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God in Catastrophe

Adam

During my time as a chaplain I prayed with dozens, maybe hundreds, of patients. Sometimes I felt I was doing a good job. Other times I felt I was completely inadequate.

One night I was the on-call chaplain and got a late call. A Roman Catholic family wanted a priest to come and perform what is commonly called last rites. Unfortunately, there was no Catholic priest in the hospital and little time because the patient needed emergency surgery. At first they didn’t want a Protestant chaplain, but fifteen minutes later they wanted anyone they could get.

I ran and got there just as they were about to roll the patient into the operating room. The family asked me to say a Hail Mary. They settled for holding her hand and saying The Lord’s Prayer. When we finished they wheeled her through the doors. She died in surgery.

The last words she heard on this earth were, “…and deliver us from evil, for Thine is the Kingdom, and the power, and the glory, forever. Amen.”  And the next thing she heard was choirs of angels.

In May of 2007 all the hard work of seminary seemed to be paying off. I was finishing up my second CPE unit (hospital chaplain training) and applying for a residency program. I was in the process of being ordained by the United Methodist Church. We were close to reaching our family goal of having Leslie home taking care of the kids and me in the work place bringing home the money.

Then one Saturday morning, our family was working together to spruce up our yard. I was trimming some overgrown shrubbery. The next thing I knew I was looking at a field of brown and someone was asking me about my address and phone number. As my eyes cleared I realized that I was talking to paramedics. I wouldn’t have been able to answer their questions without Leslie’s help. But Leslie convinced the paramedics that she could take care of the transportation–because she wanted me to go to the hospital where she worked and where I was doing my training. We got into our car, and she drove to the emergency room.

Along the way I called my parents and the pastoral care office at the hospital. As we drove I started feeling worse and worse. I felt nauseous and had what epileptics and neurologists call auras, a combination of vibrations, sparkling lights and earthquakes inside my head. We couldn’t get to the hospital quick enough as far as I was concerned. When we pulled up I quickly opened the door, undid my seatbelt and put my feet on the pavement. I was too dizzy to stand up. Leslie ran to get someone with a wheel chair.

I remember being impatient and  uncomfortable–then nothing until I woke up in a hospital bed with restraints on my forearms and ankles. As a chaplain I’d talked to many patients in restraints, but now I was the patient, and the feeling was definitely odd. One of the chaplains from the pastoral care office came in, and I could greet her by name, though most of that day I was disoriented. The powerful anti-epileptic drugs knocked me out of reality. Two grand mal seizures within an hour had completely exhausted my muscles, and I could barely move.

I remember one of the chaplain supervisors telling my mother that I’d gotten into the residency program, news I was eagerly anticipating, but I was too far gone to care.

That evening I had an MRI to see if my brain tumor had come back. I couldn’t experience anxiety and fear before the scan, nor feel the joy of relief after learning the answer was no.

I didn’t experience God that day, not personally. But that was because I couldn’t see the other side of my reality. But God showed up.

You could argue that He always shows up, and this is true. But we only become aware of His presence when we pray. If we have a seizure, or are drugged, or just plain too sick to care, we are unable to pray and unaware if the Lord is present or not. When we need Him most, we are unable to call His name.

I am very blessed. From the moment I called, my mother contacted our family and her prayer partners, and by the time the hospital staff extracted me from the car seizing and hauled me through the lobby to the ER, a hospital chaplain, a minister from our church, my parents and their five prayer partners were praying for me and Leslie.

They prayed for my family while they were traumatized from seeing me have a seizure. They prayed for my health, and that I wouldn’t have a recurrence of brain cancer. They prayed for God’s presence to be close to us during a hard and frightening time. And the prayers were answered. God comforted my family, He kept me from further harm, He gave us peace.

Now I try to prepare. Two prayer partners and I meet each week, praying for everything from help finding our lost sunglasses to the forgiveness of sins that seem unforgivable, and healing from illnesses that seem incurable. We know each other and each other’s business. My prayer partners see my blind side, the things I don’t know about myself.

When catastrophe strikes me again, these two people will pray for me. I feel good about it; they’ve already practiced.

Do you know who will pray for you when you can’t pray for yourself? Maybe it will be a minister or a priest or a hospital chaplain. Maybe a family member. But maybe you want someone who has practiced. And the best way to do that is start now.  Find someone you trust with your blind side, and share your prayers.

