a problem. Such clot is soft and easily dealt with by the body's usual defenses. More serious is the possibility that the catheter bump into some loose calcified stuff just barely hanging onto the side of the artery, causing it to break loose and drift off to plug something. Using soft thin catheters and doing as little as possible reduce that risk.
After the last injection, the catheter is taken out. The radiologist or the technologist presses on the puncture site for ten minutes so it won't bleed while the body sets of a clot to plug the hole. Afterward, you will be asked to lie flat holding your hip straight for a few hours so as not to get a bruise.
That night, your doctor comes by and says, "Arteriogram was all right. Don't know why that Doppler study was wrong. Anyway, everything looks normal so far. Tomorrow I'm setting you up for a myelogram, a gallium whole body scan, a lymphangiogram..."
IDOC, you say, "I feel a lot better. Really, I think I'm cured."
"0? well, I don't see why you can't leave first thing in the morning. I'll check with you before breakfast, and if your leg there feels OK we'll let you go and you can corne see me in the office in a week or two, see how you're doing.
The next morning you leave. Going down the steps, you trip and fall headlong. You try to break your fall with an outstretched hand, but succeed only in breaking your wrist. A few minutes later, as you are waiting for your wrist x-rays to come out, you say to yourself with satisfaction, "See? I told you something was about to happen.
Booty
HIBISCUS
Editor's Note:
WILD SURMISE is an occasional newsletter on speculative matter. This month we are about three weeks behind. The next issue will come out in August. Booty will be talking about values. N will tell another adventure, and Cooter will deliver a sketch and a photograph or two.
The other day M, who is not to be confused with Auntie Em, took the achingly beautiful Wild Surmise official laboratory assistant to a party. They went drag and in blackface. Results were mixed. As "Uncle Joe," the laboratory assistant still looked tender and sweet. N turned out to have a real talent at being a fat, raucous version of "Aunt Pittipat." The prize, however, went to Old Moneybags' old Cadillac, which has turned its speedometer once and half way around again.
So we've talked him into getting a new car. M voted for a Lamborqhini Countach. The beautiful laboratory assistant rather fancied the Rolls Royce Corniche. Cooter thought a Range Rover would be handy for carting about his cameras and paints. I though a top-of-line BMW or Porsche was the obvious choice, while Booty confessed to a craving for a Ferrari Testarossa or an Aston Martin. Then Moneybags allowed as how he wasn't about to put down good money for some foreign car. We huddled again. Booty suggested a Buick Regal. He pulled out a magazine that reported zero to sixty in 5.5 seconds as compared with 5.3 seconds for the Ferrari. Not rnuch difference. In fact, according to the magazine, it looked as if the only tbinqs that could pull away from the Buick were the Larnborghini and the Aston Martin. And a Buick might be just a little easier to get parts for. Not to mention cheaper. It makes you wonder how those exotic cars are able to compete at all. Pity. A Rolls Royce would have looked quite nice with the laboratory assistant in it.
copyright June, 1987, WILD SURMISE
FAMIlY OUTINGS ON PRAIRIE CREEK
Walt
Heraclitus, I have recently decided, must have been an only child, otherwise he would never have said it was impossible to enter the same river twice. His idea was that the river provided an analogy to the flo~ of atoms in the void constituting all of reality, and as that f]ow moves forever onward and never returns upon itself, so the universe passes through continuous changes from one unrepeatable state to the next. The second time you enter the river, neither you nor it is the same.
If Heraclitus had had brother and sisters, or had even reflected with interest on his relationships with his parents, he would have seen that the air of tragic nostalgia clinging about this statentent tripped hini headlong into error. The truth is you can't enter the sarne river once, so there S no point mooning about not getting to do it again.
This was brought home to me on Prairie Creek, which runs south from Newnan S Lake, one of the many medium-sized-to-large lakes that make irregular spots on the map of Central Florida. Newnan S Lake lies just east of Gainesville, Florida, where I grew up with my two brothers and iny two parents.
The first time I attempted to enter Prairie Creek took place when I was eleven or twelve years old; the second attempt took place some thirty-five years later, in March of 1987.
When I was a boy, I formed a vision of a father-and-son fishing trip. In some primordial sense it seemed right to me that a boy and his dad should do sporting things together. I fished a great deal by myself in those days with a cane pole, using dough balls or - better yet - worms scratched from under the jasmine bushes, but these excursions were only warm-up exercises for the man/boy fishing trip of my vision. This trip would involve the mystical high technology of fishing, as I had absorbed it through countless readings and re-readings of the advertisements - and to a lesser degree the stories - in Sports Afield and other magazines of hunting and fishing. Here I feasted my imagination on Shakespeare reels and Pfluger reels - intricate level-winding mechanisms - mounted on Heddon rods, and spinning with noiseless ease as the lure flew forth. Ah! such marvelous lures: the Dalton Special, the Hawaiian wriggler, the Jitterbug, each glowing with its own special charisma.
Of the lures none rivalled the Injured Minnow for fascination and cunning. The Injured Minnow had its treble hooks screwed into the side rather than the belly of the little fish that the plug was m~ant to resemble, so that the bass looking up from its lair beneath the water would see its prey critically weakened and incapable of escape. only the largest and craftiest and cruellest of the bass would perceive this, and shouldering its lesser brethren aside would engorge all three sets of gang-hooks in a single ravening gulp. Such poetic justice! The craft and subliminal cruelty of the fisherman working so as to ensnare a bass whose character recapitulated his own - the fish and the fisherman not only different, but positively at odds, - and yet strangely, insistently at one!
Already you see something of Heraclitus' error. You can't enter a river once because you are already there before you enter it.
My father was immune to my enthusiasm for fishing and hunting, and parried my blandishments with the observation that he didn't have any of the numinous contraptions on which such a venture depended. No rod, no reel, no lures. Somehow this consideration - like the impossibilities checking a quest for the Grail - did nothing to alter my certainty that such a trip would someday take place. And in due course, my father was given as a gift - to repay his teaching the Men's Class at church - a Heddon rod and a Shakespeare reel. All that remained was the purchase of line and an Injured Minnow.
