On a cold December night, more than a dozen people mill around the entrance of New York University Langone Medical Center in Midtown Manhattan. The hospital has been closed for over a month, but the crowd isn't waiting for a patient -- they're awaiting a mobile MRI making an all-day, 630-mile trip from Michigan.

Before midnight, the trailer, which has been driving straight since 10:30 a.m., pulls up. Immediately men with bright vests pour out onto First Avenue to stop the busy late-night traffic. The 50-foot trailer is then guided through two huge double glass doors. This is a slow, tense process, as the trailer is eight and a half feet wide, but the doors only leave a 9-foot opening. But the unit squeezes through, drives over the entrance foyer where patients and staff used to walk, and then goes out into the hospital's muddy back courtyard -- its temporary new home.

The crew then spend the rest of Thursday night, until four in the morning, painstakingly shifting blocks of wood required to support the weight of the mammoth trailer as it inches forward to its final location.

Everyone's impatient, because they're in a race against time. The machine has to be installed and ready for inspectors from the state health department by Dec. 20 -- the second-to-last business day before the holidays. If the deadline isn't met, the hospital will have to wait until later in January and won't be able to provide imaging services during the Christmas season.

"This is a big deal," says John Vartanian, owner of Medical Imaging Resources, a mobile medical company with a fleet of 40 trailers that's providing the MRI.

NYU was one of several New York City hospitals to be shuttered after losing power and getting flooded when Hurricane Sandy made landfall on the East Coast in late October. Floodwaters from the storm reached the hospital's basement where its three MRI scanners were kept. All were destroyed.

The hospital is now re-opening in stages, with its main campus expected to be fully operational at the end of next month. In addition to the mobile MRI at its main campus, the hospital has acquired three other scanners, two now parked several blocks north of the hospital, and another kept downtown for women's imaging, Vartanian says.

"Knock on wood, they're going to get their certification and then the people in the area will have MRI to come to in the holiday season, which is a tough season. People get sick quite a bit then, and staff is low, so they need that service," he says.

'Tis the season

The mobile MRI only made it in time because of the extra effort on the part of its earlier leaseholder, a 113-bed community hospital in Chelsea, a town west of Ann Arbor, Mich., where Vartanian's company is based.

"You have one community helping another," Vartanian says.

Chelsea Community Hospital, which was renting the mobile MRI, had a seven-week contract for the equipment. The hospital, you see, was moving house. Its diagnostic imaging department, the emergency department, ICU, therapy services and inpatient medical-surgical beds, among other units, were being transferred to a new building that was scheduled to open on Dec. 17. The hospital needed the mobile MRI while its own fixed MRI underwent the lengthy process of being taken down from its original location and moved into the new building on campus, where it would then be reassembled.

When Vartanian approached the hospital asking if they could release the MRI early so it could arrive in NYU in time, they knew it would be tough. It meant they would have to get the MRI department in the new building ready earlier than planned, and all without an interruption in imaging services for their own patients. But after considering the matter, the hospital decided to help.

"We knew it would be a bit of a stretch for us," says Kathy Brubaker, executive vice president for patient care services at Chelsea. "However, when we thought about everything the patients and staff and community of NYU have been through, we said, 'We can handle this. We can make it work.' So we did."

The mobile unit scanned its last patient in Chelsea Wednesday night, then early Thursday it was on the road to New York. Meanwhile, that same day the hospital's fixed MRI was up and running and scanning patients -- four days earlier than expected.

"I've been doing this for 22 years now with my own company, and this is one of the better projects we've had to get involved in," Vartanian says.

New home

The unit in question is a three-year-old Siemens Avanto 1.5-Tesla machine. As NYU is now down from three MRIs to one, Vartanian says they needed a newer, more powerful unit with high throughput capacity.

"It's a really good mobile scanner," Brubaker says.

The new trailer is expected to enjoy a possibly year-long residence at NYU as the hospital considers what to do about a permanent MRI. In the meantime, the hospital is constructing a temporary shelter in the courtyard grounds where patients can wait before boarding the trailer for their scans.

One of the main challenges of storing the new MRI trailer to this new home, though, is its weight. At more than 65,000 pounds, the trailer poses a threat to structurally weaker areas of the courtyard and the basement department that sits directly below it.

To ensure the trailer wouldn't overload any point during its drive in, staff with J.C. Duggan, a rigging company, covered most of the courtyard with a timber mattress made of 12-foot long wooden beams bolted together. These beams help disperse the weight evenly as the truck rides over it. The company also laid out 65 metal sheets, one and a half inches thick, over the area to give better traction to the vehicle.

"Its' all dirt and we've gotten a lot of rain in the last week or so," John Cereghino, vice president of Brooklyn-based J.C. Duggan, explains. "It was very wet mud, so we were afraid of getting the trailer stuck."

When the MRI trailer arrives, it has to tread slowly and circuitously. In the courtyard, it drives up a ramp, rambles over the vast wooden mattress, and comes to a halt maybe 60 or 70 feet from the entrance. Then it jackknifes in reverse to reach the spot next to the under-construction patient shelter. To safely escort it to this spot, crews have to disassemble parts of the wooden mattress near the entrance that the trailer already drove over and then reassemble them in the new location the trailer is headed to.

It's a lot of work. Looking at what has to be done for the installation -- not just moving the trailer into place but also plugging it into the hospital's power system and getting it ready for inspections -- one crewman shakes his head.

"We're gonna have to dig deep," he says.