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Acts of God

 

In the third year of medical school, on the second day on neurosurgery, I am assigned to shadow the resident Dr. Fernando Diaz and follow him to the University Hospital Emergency Room at about nine PM.  An old man lies unconscious on the stretcher.  He had taken out his garbage, slipped on the icy sidewalk, struck his head and didn’t wake up.  Despite an operation–the first craniotomy I ever saw–he would die the next day.

I learned a lot from his case–how to  evaluate the unconscious trauma patient, the steps of emergency brain surgery, quick evaluation and treatment of bleeding disorders.  Yet, the big question, the Why, remained unanswerable.  Why this time, after taking out his garbage thousands of times, walking on icy sidewalks every winter of his long life, why is this the last thing he does?

A couple of years later, a young woman walks across the New Haven green on a blustery Spring day.  A limb breaks in the wind and falls, striking her on the head and knocking her to the ground.  Rescue is called and she is brought to the ER but it is too late.  She is dead on arrival.

Two years later, an eight-year-old boy is playing on the sidewalk waiting for his school bus on the busy Whitney Avenue.  He trips and falls into the street in front of a garbage truck. Brakes screech, horns blow, but still there is a sickening thump.  Traffic stops.  An ambulance arrives and the boy is transported to the ER on a respirator.  He was only a couple of years older than my oldest son and got hit in front of the preschool my son attended.

An act of God, according to the Wordbook dictionary, is a natural and unavoidable catastrophe.  Most ER trauma cases are not acts of God.  Someone pulls the trigger, someone gets drunk, someone drives too fast–and someone suffers an avoidable catastrophe.

But sometimes a guy just takes out the garbage.  Or a woman walks across downtown green space.  Or a kid plays while waiting for the school bus.

The hospital staff has a funny reaction to the acts of God.  Everyone does their job, but I hear the murmurs and the whispers.  He should have put salt and sand on his sidewalk.  She should have waited out the storm before going for a walk.  Kids shouldn’t play so close to the street.  We blame the victim.

It is a defense mechanism.  We want to believe that a catastrophe is someone’s fault.  If we behave and others behave, we will be protected.  Otherwise the world is unpredictable and dangerous.

But sometimes there is no one to blame except God.

I learned from the first case, I watched the second case, but on the third case, the kid hit by the truck, I was the senior neurosurgery resident directing his care.  I saw him in the ER as the original resuscitation took place at nine AM.  Even after oxygen and blood pressure were restored his exam looked grim.  A CT scan showed no blood clots to evacuate, only a diffusely injured and swollen brain.

I called our director of pediatric neurosurgery and described the case.  He asked me my assessment, and I told him it looked hopeless.

Well, almost hopeless.

We believed that young children shouldn’t die.  We believed that maximum effort and state-of-the-art skill and knowledge would be rewarded.  So we gambled with the almost and ignored the hopeless.

I placed an intracranial pressure (ICP) monitor to guide treatment, optimized the respirator rate and administered various medications to control brain swelling.  By two PM, these measures had failed.  Another CT again showed diffuse brain swelling.  At three PM we took him to surgery to remove a large part of his skull so that even as the swelling increased his brain would not be compressed and the damage would be limited.  But even as the skin sutures were placed, his brain continued to swell.  The ICP went up again to dangerous levels, and then to levels incompatible with life.  By six PM, the battle was clearly lost.  The child would die.  A catastrophe.  An act of God.

This particular case affected me deeply.  I had been part of surgeries that had in one way or another failed, and this was not the first person I had seen die, nor even the first child.  Although always difficult and sad experiences, I had become inured.  But somehow this case cracked my shell.  Maybe because this time the victim looked too much like one of my own children.

So I buried myself in the paperwork; the demands for immediate hands-on action all day had outstripped the time available to document the required medical records.  But mostly I didn’t want to talk to anybody.  I was afraid if I had to talk, I’d cry.

I know what God told Job:  Where were you when I laid the cornerstones of the universe?  You’re just a man, you can’t understand the grand scheme of things.  At the end of the book, God gave Job a new family.  All very comforting and logical.

Until one is holding a dying child.

Then I want to know the Why.