At Jimmie Hughes Sporting Goods we surveyed the great array of plugs, and in the ensuring discussion my vision began the first of several disintegrations. For one thing, my little brother was along. Not my baby brother, then three or four, but the brother just two and a half years younger than me. He was definitely not part of my fantasy, and hi~s role as an irritant became more pronounced as I found myself trying to choose among the half-dozen or so models of the Injured Minnow that Jimmie Hughes had in stock. I was deciding between a grey-greenish one that looked cat-fishey, and one that looked blue-gillish when Little Brother pointed out that we should not get an Injured Minnow at all. "The water is too dark,N he observed. "They'll never see a top-water plug unless it splashes, like a Jitterbug."
He was right. The cypress trees in Florida swamps make the water dark as root-beer.
So I looked about for a Jitterbug, a plug slightly less mana-laden than the Injured Minnow, but still in the literature, so to speak. Jimmie Hughes had no Jitterbug.
Then Little Brother spotted a completely unheard-of plug that looked like a frog and promised to thrash and gurgle through the water. "That will do just as well," he said, and unaccountably my father agreed. Then we purchased an underwater plug that was similarly uncanonical and profane.
When we arrived at Prairie Creek, my father went off to rent a rowboat, while I gazed into the root-beer-dark water. In it I saw the giant crafty bass whose fated conjunction with the Injured Minnow still seemed inherent in the moment. But there were also discrepant bass, thoughtless secular bass that would notice the clamor of the "frog," but only as pointless curious idlers, not driven to attack and engorge prey. They were there too, in an alternative world occupying the same space as Noby-nass.
Boarding the rowboat, we pushed off into the current, which carried us down stream around a bend, far enough so that we could see where the creek became impassible. It ran, actually, into a heavy thicket of swamp, fringed on its upstream side by a wide margin of water hyacinth. It was as though the stream vanished into the cypress trees. Our way of fishing was obvious, then. We would rift downstreanh casting, and then row back upstream and drift again. We had probably one hundred and fifty yards of open water, and soon found that the frog made a bubbling splattering racket when pulled upstream against the current.
I was not surprised when no bass struck the frog, so remote it was from any imaginable scenario of catching fish.
So we tried the underwater plug, and on the third or fourth cast it became snagged on a nameless something deep in the dark water. This was a heart-catching moment, first because of the fleeting hope a bass might have struck, and then because of the dawning awareness of financial catastrophe.
My father bad given a slight lurch, back at Jimmie Hughes Sporting Goods, when it was revealed to him that a plug would cost over a dollar, and he suggested we might use worms instead, of which a day's supply could be had for~a quarter. He had yielded on the
issue of buying plugs (only two!!) in the discussion already mentioned, but not without imprinting on my consciousness the fact that a huge expense was involved - to which I had responded by pointing out that a plug could be used again and again. For years, in fact. As the years passed, the plug would become battle-scarred - as famous as Odysseus' shield with the dints of battle - as an endless procession of mighty fish passed out of the multitude of waters and into our refrigerator.
Now Prairie Creek offered to swallow up this history on its first day, whereupon my father affirmed that he would retrieve the plug by swimming down to get it. The sense of fiscal gravity deepened further, and sour regret began to infiltrate the texture of the day, like a dull stain spreading out through fabric.
My father removed, deliberately and methodically, every stitch of his clothing, so that his body shone very white in the sun1 and then glowed tan as he slipped into the water and began to swim down the line toward whatever it was on the bottom that had claimed the underwater plug as its permanent possession.
In a moment nothing of him was to be seen. There was only the water and the fishing line at a taut angle, and my brother and me left in the boat - long enough for me to feel very much alone, and to have the strangest of momentary visions. I saw three figures standing off in the swamp in dark garments, like monks with their faces sheltered in deep cowls, but evidently looking in our direction with ominous intent. Were they a premonition of death? one for each of us? Were they figures of the differences among us, and of our rivers? Were they figures of my differences from myself and the river's differences frorn itself?
Then the line stiffened and went slack, and a moment later my father broke through the surface and shook his head vigorously to clear the water out of his eyes and ears and hair. He did not have the plug. The line had descended into a tangle of branches, and he had broken it trying to yank the plug free.
"Are those three nuns over there watching all this? I asked as he clambered back into the boat. At this he was greatly amused. In fact the whole situation now lost its gravity "This is ridiculous!" he said with delight. "I took off my clothes so as to keep from getting them wet, and now I can't put them back on, or I'll get them wet doing that."
"This is completely ridiculous," he exulted.
He sat there a few moments gleaming white in in the wilderness, then sponged off with his shirt, put his pants back on and spread his shirt to dry over the prow of the rowboat. Very quickly it, too, was dry.
We cast the frog a while longer, without any expectation of catching fish, but enjoying. the warm sun. And then we went home. We never went fishing again.
In the thirty-five years that now have passed, my father has died. The Little Brother of this story - cultivating his accurate disconcerting counterintuitive intelligence - makes a living in high technology and is a deep student of myth. His name is Marshall. The baby brother, Carlisle, is an attorney specializing in litigation, with a prominent Chicago firm. I myself have learned that my father's approach to the fishing venture, as to many other things, was passive-aggressive. He didn't want to do it, but did it anyhow, but so that how bad an idea it was would be dramatized without his having to say so. Even in his spectacular nakedness there was more of him than met the eye. He hadn't entered the river once, and neither had I. It never came into my mind that I'd get a second chance; I certainly didn't want one.
It took place when I was visiting Gainesville to read a paper at the University. In the planning for my visit it became apparent that my mother had conceived how splendid it would be for us to have a canoe trip by moonlight. This trip was to take place on the Ichtucknee River, where a canoe rental and guide service is available for such outings, and it was true my visit coincided with the full moon.
Both yiarshall and Carlisle were coming for a visit to coincide with mine, but by the time our arrangements were set, the reservations for moonlight canoe trips down the Ichtucknee had all been taken. "I spoke to the Than in charge of the canoes, II my niother reported indignantly, "and I pointed out to him that we could bring our own canoes, and sirnply join in the trip, and I offered to pay him his regular fee," The guide had refused this plan, for reasons he apparently did not explain. "He had a narrow bureaucratic mind," my mother stated, "without any imagination. Anything outside his regular routine seemed completely beyond him."
The obvious reply to the obtuseness of this petty functionary was for us to organize a canoe trip of our own, so by the time I reached Gainesville iny mother had reserved two canoes at the United Rent-All place. We could pick thew up any time on Saturday.
