Version in German

^{(Ein wichtiger Hinweis: Ich bin medizinischer Laie. Ich habe nur lange mit meiner Krankheit gelebt. Ich kann alles medizinische hier falsch verstanden oder falsch wiedergegeben haben. Jede in diesem Text wiedergegebene Information ist potentiell aus dem Zusammenhang gerissen, falsch, unvollständig. Hört auf Euren Arzt! Fehler sind meine Fehler, nicht die meiner Ärzte.Meine Erfahrungen sind anekdotisch. Eure Erfahrungen können anders sein.)}

Imaging magic

I wrote of an MRI follow-up check? Yes, over the last few years I have probably seen an MRI more often than many people will in their entire life. And my operation will probably mean that, for the time being, I have to do this every further year. As a check that everything is still in order. Something I would very, very gladly do without, but which is probably necessary. I hope that someone will at some point say: nothing more is happening there, come back in two and later in five years.

I somehow find magnetic resonance imaging fascinating. Basically, magnets produce an image. From the tumbling of equally aligned atoms, after you nudge them with another field, an image is created. There is something of magic about that, even though I of course know that behind it lies absolutely zero magic, but a lot of technology and mathematics. I think this technology is among those that can seem like magic to an insufficiently advanced observer.

But that doesn’t mean that I like being in the MRI. Many years ago, after a fall, I had to go into an MRI. That must be 16 or 17 years ago. I felt somewhat uneasy about it. I was supposed to keep my eyes closed. But I couldn’t. With every loud noise my eyes opened. I experienced the MRI as unpleasant. I simply could not stick to the instruction to keep my eyes closed.

That is still the case today. By now my eyes stay shut, but the uneasiness has remained. The MRI is no longer completely foreign to me. Because of my illness I had to go into an MRI so often that I wonder why I didn’t recognise earlier, with the song “Hello” by Mr Solveig, that all of that surely sounds like an MRI. Why I needed a YouTube video for it. Actually I should only have had to hear it once to recognise that it is an MRI. Maybe it is simply because I don’t like the song.

In August 2025 it had already been well over six years in which I ended up in the MRI once or twice a year. At the Albertinen hospital in Hamburg. At the beginning it was twice a year. The first one even with contrast agent. Later that reduced to once a year. Without contrast agent. Because with contrast agents you are also not so sure how that behaves when you use them very often. In any case, after a short time the number of examinations reduced. My disease did not progress fast enough to justify two examinations a year. And I didn’t want them either. I’ll just say: uneasy.

For it I always went to the same hospital. I believe it was always the same changing room in which each time I first had to undress down to my underwear in order to de-metallise myself. Each time the same worry of having forgotten something metallic. But that is hardly possible if you go into the MRI room in only your underwear. Surely no troll-gnomes will have sewn metal threads into my underclothes overnight, so that the MRI machine then wrenches them out of me. They are already busy sewing my clothes tighter.

Although: I wonder why before the MRI you are not waved over with one of those things that is also used at the airport when you have once again set off the security gate with a button. Why is this not done at an MRI, in order to ensure that a patient is not dragged towards the MRI by a ring threaded through a very sensitive body part and, unfortunately, not paramagnetic after all, or that the metal heats up so much that there are burns? Which at the relevant spots is certainly also not pleasant.

Since I have no metal body decorations and I do not spend time in regions where grenade splinters would be expected, the worry is actually unfounded. But this strange thought is nevertheless there: “Have I really taken off all the metal?” And even though I have been in the MRI so often: my dental bridge will hold. Yet it has never made even a peep or moved a millimetre. It hasn’t even got warm.

I believe it was also, over the years, the same MRI machine as in the previous years. I don’t even know whether they replaced the machine over the last six years. It always looked identical. At least in my memory.

It was always the same doctor. The latter was intentional and the reason why I lay in such a machine in Hamburg. So for this examination I accepted a somewhat longer journey. There is MRI in Lüneburg too. For that I wouldn’t have had to go to Hamburg.

