The following is an excerpt from Belt’s forthcoming The Pittsburgh Anthology.
By Eric Boyd
“This is just a simulation, but you’ll lay there in the bed, and we’ll slide you into the tube,” the technician points at the fMRI bed and motions for me to lay. But it’s not a real fMRI, it’s just a big, cheap-looking model of one. I lay and look up at the ceiling: fluorescent light boxes, but with these faded stickers of plants and flowers on them, as if that will make the environment more pleasant; instead, the room is filled with strange, uneven light. “So you know is just a big magnet that takes pictures of your brain, yes? Have you had an MRI before?”
[blocktext align=”left”]In Pittsburgh, people are pretty well-known for giving up their sweat and tears for an honest buck.[/blocktext]I nod vaguely in no particular direction. I am too embarrassed to say I’d had one the day before, for a different study.
Over the last couple of decades Pittsburgh has dedicated itself to technology, and nowhere is that felt greater than at UPMC, Pittsburgh’s not-for-profit-but-for-profit mega-hospital. Between them and the nearby Carnegie Mellon University, the Oakland area of Pittsburgh is filled with colleges studying various fields of science with state-of-the-art equipment. UPMC, being the medical school of Pitt University, focuses on every aspect of human health, from cancer treatment to stress management. Most of these studies need human research participants. That’s where I come in: I’ve done dozens of research studies over the years as a healthy patient. Anytime anything is studied on anyone, I can typically be part of the control group.
Here’s a couple I did:
- A study on the effects of irregular sleep on veterans. For this, I spent the night in UPMC’s Western Psych mental hospital, and was only allowed a half-night’s (four hours) of sleep; then took a series of tests in which I had only split seconds to make decisions. If I made a wrong choice, I was shocked by a small electrode attached to my left index finger. Paid out: $275
- A study on opinions of health. For this I had to share my thoughts on different situations and which outcome I’d prefer; for instance, if I were crippled, and had a 50/50 chance of a full recovery through a radical procedure, would I take it, or would I take a 90/10 chance at a partial recovery that would leave me with a noticeable limp for the rest of my life? Other topics included: would I rather be depressed or unhappy? Would I rather be bored with my life or feel helpless? Paid out: $35, plus $10 in travel expenses.
Here’s a couple I didn’t do:
- A study on genetically modified cigarettes. For this I would have spent one week in a hotel, unable to leave my room, and allowed to smoke as much as two packs a day. There was a 50/50 chance that the cigarettes were normal or that they were modified to contain no nicotine whatsoever. I am not a regular smoker, so I took it up for 2 weeks before the study called to see if I qualified. The morning before I had to go in I took some nicotine lozenges I’d gotten from a friend. Still, there was not enough nicotine in my system. Would have paid out: $500. I got $5.
- A study on bipolar disorder in which I would have had to ingest a small radioactive tracer that would map my brain for the sake of a PET scan; the radiation would have been in my system for roughly three hours, total. I asked the study’s principal doctor how much radiation was in the tracer; he informed me that it was equal to the amount of 25 X-rays. I was still interested, but I think maybe I asked too many questions. Plus my EKG was fucked. Would have paid out: $800. I got $200 for doing the first two steps.
In Pittsburgh, people are pretty well-known for giving up their sweat and tears for an honest buck. Once the mills went out and science came in, I guess it was only fair to stay on that track, so a part of me is proud to say I’ve given up nearly every other bodily fluid imaginable. I think I even gave earwax once. No kidding.
Anyway, I’m on the fake fMRI table while this technician tells me everything I’ll have to do. I grumble, “yes, I understand” every few moments and pretend to listen. The study I’m getting ready for is a joint effort between UPMC and CMU — the scan is going to be on CMU’s campus in the middle of Oakland — and it’s on emotional responses in healthy people versus depressed people. I’m not sure what any of that means, but I signed a bunch of stuff that might have explained it. All I know is they didn’t have to draw blood, which is the only thing I typically ask about; I donate plasma across town, on the North Side, twice a week, and drawing blood right before one of those days puts me at a pretty big risk of blacking out. But I eat plenty of eggs and red meat, so even when that does happen, I’m fine.
