The RAI Scan: Radioactive Iodine for Thyroid Cancer

The RAI Scan was Not What I Expected.

This is the one process I have been through that I didn’t research prior to experiencing it. For some reason, perhaps related to the sludgification of my TSH-deprived brains, I decided this scan would be like all the other x-rays I’d had of late. I would wrap heavy aprons around my abdomen and be asked to twirl a few times. Nope. The RAI scanning machine or “gamma cam,” looks and operates like an MRI machine. A whole-body immersed in a small white tunnel kind of machine. This can be a bit intimidating, especially if you are claustrophobic (I don’t think I am, but I have always been wary of tanning beds and I did panic a little that time I got stuck in a tiny dressing room with a too-small dress pinning my arms to my face).

What the RAI Scan procedure is like.

I arrived at the hospital in a “work out” outfit as requested. You are not supposed to wear anything metal (normal bra straps/hooks do not count; I asked). I waited while they “warmed up” the camera and drank the bottle of water that one very confused or mischievous tech told me to drink before my exam. Since the test requires absolute stillness for about an hour, drinking a full bottle of water beforehand is not the smartest idea.

I was then escorted into a large room with an automatic sliding wall (awesome) by a different tech who asked me if I needed to use the restroom. When I held out the empty water bottle and explained that I had finished it as instructed, he responded “they shouldn’t have done that” quite sternly, and began to watch me as if I were a trembling puppy sitting on his million dollar piece of equipment.

The room was completely empty except for this large, white, coffin of a machine. I placed my purse on a chair and laid down on the bottom half of the machine. A pillow was placed beneath my neck and shoulders so that my neck would project as far upward as possible (not terribly comfy). The lower half of the machine (much like an exam table) slid back inside the tunnel and raised me until the top half of the machine was approximately an inch from my face. I was then asked to lie perfectly still for 45-60 minutes while the machine moved me in small, extremely slow increments and took pictures of me.

That is what physically happened to me. What psychologically/emotionally/spiritually happened to me is a stranger story. Even though I can ride in elevators and smart cars without breaking out in a cold sweat, I am not a huge fan of staring at a wall one inch from my face. So three seconds into the procedure, I closed my eyes. Since I was going to be there a while and needed to keep myself from fidgeting, I began to count. This is usually very therapeutic for me in scary situations, but I was feeling increasingly alone and sorry for myself. So I began to pray; again, something therapeutic that helps me get through anxiety-provoking situations when otherwise helpless.

I have been to yoga classes and camps where they ask you to meditate. They would warn us that we might cry at the end of a session, that it was perfectly normal to do so, and I would think “Because we are in a room full of mirrors?” I think it is this focus on external self that has kept me from successful meditation. I was always far too focused on how I looked in yoga pants or what the people near me were thinking or doing to ever really connect with myself on a spiritual level or to silence the incessant “to-do list” dialogue in my brain. 

At some point in the gamma cam I allowed my mind to wander and, inevitably, it walked straight up to the image of me lying in a coffin and tapped it on the shoulder. I started thinking about death and funerals and out-of-body experiences. Not comforting. Rather than dwell on my own demise, I went to my memories of my grandfather’s recent wake, the first time I’ve seen the body of somebody I loved. I remembered how outraged I felt when I saw him. How I kept glancing at the body out of the corner of my eye, refusing to look at it directly, feeling lied to, betrayed. How I kept thinking, “That is NOT my grandfather,” and hating everyone in the room for pretending it was.

And this is where I ask you to suspend disbelief: I started having a conversation with my dead grandfather inside the gamma cam. I’m not claiming any kind of medium abilities and I can’t really say it was my grandfather. It was more like, in a moment of complete stillness and silence, my mind was able to piece together all the things my grandfather used to say to me when he was alive, and constructed a new conversation out of it. It was as if I knew exactly what he would have said to me had he actually been there. How he would have comforted me, what his hands would look like wrapped around mine, the tone of his voice when he'd say "Oh sweetie, you're going to be just fine." It was one of the most real and spiritual moments I have experienced.

An hour is a long time to be awake, silent and motionless. I won’t lie and say it was pleasant. Physically, the discomfort is minimal. Emotionally and psychologically, I was in tears by the end of the session. I had a very hard time hiding these tears when the nurse turned off the machine and escorted me into the hall. Either she was used to emotional patients or thought I was a nut; she never said a word. But as sad as I was and am about my grandfather, I also feel cleansed by our conversation. Like some of the “why me” bitterness of this whole cancer experience was washed away. Life sometimes sends lovely reminders that we can never be completely alone.

I still don’t think of myself as someone with cancer. I know this because when the RAI doctor was leading me to the room and reading my chart, he said, “So, Ms. Noon you are here because you have thyroid cancer,” and my instant thought was “I am?” A shock runs through me sometimes, when I hear this term linked with my name, my identity. It is like a stranger calling me a bad name. I feel offended and I want an apology. It must be a mistake. This kind of instant vulnerability makes me angry with the universe sometimes. But then I think of all the other people affected by cancer. How vulnerable they are. And the vulnerability becomes something human again. It gives us something to both struggle against and accept.

I must accept that I have cancer.

I must not allow it to have me.