If only because you don’t necessarily have to subject yourself to the Elbe tunnel without necessity. Although: I really like driving the route via the A7 when there isn’t a traffic jam. From there you simply see everything that makes up Hamburg: the Elphi, the television tower, the Köhlbrand bridge, the harbour. The northern bank of the Elbe, even if not the Elbe itself. Sometimes you see a cruise ship. Occasionally even a container ship heading for the Altenwerder container terminal. Precisely many things that make up Hamburg. A plane gaining altitude over Hamburg. From the left if it took off in Finkenwerder, from the right if it departed from Fuhlsbüttel. In the past you sometimes saw an A380 take off here; since it is no longer built, you have to wait for the relevant Emirates aircraft for that. I find that magnificent. But just not when there is again a traffic jam on the route. Or some lorry has triggered the height control and sent all the plans to hell. That sometimes made the journey to the hospital quite nerve-racking.

I nevertheless drove to Hamburg for it every time. Even if I sometimes had appointments at the most jam-prone time. Because in my case the repeated measuring by one person was absolutely sensible. It was meant to ensure that the findings of the imaging remained absolutely comparable. So that always the same evaluating doctor gives his assessment. My first MRI for this problem was in Hamburg at the Albertinen hospital with a particular doctor, and with that I stayed.

With all the tool support, evaluating an MRI is still also a matter of experience. I do believe that radiologists, as the first category of doctor, will have or have had a problem with machine learning. But in the end there should still be the human being whose experience really counts. And I wanted a doctor to always carry out these evaluations. Moreover one has to say that this doctor was extremely nice and friendly, glossed over nothing, but also dramatised nothing.

See you in a year

So once a year I drove to the examination. The radiologist and I already recognised each other. By now you greet each other in a friendly way. “I’m back again.” – “Another year gone by?” – “Yes, a year gone by.” I sit down on the couch again. Lie down. “Are you lying comfortably?” – “Yes.” A headset is put on me. I have the somewhat unwieldy signal amplifier placed on my chest. I am handed the funny squeeze-bulb with which I can signal if something goes wrong. So far I haven’t yet had to press it “for real”. The “bed” moves into the machine. It feels, as always, cramped in this tube. It is loud. Even though it is only the standby noises of the MRI. Music is played. And no matter what I tick on the registration form, what music I would like, it always seems to be the same music. Underscored by the noises of the tomograph.

“Please hold your breath.” – “Breathe out again.” “Please hold your breath.” – “Breathe out again.” “Please hold your breath.” – “Breathe out again.”

In between the noises change. Probably other sequences that bring other answers. It usually takes around 15 to 20 minutes. I think. I never checked it.

Afterwards you hear again the motors of the couch, which pull you back out of the tube. And a short time later the doctor stands in front of me and tells me the number of the day. In millimetres.

You say goodbye with a “See you in a year”. And a few days later the letter is there that puts the findings into writing. With the repeated reminder to come back in a year. That was the way of the last years. It could happily have gone on like that for a few more years, even if the whole development of the illness gnawed at me.

In the sixth year I had by now a certain routine of timing my check-up examinations so that during the cycling season I first had an ultrasound in spring, then the MRI in summer and again an ultrasound in late autumn. That always shifted a little, depending on whether I had thought of making the MRI appointment early or late. With my cardiologist I at some point started to arrange the next appointment when I came out of his consulting room. That proved its worth. So over the years I had very good coverage to check the course of my disease.

I still find the MRI unpleasant. It is cramped and it is loud. But I have got used to it. Personally it helps me, before being pushed into the tube, to close my eyes, to think myself far away mentally and not to open them again before I notice the stopping of the couch after it has been pulled out. That way I barely perceive the cramped space of the MRI. Against the noise, however, that doesn’t help at all. No matter how far you tidy yourself away, no matter how far you think yourself: the noise penetrates this mental shell. No thought is able to prevent that. But it at least distracts a tiny little bit. You also can’t put earplugs in your ears. You have to keep hearing the instructions.

My note to those who read this text with a similar disease: I consider it essential to have the imaging done over the years always by the same doctor. So that everything remains comparable. With ultrasound, in my observation, that is even more important. I have the impression that the measuring with ultrasound depends even more strongly on the person measuring than with MRI. If only because the MRI is, after all, very automated. There is no wrong holding of the measuring head, no “non-perpendicular” measuring. From today’s perspective I would pay even more attention to the imaging always being carried out by the same doctor.