Somehow this whole plan remained indistinct in my rnind until mid-afternoon on Saturday. I had plenty of my own arrangements to look after, what with Gainesville friends and people at the University to see. I had constructed a litt~e calendar of the visit, on which I had placed my engagements, and the arrivals and departures of my brothers: Narshall and his friend Linda were due on Saturday, and Carlisle was flying in Sunday afternoon.
We had a late lunch on Saturday. By that time the calendar was stabilized, and ~arsha1l had arrived, and talk slowly turned to the question of the canoe trip. As I was helping to clear the table, I asked where this trip was to take place, the Ichtucknee now being controlled by mindless poltroons.
"Here is a map," Thy mother said, putting a newspaper in my hand. It contained an article about a patch of wilderness east of Newnan's Lake that had been proposed as an outdoor recreation area. Once fully developed, the park would allow canoeing to take place down Prairie Creek for quite a considerable distance, from the highway that crosses it at the lake to another highway some six or seven miles downstream. But the map did not describe a passable stream currently in existence, only one that was planned.
This information brought me a measure of relief. It dawned upon me as I was carrying dishes to the kitchen that the canoe trip could not take place because there was no place to have it. "We need to consider this whole question of the canoe trip," I said as I returned to the dining room. "Do we really know where we re going to do this?"
Somehow I had expected this reasonable question to lead directly into a prornpt exchange of views between my mother and Marshall and me, in which the impossibility of the plan would become evident.
But that was not what happened. Instead, there ensued a kind of easy silence - as though J had spoken inaudibly, or had not spoken at all. The conversation strayed effortlessly to other subjects, including allusions to the grand canoe trip my mother and Narshal~ had enjoyed in Pennsylvania the month before. Then it was suggested we should go ahead and get the canoes, and work out the question of where or whether to go canoeing after that.
I had been watching the clock during this interval, supposing that the United Rent-All closed at five, and figuring that with luck we'd get there after it closed. Things looked pretty hopeful when we arrived: the yard behind the cyclone fence was deserted, as were the open sheds at the back of the yard.
My mother sprang from the cat and walked down the fence toward a doorway in the adjoining building, and found when she tried the doorway that it was locked. On the door was a notice saying the establishment closed at four-thirty on Saturday, but also was open on Sunday from one to three.
This doorway was not the entrance into the United Rent-All, however, but into a nursery and garden-supply store next door. The United Rent-All doorway was behind the cyclone fence, and I noticed as we walked back toward the car that the gate in this fence was standing slightly open. I further noticed as we got in the car that a man was emerging from the United Rent-All building, with the evident purpose of locking the outer gate and close the place for sure.
"Well! We'll have to come back tQmorrow," said my mother, as I swiftly wheeled the car around so as to screen from view the United Rent-All man approaching the fence.
My duplicity was like my father~s before me, although his involved nothing so perfidious as my conscious effort to deceive. I didn~t want to go on this canoe trip, but didn't want to say so. I just wanted things to work out so that the trip wouldn~t happen. I felt I had gained an ally when Carlisle got off the plane on Sunday; he was unsettled to learn that the canoe trip had not taken place the day before, but was planned for that very afternoon. I did not impart to him my secret knowledge of the fact that the canoes were safely locked up for the weekend, and that only gardening supplies would be available in the vicinity of the United Rent-All place that day.
I had kept this guilty knowledge to myself all the rest of Saturday evening, as we drove through the countryside investigating places to go canoeing. We drove out to Prairie Creek, which was not so broad a body of water as before, though it still ran a hundred yards or so down stream and then turned right to run out of sight into the grey fastness of the swamp. we found the highway crossing it downstream, as featured on the "map" and then found another highway crossing it further downstream.
We had ended our explorations at Cross Creek, a channel that connects Lake Lochloosa with Orange Lake, where there are numerous fishing camps and where the home of Narjorie Kinnan Rawlings still stands, and a restaurant called The Yearling perpetuates her fame. Dining on soft-shelled turt~e at The Yearling, after a crisp rnartini, was as close to the wilderness as I cared to get.
On Sunday afternoon, I went with ~arshall to the United Rent-All place to see about the canoes, knowing perfectly well they would be unavailable and anticipating the realization we had mistaken the garden supply place the day before.
What startled rne was my brother9s response to the eclipse of the canoe trip, once the little tangle of confusions cleared itself up. He went a little pale and pressed his lips together and looked slightly stunned, as though something had struck him in the back of the head. He was, in short, furious. "Cheezes me 0fffl was all he said, as we drove silently home.
Swallowed rage. The moment rerninded me of my father. If I had played his passive-aggressive strategy, my brother here recapitulated his way of giving you a glimpse of apocalyptic fury just as it was clapped under irons.
"Maybe we could rent a canoe from one of those fishing camps down at Cross Creek," I suggested as we drove into the driveway.
within thirty minutes we were all on the road, dressed for adventure, headed for Cross Creek to get the canoes, in two cars:
Carlisle, Marshall, Linda, my mother, and me. By now there were at least five of me - the two were were at work originally, duplicitously subverting the trip, the one who had been called into existence by my brother's anger and disappointment, and two more: one beginning to watch this process as though it were happening to someone else, and another one growing seriously afraid we were going to do this thing.
What were we going to do? We had precious little idea. We knew that Prairie Creek ran east and south, crossing three highways. Of what happened to the creek between those crossing points we knew nothing. At the fishing camp we obtained a crude county map, featuring a border filled with advertisements for cheap motels, auto-parts places, fishing supply stores, and fast-food cattish restaurants in the vicinity of Cross Creek. From that map we learned that between the second and third highway crossing, Prairie Creek ran into the River Styx. Everyone thought this was funny.
Soon we arrived at crossing #2 where we planned to leave one car, so as to drive back to our point of departure at crossing #1 once we had made it down the creek. At this moment, there appeared a slim pale tall young woman wearing sturdy boots and green garments like those of a forest-ranger. She had her canoe pulled up in the grass on the downstream side of the road, and seeing our canoes had walked across the road. She did not speak in a familiar accent - certainly not central Florida. She told us she had paddled down to the River Styx and had come to an impassable stretch, whereupon she had paddled the whole way back upstream. She also had a real wap, showing the course of Prairie Creek down from Newnan~s Lake to the bridge where we stood, thence into the River Styx and Orange Lake. She put her finger on the spot where her progress had been blocked. Nothing on the map indicated a barrier or a patch of heavy swamp intercepting the stream. I considered her slim muscular shoulders and torso, fitting snugly down on hips and steady legs - comparing all this to my own quaking professorial flab - as she gazed at us with quiet green eyes and said, "It's pretty late for you to be starting. I've been on that creek, down and back, most of the day."