And I if my sons were taken away by an act of God, replacement boys coming along a few years later might carry blessings, but the grief from losing the first two wouldn’t go away.  As a matter of fact, I expect that the love I would feel for the replacement boys would carry a undercurrent of terror–the fear of another loss.

As I hid behind the paperwork in that pediatric ICU, the director of pediatric neurosurgery, the one who had been guiding and encouraging me all day, came and stood across the desk from me.  “There’s someone outside to see you,” he said.

I respected this man for his knowledge and skills but didn’t trust him for emotional sensitivity.  He made too light of difficult situations.  He had been inured.

I shook my head; I was still afraid I would cry.  Besides, no one came to see me; I was just the resident.  Or worse, maybe the parents were waiting.  I couldn’t face them.  Not yet.

“Come on,” he said.

“No.”

He stared me down, long enough that he knew I was in pain, and I knew he wasn’t going away.  “Come on,” he said.

I got up and followed him.  After all, he was my boss.

In the hallway outside the ICU stood a teen-age girl in a cowboy hat.  Long, dark hair spilled out from under the right side of the hat, but no hair on the left, and maybe a hint of a scar in front of her left ear.  She smiled, but it was crooked, and she leaned on one of those aluminum canes.

Then I recognized her.  Six weeks previously, she had bled from something called an AVM, a congenital malformation, into the part of her brain that controlled speech and language.  She needed emergency surgery to save her life, but the cost had likely been the permanent loss of speech and movement on the right side of her body.   Two weeks later she was discharged to a rehab facility, aphasic and hemiplegic.  Another catastrophe.  Another act of God.

Now here she was, only a month later, walking with a cane–but walking already at just six weeks after her injury!  If she could walk with a cane now, she might be able to run in another six months.  Just to see her lifted my spirits.  Could she talk?

The words were slow and overly round like her tongue was too big.  “Thank you,” she said.

I don’t remember what I said.  I remember I had to hide my tears, but now tears that held a measure of relief, hope, possibly joy.

Maybe it was a coincidence that this thoughtful young woman took this particular moment to say thank you.  But maybe God sent a messenger to tell me that I couldn’t know everything He has to know, and I won’t know the outcome of many of the things I do, and the important thing is to trust Him.

I expect that God sent comfort to the parents of the child.  Because God doesn’t just watch our suffering from on high.  He gets down and dirty with us, and gets tortured and killed.  The passion of Christ was a historic event, but I think in some cosmic or mystical sense that the crucifixion and the resurrection is also a continuing experience.  When the kid gets hit by a truck, Jesus gets hit by a truck.  When Jesus rises from the grave, the kid rises from the grave.

We believe God is good all the time until we face catastrophe.  Then we wonder.  But we do not have to wonder if God cares.  In the Old Testament, He promises a time that He will wipe away all of our tears.  In the New Testament, He weeps for the death of his friend, Lazarus, and again for the destruction that will come to Jerusalem. When the parents of a dying child weep, God weeps.

I understand now why the book of Job ends with his fortune and family restored.  Those aren’t really replacement children.  They represent the fact that for every “act of God” there is an act of mercy.  He will dry your tears.  Sometimes He will restore your fortune, sometimes He will send another child.  Sometimes He sends a girl with a cowboy hat and a crooked smile.

 

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Random Acts of Violence

A three-year-old boy is brought to the ER by Rescue, CPR already initiated at wherever they found him, bruises all over his body, left arm askew, certainly broken, not only unconscious but with the floppy motor tone and fixed pupils that signal brain death.

A thirty-something year-old woman is brought by Rescue at nine AM, her face a mass of bruises and lacerations, both fresh and old.  Her nose is broken, her eyes are blackened, her lip is cut.  She is alert and angry and hostile and still drunk.

A twenty-three year-old man is brought by Rescue from a convenience store after a robbery.  He has a red hole in his face, almost indistinguishable from his nostril.  Unlike the first two, he articulates what happened.  “I told him, ‘Don’t shoot, you can have the money.  Here’s the cash register.  Just don’t shoot.’  He shot me anyway.”  This he kept repeating, convincing himself that this actually happened, as he adjusted to a new reality. Traces of anger dawned as the repetition continued with the awareness that he had been shot anyway by a stranger who already had the money.