The MRI of 2025

I’ll fast-forward a little now. 2025. For this year too an MRI was planned. I had an appointment for 1 August. By and large it was the well-known “Groundhog Day”. Apart from the end. That was so completely different last time. In 2025 this “See you in a year” part of the farewell was missing.

At least I can’t remember it, as hard as I try. Maybe my thoughts had also drifted off right afterwards in such a way that I no longer perceived it at all. After that first number which the radiologist had told me, which boded so very little good.

I was probably already in that mental hole that blocks the view of the outside world, that concerns itself more with the “Damn! What now?” than with the surroundings. I noticed that my head was immediately starting to accelerate the thoughts. That is not unlike a cork that you throw into a water vortex.

Ominous mail

So a few days after that day I found this year’s letter from the hospital in my mailbox. That letter I spoke of at the beginning. For the bill it was still much too early. Yes, I admit, I am not in the statutory health insurance. My experiences are those of a private patient. I therefore receive bills for everything medical.

The clinic usually always takes what feels like forever. As if the hospital in which the MRI stands did not need the money. Mostly the bill comes when I am wondering whether they have forgotten that I was there. Or whether, after a certain number of MRI scans, I get one examination for free. But it is never forgotten, and my MRI loyalty card still does not seem to be full. A bill always comes, but always late. So this soon after the examination it could only be the findings.

And with that we were at those envelopes that you don’t like to open, because you already have an inkling of what the letter inside will convey. There are such letters repeatedly in life, ones you would most like to put into the shredder unread. Letters where you think: “Letter, nothing against you personally. But I will not like your content. I first have to prepare myself mentally for it. May I at least finish my tea?” Letters from a distant traffic authority are, in this direction, such a classic. Holiday souvenirs on account of a moment of carelessness or the result of distraction.

Here I am talking about letters that have more influence on the future. Some letters are life-changing or at least throw life completely into disarray for the next few years. In August 2025, sitting in front of this letter, another letter came to my mind that I had received a very long time ago.

About 30 years earlier. A letter from the district military recruiting office (we call them Kreiswehrersatzamt in Germany). Would I please report on a certain day at a certain barracks – which today no longer exists. Would I please start to serve my military service. My carefully assembled portfolio of findings apparently was not enough for the Bundeswehr to refrain, despite the established limited fitness, from “inviting” me to serve.

I have to admit here too: I wanted neither to join the Bundeswehr nor to do civilian service, and it could even be that back then I brought along things as findings that were partly relevant but partly also had the pathological value of protruding ears. But that just sounded good. Drown them in data. Unfortunately the doctors at the recruting office also knew the value of many of these diagnoses. In any case they did not let themselves be dazzled. I was certainly not the first to try this.

For someone who actually didn’t want to join the troops, it didn’t go according to plan here either: in the end I was even supposed to stay longer, namely two years, with the Bundeswehr. I got a medal (“Honour Medal of the Bundeswehr”). After seven months I was promoted to senior lance corporal. I had figured that, since I was here anyway, I might as well make use of the time somehow. But after that time I’d had enough. I wouldn’t have wanted to stay any longer.

My experience, however, had little to do with the regular Bundeswehr that one imagines as a conscript. At least I gather that from the conversations I later had with friends who had a completely different experience during their military service. I was deployed at division and corps level. Maybe that made the extension seem more desirable than with a rather normal Bundeswehr experience. I did something that today I would describe as a mixture of user support and administration. Days in green were rather thinly sown. I was young and then did want the money after all.

Which I partly used to buy myself a really decent computer for the time, on which I gathered my first experiences with Linux. Actually I used the time well, when I really think about it. Yeees, I already had Linux in my fingers when some people who today would most likely place me in the museum because of my Solaris knowledge were not even planned yet. And I’m now feeling even older than I am.

I also used that time to determine for myself what I really wanted to do with my life. Back then I decided that I wanted to have as little to do with computers professionally as possible. Computers as a hobby seemed okay to me. As a profession, rather not.

That is now about 30 years ago. And what can I say: that worked oooout veeeery well. If you want to hear the universe laugh, make a plan. We had that already in the last part.

So when I got the letter from the office back then, I didn’t want to open it either. That may, in light of all the things that happened later, seem rather trivial and small. Yes, for some reason Reinhard Mey has sneaked into my writing playlist. But I like the song.

But you have to see it from the perspective of a person around 20. At that point this letter is disruptive. Especially when you have just started studying.