"She had forgotten," said my mother triumphantly as we got back into the car to drive to crossing #1, "She bad forgotten that tonight's a full moon."
Carlisle, my brother the lawyer, was always a quiet presence in the family constellation. It frequently happened that my father and Marshall and I would stay at the table after dinner arguing cheerfully and tirelessly about literature, or Sunday's sermon, or some recent marvel of science, only to realize after an hour or so had passed that Carlisle was no longer present. My mother would remain, and joined in the conversation from time to time: but Carlisle without evident uneasiness would simply vanish from the scene. Now he makes his living making arguments: verbal combat is his bread and butter. You can see why I've always had difficulty picturing this.
What were his thoughts now? I knew he was not pleased at the prospect of the canoe tip from the way he responded getting off the plane, and he had joined in my effort to deflect the plan from Prairie Creek when we rented the canoes. Wouldn't it be better, we had intimated, to paddle down Cross Creek from Lake Lochloosa to Orange Lake, paddle around Orange Lake to see if we could locate any of the fabled floating islands there. We had exchanged enough glances to seal our alliance, and also to mark its defeat, as our canoe-laden automobile pulled off the road at the head of Prairie Creek, and we surveyed our fated point of departure.
Below a broad black pool the river passed under the highway bridge and then passed under a railroad bridge that was considerably lower to the water. There was plenty of clearance for our canoes beneath the highway bridge, but it looked as though the lower bridge would block us. Carlisle and I got in one of the canoes to give it a try, ducking low under the first bridge and then carried by the swift stream toward the second. As we approached it we could see there was not enough room and - in a long moment -it also became evident we might be sucked under water if the stream swept us against the bridge. I retain in memory a sharp vision of that molassas-black water, suddenly very close at hand, pouring silently and rapidly past the upright concrete pillars supporting the bridge, passing under the white horizontal of the bridge itself with that catlike force of moving water which is paddled down to the River Styx and had come to an impassable stretch, whereupon she had paddled the whole way back upstream. She also had a real 'nap, showing the course of Prairie Creek down from Newnan~s Lake to the bridge where we stood, thence into the Piver Styx and Orange Lake. She put her finger on the spot where her progress had been blocked. Nothing on the map indicated a barrier or a patch of heavy swamp intercepting the stream. I considered her slim muscular shoulders and torso, fitting snugly down on hips and steady legs - comparing all this to my own quaking professorial flab - as she gazed at us with quiet green eyes and said, "It's pretty late for you to be starting. I've been on that creek, down and back, most of the day."
"She had forgotten," said my mother triumphantly as we got back into the car to drive to crossing #1, "She had forgotten that tonight's a full moon.
Carlisle, my brother the lawyer, was always a quiet presence in the family constellation. It frequently happened that my father and Marshall and I would stay at the table after dinner arguing cheerfully and tirelessly about literature, or Sunday's sermon, or some recent marvel of science, only to realize after an hour or so had passed that Carlisle was no longer present. My mother would remain, and joined in the conversation from time to time: but Carlisle without evident uneasiness would simply vanish from the scene. Now he makes his living making arguments: verbal combat is his bread and butter. You can see why I've always had difficulty picturing this.
What were his thoughts now? I knew he was not pleased at the prospect of the canoe tip from the way he responded getting off the plane, and he had joined in my effort to deflect the plan from Prairie Creek when we rented the canoes. Wouldn't it be better, we had intimated, to paddle down Cross Creek from Lake Lochloosa to Orange Lake, paddle around Orange lake to see if we could locate any of the fabled floating islands there. We had exchanged enough glances to seal our alliance, and also to mark its defeat, as our canoe-laden automobile pulled off the road at the head of Prairie Creek, and we surveyed our fated point of departure.
Below a broad black pool the river passed under the highway bridge and then passed under a railroad bridge that was considerably lower to the water. There was plenty of clearance for our canoes beneath the highway bridge, but it looked as though the lower bridge would block us. Carlisle and I got in one of the canoes to give it a try, ducking low under the first bridge and then carried by the swift stream toward the second. As we approached it we could see there was not enough room and - in a long moment -it also became evident we might be sucked under water if the stream swept us against the bridge. I retain in memory a sharp vision of that molassas-black water, suddenly very close at hand, pouring silently and rapidly past the upright concrete pillars supporting the bridge, passing under the white horizontal of the bridge itself with that catlike force of moving water which is relaxed and gentle until it swiftly and heavily takes hold and crushes you. Our canoe at that moment felt like an eggshell - a long narrow eggshell containing me, my brother and my mother, who at age seventy-six had outlasted by reason of strength her scripturally allotted threescore years and ten. Would any of us survive being sucked under that bridge? would she?
Carlisle and I dug our paddles in hard and moved back from the bridge, quickly losing the canoe into a patch of reeds at the water's edge. The idea now was to take the canoe out of the water and carry it across the railroad-bridge together with the other canoe - and put in downstream. As we tried to stabilize the canoe, my mother got to her feet and began trying to find some firm ground to step out on, as Marshall and Linda hovered close by, offering to help if they could.
Then Carlisle suddenly spoke. "NO!" he said. 'This is NOT a good idea.~' It was to me - to all of us - as though our father had spoken from beyond the grave, with the sudden vehemence that was his signal of assuming unchallengeable command, and in his very phrases. They were phrases oracular, likewise, in their breadth of application - as broad as the canoe trip itself.
"Yes," my mother replied. "Carlisle is right. Let's go back to where we put the canoe in to begin with. We can carry the canoes across both bridges from there."
Once again the question of whethen to do this trip was swallowed up in the question of how, with my mother insisting it could be done as a way of insisting it should be. She was daring us to endanger her life, and daring us not to. Yet an enchantment held me fast, so that I couldn't break out of the rhetoric of what was possible, to take up the rhetoric of what was sane.
fly the time we put the canoes in below the railroad bridge I wasn't there at all. Only the situation was there, rendered uncannily vivid by my unspoken terror. whatever it was we were doing: entering a river, this one or that one, I certainly wasn't doing it. The internal multiplicities had shrieked into an exponential augmentation and the river was so many rivers, more than I can count up even now in retrospect. It was all of the many waters moving under sleep that carry forward the mental life whose source is this family of homebound nomads, so tightly knit and so tightly riven.
