The Two Kinds of Decay

More Tests

For a nerve conduction velocity test, electrodes are stuck to the skin above the tips of the neuron in question. Then electric shocks are delivered directly to the nerve cells. You lie there and get shocked. You know the shocks are coming. It’s simple.

The shocks start small and get bigger. There is a break of one second between one shock and the next.

For the first few series of shocks, you think it wasn’t so bad. Even the strongest shock isn’t enough to make your whole body seize. If it’s a leg nerve that gets shocked, the biggest shocks will only make your leg thrash.

That’s the whole first part. It lasts an hour or less to test three or four nerves. And while the discomfort is unrelenting, the pain is not excruciating.

An electromyogram is more or less the same — electrodes delivering shocks — but with sensor needles in the muscles that those nerves innervate. So it’s the same shocks, but you must keep the muscle tense while the shocks are delivered to the nerve cells and while a needle is jutting out of the muscle.

The technicians always ask whether it’s your first EMG. If it is, they say it’s all right to cry. And maybe they’ll add that men cry more than women, or that a great big juiced-up guy from South Boston is more likely to cry than a librarian from North Cambridge. Or that people who try hard not to cry are more likely to cry than people who are open to the possibility that they might cry. The EMG technicians watch people get tortured all day, but it is hard even for them to guess how anyone will hold up until the actual breaking point.

I got through my first three EMGs without crying. Each one got easier.

But then one day, when there were no lab technicians available, a doctor administered my EMG. He could deliver the test as well as interpret the results, right there, while the data from the first shocks showed on the computer screen.

And I asked him what the data looked like, and he said the data looked bad. My nerves’ conduction velocities were slower than they’d been the last time, and their conduction block had increased. The antibodies had destroyed more myelin.

And right away I knew I would need to get a new central line implanted and have my plasma replaced again, and I also knew that each time the myelin was stripped from my nerves, it was likelier to grow back imperfectly, and that I was likelier to lose strength and sensation permanently.

It wasn’t the EMG but the bad news that made me cry. It’s probably best to have an EMG while someone’s opening your mail and finding that you got into college, or while you’re watching the right lottery numbers appear on the television screen.

If you start crying during an EMG, you can pretty much forget about trying to stop crying until the test is over.

I’d guess that if you get a dozen EMGs in your life, it’s likely you’ll cry during at least one of them.

I don’t know any other hospital procedure that makes people cry as reliably as an EMG except the test of the blood’s clotting agents, when you just sit and bleed from a puncture wound, and the blood drips until your fibrinogens and platelets create a barrier to the bleeding, or it’s decided you’ve lost enough blood that it’s certain your fibrinogens and platelets aren’t going to be able to stop the blood, and then the test is over.