We finish up discussing how to take an fMRI and, again, I choose not to say I’ve had maybe ten in the last two years. Why bother. Most of these studies are run by grad students who get refreshed every few months. I rarely see the same people twice. I get up from the bed and we go to where the real equipment is. I change into some Prince-purple scrubs and put my clothes into a locker; from there, I head out to a hallway, where another technician leads me to the fMRI machine.
I’m given ear-plugs, and as I’m being told how to put them in I pretty much give myself away by doing it in five seconds flat, exactly the way I’ve been instructed to before.
“I suppose you know what you’re doing,” he says with a smile.
That’s good, I think. At least he doesn’t care.
“Alright, now put your head in here and we’ll secure it with some foam.” He wedges soft, gray blocks between me and the headrest; from there he places a mask over me that makes me look like a cross between vintage Iron Man and Hannibal Lecter. Through the mask all I can see is a mirror that directs my eyes to a computer screen behind me. A palm-shaped controller is strapped to my right hand, with buttons for each finger. In my left hand I’m given a cord with a squeeze-ball on the end; I am to squeeze it in case I freak out. Suddenly I feel myself wheeled into the magnetic tube of the machine and I can see that the room is now dark. All of the doctors and technicians are in the next room, viewing me through a window. Many people are bothered by fMRIs, but I’m not. I like small spaces and, for whatever reason, the loud, grating noises of the machine are soothing to me. It’s both random and predictable, a steady loop of different patterns.
Click click click. Ka-kakaka. Click click click. Vrmm, bah, vrmm, bah, bah.
[blocktext align=”right”]The idea of viewing these things for a few dollars doesn’t appeal to me much, but making a living from hard things somehow seems correct in Pittsburgh.[/blocktext]The sounds are like a factory, like something’s happening. I can only imagine Pittsburghers past sleeping to these same sorts of noises every night while the blast furnaces erupted.
Before the scan starts, a voice comes on through a loudspeaker. “Hello, for this study, you know that we’re looking at how people can control their emotions; for this, we’re going to have you use some images. You’ll see one of two prompts on the screen for each image. One will say, ‘look,’ in which case you must simply view the image on the screen. The second option will prompt you to ‘decrease,’ in which case we ask you to think of the most positive aspects of the image on the screen. For example, you may see a startling image in which shocking things are happening, but perhaps it appears staged; in that case, you’d simply think of that instead of allowing the content of the image to upset you. Do you understand?”
I don’t remember any of this being described. In fact, I’m sure it wasn’t. But I’ve done plenty of these studies, and I know they like to throw curveballs now and then. Like for that sleep study I did, I was told that I needed to make the correct decisions during the tests I was taking, or I wouldn’t be paid as much; at the end of it they explained that was just a way to stress me out and see how I could react under pressure. Not a big deal.
I actually have to stop myself from laughing because this guy sounds so Yinzer it’s hard to take his medical instructions seriously. It’s more like, “You’ll see one’a tah prompts’n the screen.” I expect him to break out into a Pittsburgh’s Goin’ to the Super Bowl chant at any moment. But I say back, “Sure thing,” and wait.
A few moments pass and the machine begins its scan. The usual machine-sounds and gentle vibration that comes with it. It’s like a giant cradle you can’t have metal around. After a minute the computer screen blinks on; it takes my eyes a second to adjust. It’s just black with a small X in the middle. Then the words, “Are you ready?” appear. It counts down 3, 2, 1: “LOOK”.
A photo of a pleasant old lady comes up on the screen and stays for maybe five seconds. The screen turns black again. That wasn’t so bad.
Then, “DECREASE”: A photo of a woman being raped at knifepoint by a man with panty-hose over his face. The photo looks like it’s from a very bad ‘80s slasher flick, so I think to myself that it must be. Gruesome stuff, but definitely phony.
“LOOK”: a beautiful Italian market, cobble-stone streets and hams hanging from window displays.
“DECREASE”: an African boy whose face is covered in flies.