Of course I was hoping that, as before, the stream would become impassable just beyond the point at which it turned to the right. That would wake it easy. We would float do~n, then paddle back, congratulate ourselves on having given it our best, and take the canoes back to Cross Creek. Maybe there would even be another martini in this, at The Yearling.
Instead, we found that the stream continued passable around that bend, and several subsequent bends. And then it shallowed somewhat and spread broader, so that the greater share of its breadth ran through heavy underbrush at the sides, with only a narrow channel through which we could direct the canoes.
We were passing now through an open swamp, populated by soaring cypress trees whose wattled trunks were several feet thick and placed fair~y far apart, so that one could see a good distance -maybe a hundred feet, or two hundred feet off into the surroundings. There were also oak trees, a few very large ones but most hardly thicker than your forearm, and I noticed also some ironwoods standing gaunt and solitary surmounted by a scraggy fringe of crooked little branches. There were also various densities of bushy plants, whhich more than once closed across the streant so that we had to push through them, or hold branches back, passing them from hand to hand so they wouldn't snap into the face of the person behind. Carlisle, our mother and I were in the lead canoe, with Marshall and Linda behind.
What could not be predicted was whether the open swamp would condense. It could allow passage to the flow of water - broken into hundreds of streamlets pouring though the closely packed trunks of trees and stems of bushes - and still halt the canoes. If that were to happen, there would be no choice but to paddle back upstream, since there was no shore on either side on which to carry the canoes around an obstruction.
If we were going to be blocked this way, it needed to happen soon, so the paddling back would not be too difficult. After a while, we found an oak tree that had fallen across the steam, and had collected on its upstream side a bobbing margin of styrofoam cups and paper trash. But it appeared there was a passage near the base of the trunk, where it had broken when it fell, or where perhaps it had originally grown with a sharp bend that now permitted a fairly large volume of water to pass over it. And sure enough, our canoes slipped across that spot with hardly a scrape.
By now the sun had set, and darkness began to fill the swamp, and there began twilight sounds - cries of birds settling in their roosts, frogs tuning up, both the piping hylas and the guttural boom of bullfrogs and leopard frogs. We had brought along a pair of flashlights, one for each boat, but their batteries were weak, and it was ordained we should use them only when absolutely necessary.
Our passage now became more difficult, as we found ourselves unable - at times - to pick out the true channel when the stream split around a clump of bushes. Again and again we were compelled to back ourselves out of a mass of roots and bushes into which we had fetched up trying to follow the stream. The vegetation directly overhead now grew lower. Instead of the soaring cypresses, we were over-arched by tall and not-so-tall bushes, so that it appeared wore and more we were passing through a dark narrowing tunnel.
Then we came to another fallen tree, this one without any breaks in the trunk, with the water disappearing swiftly beneath it, as it had done at the concrete railway bridge now several miles upstream.
At the left side of the stream the branches of the tree had fallen afoul the thick stems of tall bushes, through which it looked as though there might be a passable channel, maybe twenty inches across. Hut to get into that channel would require some skill, if it was passable at all, because the main course of the stream would swing the canoe against the trunk of the fa]len tree, if given the least purchase against the stern. Carlisle and I tried it and railed, whereupon Narshall and Linda tried and likewise tailed. On their second try, however, they made it through, with a good deal of scraping and screeching of the canoe against the branches and bush.
So Carlisle and I tried again, and failed. Again and again we failed, poking the nose of the canoe into the gap but then losing control of the stern, which was swept quickly against the fallen tree, so that we laboriously paddled again and again upstream for yet another try.
I looked across the log at Marshal] and Linda in their canoe, and realized we were now separated by? Momentous barrier. Suppose we could not manage to make it through to their side. Could they, paddling against the current, make it back through to our side? Suppose we did wake it through. Would we then be absolutely destined to a downstream course? Were we not already so destined? To these questions no answers were available.
"I'll give this one more try," I said to Carlisle, "and then we re heading back upstream.9t "pight,' said Carlisle, and on this attempt we hit the angle correctly and scraped through.
By now it was dark enough so that branches you never saw swept across your face. The flashlight playing on the water ahead made the channel barely clear enough to follow. "Something just dropped into the boat," my mother said, sounding alarmed. · 'It might be a snake.
"Just sit still," I said. "Nothing can fall into this boat more dangerous than our capsizing it."
This was true. No matter what mess we got ourselves into, we could sit tight - keeping body and soul together through the night - and send someone for help the next day. Unless we got wet. Soaked to the skin the strongest of us would have to keep moving. flow or where I couldn't say, bushes, so that it appeared wore and more we were passing through a dark narrowing tunnel.
Then we came to another fallen tree, this one without any breaks in the trunk, with the water disappearing swiftly beneath it, as it had done at the concrete railway bridge now several miles upstrearn.
At the left side of the stream the branches of the tree had fallen afoul the thick stems of tall bushes, through which it looked as though there might be a passable channel., maybe twenty inches across. But to get into that channel would require sorne skill, if it was passable at all, because the main course of the stream would swing the canoe against the trunk of the fa]len tree, if given the least purchase against the stern. Carlisle and I tried it and failed, whereupon Narshall and Linda tried and likewise tailed. On their second try, however, they made it through, with a good deal of scraping and screeching of the canoe against the branches and bush.
So Car~is~e and I tried again, and failed. Again and again we failed, poking the nose of the canoe into the gap but then losing control of the stern, which was swept quickly against the fallen tree, so that we laboriously paddled again and again upstream for yet another try.
I looked across the log at Marshal] and Linda in their canoe, and realized we were now separated by a momentous barrier. Suppose we could not manage to make it through to their side. Could they, paddling against the current, make it back through to our side? Suppose we did make it through. Would we then be absolutely destined to a downstream course? Were we not already so destined? To these questions no answers were available.
"I'll give this one more try," I said to Carlisle, "and then we re heading back upstrearn.0t "pight," said Carlisle, and on this attempt we hit the angle correctly and scraped through.
By now it was dark enough so that branches you never saw swept across your face. The flashlight playing on the water ahead made the channel barely clear enough to follow. "Something just dropped into the boat," my mother said, sounding alarmed. 'It might be a snake.
"
Just sit still," I said. "Nothing can fall into this boat more dangerous than our capsizing it."This was true. No matter what mess we got ourselves into, we could sit tight keeping body and soul together through the night - and send someone for help the next day. Unless we got wet. Soaked to the skin the strongest of us would have to keep moving. How or where I couldn't say.
