One morning in a suburb of Edinburgh, Scotland, an active, athletic teenager named Charli found that she did not have her usual appetite for breakfast. She figured she was just feeling a little under the weather, and was not to worried. But as the days passed, her appetite did not return. Before long, she stopped eating lunch as well, and eventually she was hardly eating anything at all. She had to withdraw from her soccer team because she didn't have enough energy to make it through the practices. When her weight began to drop alarmingly and she began to suffer from crippling headaches, her parents took her to her doctor, who diagnosed a glandular disorder.
To make things worse, Charli started getting teased at her school, enduring constant comments from other kids about her weight loss and gossip about an eating disorder. Almost two years went by, filled with doctors visits and various diagnoses and treatments, none of which were effective.
Finally, on a September day when Charli was fifteen, things came to a head. She was rushed to the hospital after suffering a massive stroke. Once she was stabilized, her doctors ordered an MRI scan of her brain. The images showed that she had a large tumor in her brain – it was benign, but its sheer size and the pressure it exerted had been enough to cause the devastating symptoms that Charli had been suffering for the past year and a half. Her doctors told her that if the tumor had not been detected, it could eventually have been fatal. After enduring an 8-hour brain surgery, Charli finally was able to start down her road to recovery. Speaking later to a journalist, Charli said of her stroke, “it was the best thing that ever happened to me”.
In Austin, Texas, a 28 year-old man named Alex was fed up with the back pain he had been suffering, the result, he assumed, of the damage from some old sports injuries catching up to him. His friend John, who was a radiological technician, convinced him to come in for an MRI scan on the chance that doctors might be able to spot something that could lead to a treatment. Alex agreed, and took a day off work to come in to his friend's clinic. With John at the controls, Alex tried to relax as he was slowly rolled into the claustrophobic MRI chamber. After finishing the scan of his friend's back and saving the images, John decided to ask a little favor. He had just installed some new software for head scans and needed to test it out on an actual subject, so he asked Alex if he would mind lying still for just a few minutes more so that he could take a test scan of his head. Unlike x-rays and CAT scans, the MRI procedure does not subject patients to potentially harmful radiation - just strong but harmless magnetic fields combined with radio waves – so there was no risk to undergoing an unnecessary scan. Alex agreed, and John proceeded with the test scan.
When the first image appeared, John was alarmed by what he saw. The new software was working just fine, but there was an ominous-looking lump behind Alex's right eye that should not have been there. Not wanted to scare his friend unduly, he merely mentioned that he thought he might have seen something that should be checked out by a neurologist. Alex was feeling fine other than the back pain – no headaches, blurred vision, or dizziness, so it was probably nothing at all to worry about.
It turned out that Alex had a golf ball-sized brain tumor. His neurologist told him that because it happened to be located in an area of the brain that was not responsible for any critical functions, he was not yet experiencing any symptoms. But if the tumor had remained undetected for a few more years, it would have continued to grow and begun to press on other areas of Alex's brain - and at that point, it probably would have been very difficult to remove safely.
Alex underwent a successful surgery to remove the tumor and was able to go on with his life, thanks to having an observant friend in the right place at the right time, with access to a powerful diagnostic technology.
The common denominator in these two stories – and in countless others from around the world – is the power of MRI to detect hidden but deadly medical problems, without causing any harm or pain to the patient. In this chapter, we are going to learn about an analytical tool used by organic chemists called nuclear magnetic resonance (NMR) spectroscopy, which works by the same principles as an MRI scanner in a hospital. While doctors use MRI to peer inside the human body, we will see how NMR allows chemists to piece together, atom by atom and bond by bond, the structure of an organic molecule.