In that envelope there could only be one thing. My notice about the result of the medical examination had long since become legally binding. I considered it very unlikely that there was a letter inside along the lines of: “Oh, you know what, Mr Möllenkamp, we were mistaken, you are unfit after all. We wish you a nice rest of your life!”

Why am I telling you this anecdote from my early adult life? In the end, despite the unwillingness to take note of the letter, everything fell into place. To read that for the next year the decision-making power over my life would be partly taken away from me was, back then, however, quite a blow for me.

Nevertheless, the time that followed was significant for me. Just totally different from planned. It was just okay. In its own twisted way, everything that followed was, after all, also a consequence of this letter. And there too I would like to claim that everything fell into place reasonably well.

Lousy letters are at first just that. They change. They add detours to the path of life. That may now sound totally fortune-cookie-ish, but you don’t know what they are good for. The book about your own life would be boring if the odd plot twist were not hidden in it. The two years with the army were a plot twist. But having ended up in IT was also quite a plot twist, although for the attentive observer it was actually clear from the start. And the letter from the hospital also promised to contain a plot twist.

I don’t know whether everything would have gone the way it went if I hadn’t had these really stupid letters in my past. Whether everything would then also have been okay. And I don’t know what would have happened if I had not received the MRI findings at precisely that point in time.

That may now all sound as if I believed in things like fate. I believe in free will, but the universe has the tendency to sometimes nudge it aside. If I believed in an intelligent higher being, I would think that it makes a sport of nudging people or even knocking them over. As it is, for me it is simply chance, combined with the consequences of all earlier decisions.

The day of the most recent letter

Back to this new letter from 2025. This letter I liked even less to open. I already knew the year’s number, which boded nothing good. Here too I considered the message “Oops, we mis-measured, don’t worry” to be very unlikely.

I just wanted a few additional seconds of not knowing how the doctors assessed the current situation. Please. I put the letter on my desk. Quickly did something else. Made myself a soluble, caffeine-free coffee (I have long since come off my 10% caffeine / 90% caffeine-free mixture, because I was sure that the wakening effect of the 10% was probably to 100% a pure placebo effect). Visited the bathroom. Went back to my desk. Stared at the unopened letter. And thought: “Shit!”

I had an inkling of what I was about to read. I had a feeling that the content would throw at least some of my plans into disarray, at least for this year. I had already assumed that after the short conversation with the radiologist. That I had to hold back even more.

That the letter would really throw all my plans into disarray, I did not suspect. That the message in this letter would not fit at all with the weather unfolding above me in the form of a steel-blue sky when I looked out of the roof window, I likewise did not suspect.

But in the end it is like with a plaster (or, as I now know, like with an adhesive ECG electrode). At some point it simply has to come off. I actually found the tearing-off of the electrodes about the most painful part of this whole affair. As far as plasters are concerned, though, I am also a wimp. With reference to the content of my letterbox: the letter has to be opened. The content has to come to one’s knowledge. Fear is the mind killer.

A pro tip, by the way, regarding plasters and electrodes: hospital plaster or electrode adhesive does not come off with soap. Simply doesn’t. I tried it. A tip from a nurse during follow-up rehabilitation was worth gold: only white spirit helps; nail polish remover probably also works. The washbag for the hospital should contain something of that kind. And whoever waits for the renewal of the skin to lose the adhesive marks, waits a long time. A very long time. I know it. I tried it. Until I got the tip with the white spirit.

So there was the letter. After some delay I then opened it after all. The message, however, was considerably more severe than I had thought. I had reckoned with a “Marked progression. Shortening of the check-up intervals recommended”. No, the letter said: “Presentation in surgery recommended”. I leaned back. The day I had been bracing myself against for a few years was here. Phew. Presentation recommended. Which, translated for me, means: “Jörg, this is it …” Shit.

This letter was even more life-changing than the one many years ago. Here there was the option of losing everything, not just one year. But here too I had the hope that everything would somehow be okay after all. Because everything had been okay so far. Not great. It could have turned out nicer with other decisions. To quote Mr Kunze, slightly altered: “I have so much luck on my conscience.” But somehow it just got okay.

But why was this letter life-changing? That is indeed a somewhat longer story, which I would like to tell in the next parts.