The flashlight revealed there was no snake in the boat.
The moon by flow had risen, though we were too deep in the woods for its light to have filtered through to us when it was close to the horizon. But as it rose higher we began to be able to see a bit more, and very soon it became evident that we were running alongside a pasture off to the right. Through the trees you could see the open ground, silver against a dark barrier of forest in the far distance. Our stream, still splaying off into the myriad swamp to the left, nonetheless began to run in a broader channel, and in longer straight stretches, far easier to manage than the tortuous twists and turns upstream.
I learned later that the stream was named prairie Creek because it had run originally into Paynes prairie, along whose fringes there is excellent pastureland, and that a channel had subsequently been cut, connecting it to the River Styx. Irhis had the effect of draining two prairie marshes, the one into which Prairie Creek had emptied and the one from which the River Styx had arisen.
For now, however, I was aware only that we were running by the prairie, and my nightmare visions of trying to walk out of the swamp receded somewhat.
Soon the glory of the Florida wilderness shone round about us. The unfathomable. unorganizable multitudinousness of interrupted shapes and permeable boundaries, vines upon vines upon thickets of bushes and tree trunks; drooping and swaying spanish moss smearing across waving lines of branches; the spongy swamp floor, lovely and watery, receiving the downward plunge of cypress trunks and returning the hooded shapes of cypress knees. The primary elements of air and earth and water being adventitious and trivial interruptions of the overruling amphibious space, or polymorphous humid sensorium, though which grubs and dragonflies and turtles and alligators and coots and gallinules and moccasins, king snakes, redbellied water snakes, and cockroaches, caterpillarsr slugs and snails and water turkeys, herons moles bats manatees foxes coons - uncountable squirrels - crawfish and actual fish: bream, perch, pickerel, shell crackers, shiners, catfish, bassi All these weave joyously their subtle indigenous courses.
From a great distance came to us the cry of a screech owl, not a screech at all but a cavernous reverberant lazy roar.
Across the stream ahead of us, and then beside us, swept a great barred owl in flight, broad wings glinting in the moonlight, carrying the massive body as noiselessly as a comet.
A bit later the stream divided at an island on which there stood a very tall pine tree with an indistinct mass in the topmost branches, which turned out to be an osprey nest, as the two ospreys came wheeling out of it skwawking at us.
By now the pasture to the right had given way to a high steep bank, while to the left of us the swamp continued and then yielded for a stretch to piney woods, the swamp soon after resuming. Now the straight courses of the channel extended five or six hundred yards at a time, so we really had no work to do, but guiding the canoe and paddling when we felt inclined.
But we did not drift easily along1 not at all. Carlisle and I, in the lead canoe, dug our paddles in hard and quickly, propelling us downstream as fast as we could, while Marshall and Linda kept pace behind.
Then I heard a sound which I thought first was a truck on the highway somewhere ahead, except that the sound did not cease. Instead, beginning as a quiet rushing sound, it grew steadily louder until it was fully recognizable as the sound of rushing water.
We halted our canoe and waited for Marshall and Linda to draw abreast. "Sounds like a waterfall," I said.
"That or a stretch of rapids," Marshall replied.
"Totally unforeseen," said Marshall.
Without mentioning the hideous prospect of trying to paddle all the way back upstream we decided to nose the canoes into the bank to the right, and see if Marshall and I could scramble up it, and find a way to explore downstream. We found, in fact, a two track dirt road running down the top of the bank, which was actually a long low dam, holding the creek out of Paynes Prairie in its new channel.
As we walked down the dam in the moonlight, it came to me what a glorious reprise this was of boyhood adventures in the Florida night, better than any number of martinis. Our danger now was of a major inconvenience, not of death in the swamp. We could all walk out by this road.
The sound of roaring water grew louder, evidently coming from a spot up ahead where the road dipped sharply down. When .we came to the place we found a collapsed bridge, with a heavy volume of stream running beneath it, through what was evidently a ruined sluice gate. We learned later that the sluice had been installed to let controlled amounts of the creek run into the Prairie to water pastures, and that it had been dynamited by disgruntled duck hunters trying to re-create their beloved marshes by guaranteeing the gate would never be closed.
We quickly determined it was possible to walk across the bridge -collapsed as it was - by picking steps carefully from timber to timber. What we couldn't tell was whether the whole stream ran through the ruined gate, whether enough remained in the channel to allow us passage.
Back in the canoes we hugged the swamp side of the stream and easily passed the sluice. Our only subsequent surprise took place when a steam entered unexpectedly from the right - possibly the water sluiced out being returned to the creek - and swept us through some riffles where the two currents joined.
Soon we found ourselves approaching the bridge where we'd left the car. "I'm proud of usi" our mother's voice rang out. "We've all done very well."
"I'm proud of us, too," I said, "all except for Marshall. I'm ashamed of Marshall. For getting us into this crazy project."
"You can't say that!" Mamma retorted. Just as much as he did!"
"You went along with it"
"That's true," I replied. "I only raised objections so as to be on the right side of the 'told-you-so' S' in case something went wrong."
with the greatest solicitude and caution my brothers and assisted Mamma getting out of the canoe.
Then Carlisle and I were left to stand guard over the canoes while the others drove off to the upstream crossing to get the other car.
"Can you believe we actually did this?" Carlis~e said to inc joyously.
"Not a chance," I said. "No way did we ever do this. It never happened."
"Completely ridiculous! He cried out gleefully for both of us, as we became our father, exultant in the reckless visionary moonlight.
MILD SUPPRISE
Grandfather's rod and reel are in the closet. The rig is sixty inches long. The rod is pitted with salt corrosion from long afternoons on Pauley's Island. The guides fell off and were tied back on with inconstant technique. The green braided line is still sound, the reel though caked with green is still functional and the torn cork handle is still on~ With a good light and a good eye, you can still make out the word "Sears" on the side of the reel.
Father's rod and reel are lighter, a freshwater rig fifty nine inches long. In contrast to the older rig, it is not gouged or marred, but only shows a patina of long use. A Heddon rod, with guides smooth and clean. A Langley reel not just functional, but oiled and silky in action, as if ready for him to come back and say, "Come on, boys. Let's go fishing." Just enough braided line on the reel to permit a child to make his longest cast, but no more than that, so as to make it easier to pick apart that child's most horrendous backlash.