“LOOK”: a bored child looking off into the distance.
“LOOK”: a man being car-jacked.
“DECREASE”: a family having a picnic.
“LOOK”: a woman being slapped across the face.
“DECREASE”: a mass grave, the bodies covered in white powder.
“LOOK”: a large, bloody ass that may or may not have been getting a skin graft.
It goes on like that for nearly an hour. Some of the images fake, most of them real. I tell myself that, if I see someone with a knife in their head, it’s okay because they appear to be on a stretcher so they’re probably going to a hospital. With others, like a man carrying the body of a bloody, dead boy, I have few good things to think of. I consider the squeeze-ball in my left hand, but this scan is worth $125. I hold on.
The idea of viewing these things for a few dollars doesn’t appeal to me much, but making a living from hard things somehow seems correct in Pittsburgh. In this town you don’t ask too many questions: you just do what must be done and get on with it. It’s easy to fall into self-pity, and I’ve come close, but never for these medical studies. I was more depressed when I was a portrait photographer at a local Wal-Mart or a cashier at a Rite-Aid. I felt no satisfaction from that work, but at least, with the studies, I can tell myself I may be helping someone, somewhere. I convince myself of this, anyway.
I say, “Okay,” and try to rest.
Click click click. The machine rocks slightly and I feel myself ready to fall asleep. Then the screen comes back on. Is this a trick? The Warner Bros. logo plays and I see that a movie is about to come on. And no shit, it’s Willy Wonka and the Chocolate Factory. This must be some ploy, I think. I’ve heard of playing movies during the last leg of an fMRI scan just so you have something to do while you’re in there, but Wonka? Of all the films in the world, that one must be up there for just screwing with your emotions. It’s funny, frightening, and sad. The movie plays for nearly 20 minutes and shuts off in the middle of “Cheer Up Charlie.” I never even get to see Willy Wonka.
The lights come up, the bed retracts back out into the room. I get up, take my ear-plugs out, and change my clothes. Nobody tells me what just happened. The first technician, the one who went over the fake fMRI with me, loads my money onto an ATM card which he says I can make one free withdrawal from at any PNC bank. He mentions nothing else so I finally say, “What was all that?”
He seems awkward. “Yes, I’m sorry. Most of that was hidden from you when you signed up for this study; we couldn’t explain the types of things you’d be seeing or you’d have too much time to prepare yourself, mentally. In order to get the most visceral responses possible, we had to kinda blindside you. I’m sorry.”
[blocktext align=”left”]I’m normally a pro at this kind of thing. I don’t ask questions. I just do what has to be done and get on with it.[/blocktext]“Well, that I get,” I said, “but what about Willy Wonka?”
His face is puzzled. He mouths the words. “Oh! The film. We usually just ask the patients if they’d like to watch something while we run the last structural scan.”
I cock my eye. “Nobody asked me anything.”
“Well, I’m sorry for that. It wasn’t a part of the study, if that’s what you’re thinking.”
“I’m not sure what to think, but alright. Thanks.” I leave the room, the building, the campus. All of this weird stuff they do with machines and technology. I’m not sure what to make of it. Was the chocolate factory supposed to be some weird way of triggering something about childhood memories? Perhaps of the old Pittsburgh? My mind reels. The images of wounds and bodies won’t go away. I’m normally a pro at this kind of thing. I don’t ask questions. I just do what has to be done and get on with it.
I feel sick; then I look at my watch: a quarter till five. The plasma center closes at six and, this being my seventh visit of the month, I’ll make an extra $20. There’s no time to be sick now. I head out of Oakland and start walking towards downtown Pittsburgh to catch the T to the North Side.
Eric Boyd is the editor of The Pittsburgh Anthology. He has lived in and around Pittsburgh most of his life and is currently writing a short story collection based in Homestead, PA, called Brownfields. His writing has appeared in, among others, Prison Noir (Akashic Books), Words Without Walls (Trinity University Press) Guernica, The Offing magazine, PEN America Journal, and Fourth River. His blog is over at EricBoydblog.tumblr.com.