Adrenaline coursed through my veins as the door swung shut behind me. I tore into the envelope, hands shaking, fumbling through the reports to the one labeled MR-TMJ.
Reason for Exam: assessment of disc displacement.
Technique: T1 and T2-weighted. Sagittal and coronal images were obtained with the mouth in closed and open position.
Findings: In the right TM joint with the mouth in closed position, there is anterior disc displacement. There is also a deformity of the disc in the right TM joint. In the open position, the displaced disc is reduced. There is slight limitation in the range of motion in the right TM joint. A deformity is identified in the right mandibular condyle which appears to bend forward. This finding raises the question of a possible old injury in the right mandibular condyle.
In the left TM joint with the mouth in closed position, there is also anterior displacement of the disc. This is best appreciated on the sagittal image #11. In the open position, the displaced disc of the left TM joint is reduced. There is a slight limitation in the range of motion in the left TM joint. No focal bone abnormality is identified in the left TM joint.
- In both TM joints with the mouth in closed position, there is anterior disc displacement. Associated mild medial or mild lateral disc displacement cannot be entirely ruled out.
- In the open position, the displaced discs in both TM joints are reduced.
- There is a deformity noted in the disc of the right TM joint which is best appreciated on the images obtained with the mouth in closed position. No deformity is identified in the disc of the left TM joint.
- There is some limitation in the range of motion in both TM joints.
- A deformity is identified in the right mandibular condyle which may be developmental in nature or may be the result of an old healed fracture. Clinical correlation is recommended. No bone abnormalities are present in the left TM joint.
N_______ P_________, MD
I squealed. I jumped. I hooted and hollered and called everyone I knew. I am so excited. There is a problem, so I can fix it; well, Dr. Stack can fix it.
This is an issue I can’t tackle on my own, thus I did not fail. I cannot correct what I am not able to correct (an equivalence if I ever wrote one). No amount of mobility work, no degree of compliance to the perfect diet, no dedication to technique and strength could have solved this problem. I am not a failure. I cannot fix myself.
A huge weight is lifted.
The feeling reminded me of when I received a perfect semester’s worth of grades. 22 credits and a 4.0. It was the culmination of prolonged effort built from a rare period of inherent trust in the process of perseverance, a careful construction of hope from a painstaking application of confidence in myself, in the subjects at hand, and in the order of the world as set forth by God.
Why this diagnosis and that report card elicit the same unabashed joy is woven within the writings of this record as well as those written and half-remembered parts to which you, dear Reader, do not have access. It is based upon the transient certainty that some things in life actually do make sense. Some things in life actually do work out. And those some things are the things which are tackled head on, repeatedly, as one insane.
As one afire with the conviction that the world is a logical world.
The grades signified achievement. This diagnosis signifies hope. Achievement, hope: these I must cultivate with deliberate practice. It is a deliberate practice characterized by relentless adherence to proper technique, tireless application of strength, intelligent pursuit of understanding, and the carving of my very soul into a channel of grace.
This is why I must study. This is why I must practice. For this is how I must live.
The diagnosis offers me a chance to do all of this in a more perfect way. Treatment promises proper alignment, relief from ghostly aches. I can imagine a day where, halfway through, I do not need to take a three hour nap. I now have the ability to imagine the perfect snatch, a balanced pullup, with me as the performer. I can plan my study schedule without fear of nodding off. My life as I strive to make it is now mine to make.
We have our crosses to bear. Mine, so small, so light, weighed heavy on my frail shoulders. I strive to be like Christ above all; but also, now that I have hope and help for my own burdens, I can look to Simon of Cyrene and his example. As I grow stronger, I can shoulder my load and another’s as well, when they cry for help.
The world is full of possibilities, and now they are mine to grasp.