My own rig, eighty five inches long, a Tacklerama hand made rod with synthetic guides and monofilament wound on a Penn spinning gear instead of reel, looks brand new. It can put the lure far away, even with an inexpert cast. There is another reel still in the box. A gift from Younger Brother.
Over the generations, we have spent more money on fishing tackle and less time using it.
Father used to point out that generally, if you wanted to get away from people you would go up hill. If you were lost and wanted to find people, you would go down hill until you found water, then follow the water until you found people. He learned that as a youth, when he used to take long hikes during summers in the mountains. He would choose a landmark and then try to make a beeline for it, going straight through whatever the hills threw in his way. He had not given up his love of solitary rambles even when we moved to Florida, because after pointing out that you can get home by going down hill, he would add, "Of course that doesn't work around here. A river is just a likely to drop down a hole in the ground."
I don't know how they got to Newberry (that's Newberry Florida, not the older Newberry South Carolina) before they built the Hogtown Creek bridge, but I remember when the bridge was new. The whole family~' went fishing out there. You could sit under the bridge, where it smelled like fresh concrete and the cloth fabric of the sandbags that shored up the approach still felt like burlap, to get out of the sun. We caught a marvelous fish two feet long with a fin running the length of its belly an a fin running the length of its back. It had a serpentine way of swimming, and it didn1t put up much of a fight, for all its size.
Father said it was a mudfish and not good to eat, but we children protested and prevailed, and Mother fried it up in deep batter and served it fresh and golden brown with lemon. The best part of the trip was sitting under the bridge listening to Father tell the story of Bill the coyote, his voice echoing richly in the dark and one of the two cars that passed that day booming overhead. The worst part of the trip was the smell of the fish when we cut into it. We threw it into the back yard, where the dog turned up its nose at it and gave us a betrayed look.
If you follow Hogtown Creek a quarter mile, it goes into a swamp and than vanishes in a sullen whirl pool.
The first bridge we fished near, so many years before that I count it almost myth, was in South Caro~ina. I remember the red clay banks and the smell of the peanut brittle Mother had brought, but I do not remember why we stopped there. Another paternal impulse, I guess. No trip was so important it could not be broken by a short diversion.
Once he took Older Brother and me out fishing on Orange Lake. We were on the lake before dawn, because I remember Father saying that the fish would start biting just as the sun rose. They didn't.
Not that we never got a bite. One we were out on Lake wauberg, fishing with Father's rod and reel. Older Brother and I had exhausted our patience and Younger Brother was fishing. Father, who was rowing, was telling Younger Brother to hold the end of the rod up. Younger firother only knitted his brows and said, "Stuck." Father started to say that he had to hold the end of the rod up so as to keep tension on the line. Otherwise, if a bass struck, it would be able to jump out of the water and throw the hook. At that moment, the prettiest bass you ever saw broke from the surface, plug hanging from its lower lip. Father, who could move faster than anyone I have ever seen, shipped the oars and scrambled over to take the rod, but the fish was already free.
Father would turn up from time to time with news of a pond he had discovered often many many miles from town. I noticed when I washed the car that although the car never had mud on the outside, there was invariably a half inch coating of mud on the bottom and inside the fenders. when I asked him years later whether he had spent afternoons exploring, he said it was~so long ago it was hard to believe it at ever happened.
I tried his trick of getting un-lost a couple times. Once, coming down from the top of Hen Lomond so early in the season there was still snow at the top, I began to loose my way in the gloaming. I went down until I found a burn, which I followed. The burn ran into the most beautiful mountain glen, a small tarn filling the floor and the sheer mossy sides growing dark in the twilight. At the end of the narrow crooked glen, the tarn spilled off into a waterfall. The only way out was up.
Another time I had got lost in Baltimore. This was during the Watergate crisis you may have read about in the history books. At that time, the president was wide~y suspect but untouched by evidence. The vice president, however, was under fire from the press. In fact, it seemed like the whole world was ganging up to drive the vice president out of office. I had got lost as I was trying to pick my we west across the city late in the day. I decided, "I'll just 90 down hill until I get to the harbor. Then I'll know where I arn." Downhill, in this case, was left.
When the light changed, I started to make my turn, but another car coming the other way blocked me. I slowed. He slowed. I moved. He moved. I pulled well into the intersection and stopped. He stopped. There was now no way I could get in front of him and no reason for him not to go about his business. Lost, with the sun in my face and an idiot on my hands, I pulled my little sports car up until we were side to side, his big sedan looming over me. I folded my arms over my door and leaned my chin on them to indicate that I had all day to listen to him explain why he was acting in such an exasperating way. Then I saw that he was laughing. when he got control of himself, he said, "You can't turn." Sure enough, it was a one way street. I block away I could see a wall of traffic sweeping up toward us. I stammered my thanks and went my way. One thing I noticed, though. Either it was a double, or the man was Spiro Agnew. Vice president of the United States. Not sufficiently ruffled by events to miss a chance to help a stranger or laugh at harmless confusion.
So the principle, "Co down hill and follow water," had not served me so well as it had served my father hiking in the Carolina hills.
Older Brother, of course, was the explorer, the hunter, the fisher. But Father was the organizer of expeditions. The day his Sunday school class gave him the rod and reel I still have, he took us out to Prairie Creek to fish. We parked the old Studebaker beside the road and rented a rowboat. We had a yellow surface lure that wiggled its hips in the strong dark current in a way that delighted Father no end. There was an underwater lure, too.
The first time the underwater lure caught a snag, Father stripped down to the buff and hopped in to get it back. Older Brother, his sense of decorum evidently strained by this display of devil-may-care-ness, suggested that a couple nuns either were or would be crossing the nearby bridge any minute. At that Father laughed so inordinately that I had to ask what a nun was, and why it was so funny.
On the next cast, the plug caught again. Father cautioned not to break the line, but calling on muscle instead of brain, I gave a heave and the line parted. This time there was no recovering the lure. I suspect my father never quite forgot that. I really did not realize how important the line was in getting the plug back. when we got back to the car, it had got so hot inside that a little thermometer Father had clipped to the visor bad burst.