This is my introduction to the Emergency Room in New Haven, Connecticut; I am in shock.  In my world children were never beaten, women were never struck, and no one I knew would shoot anybody unless the other drew first.

Up until this point I had been willing to believe that all people were good at heart but were sometimes misunderstood or misled or emotionally distressed, and at moments made mistakes, things for which they were sorry and would repent and ask forgiveness, if only given the chance.  I am an idiot in my innocence–not innocence as in the absence of guilt, but innocence is the sense of naivety–and I am now confronted by random acts of violence that must change my understanding of my fellow man.

The world is not filled with the innocent until proven guilty, but with the guilty, only some of whom are convicted.  Maybe the motivations that move society are not generosity and enlightened self-interest, but self-interest alone, and the rough calculation that all actions are permissible as long as the negative consequences can be avoided.  Thus, it is okay to silence that whinny kid with a swift kick or two, to slap that drunk wench into submission, to shoot that kid who might someday identify you in a line-up.

And if that is the way the world works, I have been playing by the wrong rules.  The choice is not whether to do good or to do evil, but whether to be a victim or not.  I need to look to my own interests first, then my family, then my friendships–although I shouldn’t think of them as friendships anymore, but as alliances.

I blame my father for my idiotic innocence.  He was not only a gentleman but a gentle man.  I remember only one time that he raised his hand to spank me, and this ironically for fighting with my brother.  I don’t remember the blow, but I remember what he said afterward.

“Don’t you know,” he said, “how little time we have together?  What few chances to love each other?”

I didn’t know what he was talking about.  My life was a continual competition with my brother.  We fought out our differences.  Sometimes I won, sometimes I lost, and always I prepared for the next battle.  What was Dad thinking?  He’d been an officer in an armored division in Europe during World War II; certainly he must understand the need for conflict.  Dad’s words puzzled me then and still puzzled me again as I stood on the bloodied floor of the ER.

A choice needed to be made: innocence or preparation for battle; allow mercy or demand justice?

But the practice of medicine demands mercy.  Sooner or later, the one who killed the child, the one who beat the woman, the one who shot the store clerk, all come in injured themselves.  And they are cared for with all the same resources that their victims received, perhaps with more reluctance on the part of the caregivers, but with the same skill.  Even knowing better, we act as innocents; our only battle is with the disease or the injury.   Justice is invisible, but vengeance is never an option.

Still, I wonder if I am a sucker, never ready for battle.  Mercy is my discipline, but a small ticking clock in the back of my mind waits for justice to show herself.

Years later I testify at a murder trial.  The victim had suffered a severe head injury resulting in an acute subdural hematoma and multiple areas of bruised and swollen brain.  Acute and chronic alcohol abuse complicated her care by liver and bone marrow damage.  In short, her body did not have the reserves to heal her wounds or stop her bleeding.  Despite a major operation and a week in intensive care she succumbed to her injuries.

At the trial, the woman’s boyfriend was accused of beating her to death.  My testimony is limited to answering questions from the prosecutor about the mechanisms of her head injury; the defense attorney asked no questions.  The boyfriend is convicted.

Justice finally appears; I should be satisfied.  But I am not.

What I know is that the woman died as the result of her alcohol addiction.  And whether or not her injury was the result of a fall or an assault, her boyfriend was convicted as a result of his alcohol addiction.  The blame lay less in the blow to the victim’s head than to that obscure first drink given to a person emotionally and physically susceptible to addiction, and the lack of opportunities for redemption along the way–and this is true for both the victim and the perpetrator.  They fell like two lost children clinging to each other in the dark and stumbling together.

Justice appears and is served, but she is a blind and cruel lady.  I am happy to turn away from the courtroom and back to the hospital where mercy reigns.

Sometimes I worry about my adult children.  They are never prepared for battle.  I have watched my them treat others with mercy more than justice.  They have committed random acts of kindness: befriending refugees, paying for a dangerous tree to be removed from the yard of a stranger who couldn’t afford it, sticking with a friend who was not only sick but crazy.  They acted unconcerned about how these others got into their situations.  They acted like suckers.

Dad would have been proud.

Random acts of violence can rob me of my innocence and drive me to seek justice instead of mercy.  But innocence is not a possession to be lost; it is a quality to be chosen.  And if innocence is chosen, random acts of kindness prevail.