A few weeks ago, we decided to have another go at Prairie Creek. It was Mother's idea. She had wanted to go on a guided expedition down the Ichtucknee, but there was no opening, so she had learned about Prairie Creek and thought it might be passable. It seemed like a pleasant idea, particularly since it might include Younger Brother. By being youngest, Younger Brother had been on slightly fewer expeditions. We had done many things together, he and I, but I have always felt I was not so successful as a big brother, and had stirred up rather fewer adventures than Younger Brother deserved, certainly nothing like the number I had been permitted to tag along on.
I felt canoes were rather my field. Once one had decided not to tip the canoe over, the craft is stable, safer maneuverable, shallow draft, dependable, rugged, capable of huge loads and unlirnited distances. It requires more attention than a rowboat, but makes up for that by being lighter, prettier and able to go more places.
We scouted the creek. We found where it crossed Hawthorne road, then drove a mile east, took the first right, went south a couple miles, took the first right, went west a couple miles, and there was the creek again. Dark, swift, adequately deep. Since there are no rocks in the area, and since you can't have a waterfall without rocks, the stream seemed perfectly safe. The weather was crisp and dry, so snakes would not be basking in the branches, and gators would stay in their mudholes. Recent rains had swollen the stream beyond all threat of being mired or seriously impeded by water hyacinths. "Duck soup," was my conclusion.
We had a modest amount of to-do finding canoes, although no more than is usually the case in such expeditions. And we had some false starts actually getting the boats loaded, into the water and off, although rather less than is usually the case. Throughout the preparations, Older Brother maintained a lightly mocking disparaging attitude, which was his trademark as a child, and which he now employed far more subtly and more pervasively. Pemembering how much he had loved the woods as a youth, I felt confident he would be an invaluable asset on the trip however he bad mouthed it before. Younger Brother took it all as being very serious. Grim determination to put the event behind him contrasting with Older Brother's light hearted superciliousness.
So it was the one cold evening in late winter, we started out on the creek. Younger Brother in the bow of one canoe, Older Brother in the stern, Mother between. Lin took the bow and I the stern of the other. The others took the lead. As the light ebbed, our course coiled through a jungle of cypress and oak, untouched by change since the last of the great beasts were destroyed by savage hunters before the dawn of history.
Younger Brother handled his paddle with one hand and plied his paddle with the other. Older Brother paddled with one hand and ate a chicken sandwich with the other. From time to time one of them would point out that the whole expedition was complete lunacy and we ought to turn back before the boogy men or some other unspecified calamity snuffed us out. Lin and I paddled slowly backwards against the current so as not to drift down on them.
By last light of dusk, we came to a fallen tree that Older Brother pronounced completely impassable. He invited Lin and me to pick our way around to the right, where the top of the tree lay on visible mud. Shallow draft though a canoe is, it needs a little liquid under it, and we could not pass. We tried going around to the left and on the second try picked our way through. We then spent a few minutes watching my two brothers attempt to make the same passage. Each time the current, which ran ring under the trunk of the tree that spanned the stream, would sweep them off their course. Each time Mother would squeal with glee, Older Brother would shrug helplessly and Younger Brother would start aggressively to claw the way back upstream for another try. By the time they were through, it was dark.
Now Younger Brother, taking the lead again, handled both paddle and flashlight. I doubted we would make it past another obstacle without a mutiny. But presently we came to a pace lightly choked with water hyacinths. Lin and I bulled our way though and found the river beyond to be wide and clear again. My two brothers, who have never lacked brute strength, followed. After that, there were no more obstacles.
I asked the others to go first again; we were probably close to being through, and I didn't want to spoil their adventure by leading the whole way. At times we went through deep swamp. At times skirted beautiful moonlit prairie. Night creatures passed, animals I could not identify but that I knew Older Brother would not only identify but could give the scientific name for.
And then the river stopped. Just like that. No more river. It emptied out into a quiet lagoon. At the edge of the lagoon something was making the distinct sound of falling water.
I remembered my father's words, "Of course in the part of the world a river is just as likely to drop into the ground." I tried to swallow a large lump that had not been in my throat before. Older Brother quietly took charge.
"M, put your canoe against the bank. Let's explore this."
Who could resist? Here was Older Brother, inviting me once more on an explore and an adventure of his own design.
Lin didn't much like being left with the canoe, but she didn't object. Younger Brother and mother stayed with the other canoe a few yards away. Older brother and I scrambled up the steep bank that formed one side of the lagoon. The bank, once we reached the top, was a high flood control dike. A disused dirt road ran along its summit. The dike was pierced ay a tunnel above which was a bridge, now long since fallen in ruins. With a roar like a subway train, the river was sluicing through the tunnel to burst out on the other side of the dike and wall into the marshes of the prairie, where it vanished unseen among the marsh grasses. The sense of age and decay were awesome. The bridge might as well have dated back to Ur of the Chaldees, so thoroughly had it reverted to the marsh. The road, even though passable, could not have been used for a like time, for the bridge was not passable, save by footing it nicely from beam to beam askew.
I could see nothing for it but to turn back. Toil our way back up a river we had spent two hour descending, and return home about at day break, tails between legs.
Older Brother said affably, "I suppose they've just diverted a bit of the river into the prairie. We can go on down stream.
Now there are three things rivers don't do. They don't run up hill, they don't cross each other, and they don't divide as they go down stream. Sure, rivers divide at a delta where they reach the sea, but there the current flows both ways with the tide. Yes there are temporary islands. nut one way or another, there is a path of least resistance, and the river is going to follow that path. Even if the tunnel had been meant to drain a little water into the prairie, it had obviously been destroyed long since. The water could only be going one way.
That was what the swamp was telling me. It was obviously telling Older Brother that things were quite all right.
We went back to the canoes, where the others were happy to see us. We passed the tunnel and started the length of the lagoon. The lagoon ran straight, clear and wide in the moonlight, with stra*ght sides and trees looming up as if it were a formal garden. Lin and I took the lead, slicing silently through the dark, I expecting to come to a dead end at any moment.
Preoccupied with the thought that we were going to have to go back up the river, I did not notice we had got in a race. My two brothers were trying to overtake Lin and me. When they would get close, she would put an an extra burst of speed. As the boat sped up, of course I would paddle faster too. They would then veer to one side and fetch up against the bank. Lin would rest her paddle until they made another attempt. It is a big help in a canoe if you can keep the thing straight.
We never got to that dead end. Instead, we reached a rapids. The lagoon was spilling gently over into another river. We called back for the others to follow us through the rapid water and wereswept down a clear swift current~ Not a quarter mile later, we rounded a bend and found the waiting car.
M 