Posted on

Day Hike, Night Run


A man named James, a recently retired professor of economics, broke his neck. The circumstances seemed like the usual sort of thing: One Tuesday morning he noted a light out in his kitchen ceiling so he got his step ladder, climbed up, changed the bulb, and fell. Could happen to anyone.

Except for one thing. His blood alcohol level on admission was well over the level associated with intoxication. The other lab tests did not show the signs of damage from chronic alcohol, things like liver abnormalities or bone marrow suppression, but the fact that he appeared quite sober with that alcohol level paradoxically demonstrated that his system was quite used to functioning under the influence.

The good news was that his spinal cord had not been injured. Although he was in great pain, he should survive and walk normally as long as he didn’t suffer another compounding injury before the bones of the spine healed solidly.

His neck was braced and a CT scan and MRI defined the specifics of his C2 fracture, one that carries the ominous appellation of Hangman’s Fracture. Because of the alcohol level, he also received some sedative medications designed to prevent delirium tremens. By the next day I had determined that his fracture would likely heal with a brace and he would not need an operation. By the third day, his pain was under good control and he could walk independently and safely. He could go home.

And that’s what usually happens. I go in, tell the patient to wear the brace, not drive or climb on ladders, make an appointment to see me in two weeks, and call if…blah, blah, blah. Sometimes I even add a cautionary note about alcohol, stuff like, “Drink only in moderation,” or, “Just say no.”

This morning, however, before I got to his room, I had a little more imagination–or maybe a vision from God–about what it might be like for a guy who had all the respect in the world at the university to be now sitting home on a Tuesday morning with nothing else to do but change the lightbulb and nothing else to make him feel good other than spiking his orange juice with a tumbler of vodka.

I know what it’s like to be addicted to a substance. My particular addiction is to tobacco, actually much worse for health than alcohol, but fortunately not as destructive to performance or relationships. Although I haven’t had a cigarette for years I remember clearly about a hundred times I “just said no” in the morning and smoked a pack before lights out that night.

“Just say no” was not going to work with Professor Jim. And if he fell again, even with his brace, he could very well be dead long before the ambulance ever arrived. There was a reason they called it Hangman’s Fracture.

After I arrived at his room I got him up and walked him around a little, just to see for myself if he was steady on his feet and not grimacing in pain. Then he sat on his bedside and I sat in a chair facing him. I gave him the good news about going home and the likelihood of healing and the usual instructions. Then I hesitated.

He was my senior by twenty years and a full professor–in more archaic terms, my elder. I had authority by my degrees and training to give him advice about spine fractures. But about lifestyle choices? About addictions? Maybe not. The easy thing to do, the thing I had done a hundred times before, was to tell myself it wasn’t my specialty, it wasn’t my problem, and let him go on and deal with his life as best he could. His problems, his choices.

Another story: About two thousand years ago a guy named Cleopas woke up after a holiday weekend with all hope drained. The person he had believed would usher in a new era of justice and peace and joy had been brutally and publicly executed, and furthermore, under cover of darkness, somebody had stolen the body. Cleopas could have stayed in bed. He could have drained a wineskin on his own. His problems, his choices.

Instead, he got up, took his first step, then another, then found a friend. They decided to go for a walk together, a day trip to a town called Emmaus. 

“I know why you fell down,” I said to the professor.

He nodded, a bit bemused as I seemed to state the obvious. 

“You fell off the ladder because you couldn’t help it.”

His eyes blink in agreement. He would have nodded except for the brace.

“You couldn’t help it because you’d been drinking.”

He didn’t try to nod this time. His expression stiffened, and his eyes fixed on mine.

“And you’d been drinking because you couldn’t help it.”

His expression softened, saddened. His gaze dropped to the floor.

“You couldn’t help it because you can’t fix it alone,” I said. I told him about avenues of help, about Alcoholics Anonymous. I wish I could tell you I prayed with him, but I wasn’t that wise. 

Professor Jim thanked me for the advice and shook my hand meeting my eyes again. I left to sign him out uncertain if I would ever see him again.

About Cleopas: Along the way, he and his friend encountered a stranger, told him of their hopelessness, then listened to what he had to teach them. Then they sat down to share a meal and discovered themselves to be in the presence of the Risen Christ. No longer hopeless and unable to contain themselves, they ran back through the night to tell their friends.

Professor Jim came back to office two weeks later with his wife. He had gotten up from his bed, taken a step, then another, then called a friend. They had started a journey together to to a place called Alcoholics Anonymous. There he discovered himself to be in the presence of the Risen Christ, the One who runs to you when you walk toward Him.

Jim thanked me again, and again when he kept office appointments six weeks and twelve weeks later. His fracture healed. I didn’t see him again, but he had coincidentally joined the church and Sunday School class my parents attended, a fact that allowed me to follow the subsequent ten years of his life, a life lived lived out in peace and joy.

When I find myself slipping toward despair, those times the wrong seems oh-so-strong, and I don’t feel like getting out of bed, certainly not to face reality, then I try to remember Professor Jim, and Cleopas, and I resolve to take a step, then another, and find a friend to go on a journey. I try to listen and learn, even from a complete stranger, and so far I have always encountered the Risen Christ. Then I want to run through the night to tell my friends.

Posted on

Real People

A few weeks into our surgical internship, we invited all the interns to a party at our apartment. About fifteen were able to make it. We were all in our mid-twenties, living on shoestring budgets, bright, and excited about our careers.

            We were also puzzled by many things. For most of us, other than summer jobs, this was our first real career employment, and our first serious responsibility dealing with those who weren’t young, middle class and college educated. We had culture shock. But mostly we were shocked by our close proximity to suffering and death, and the power of our profession to alleviate the same. And how, at other times, we were so powerless, rendered into unwilling front row spectators at pain and the often quick passing of life. None of it looked like what we learned in the classroom.

            That night everybody talked fast and hard, sometimes stepping on each other’s lines, feeling like the emotions of the last few weeks had been bottled up to the point of explosion, and this was the one and only chance each of us had to let it out with a community that just might understand. We should have done it more often, but we only did it that one night.

            Only once did the room become silent. One of my colleagues asked, “When does the patient become real to you again? You know, after the operation? Is it when the last stitch is in, or when the bandage is on, or the drapes are off? Or is it in the recovery room?”

            For thirty seconds, all eyes turned to him, mostly puzzled, considering. We all knew it was a bad assumption, a question that shouldn’t be asked. The patients are always real, we always treat them with humanitarian dignity. Because that is the right answer, that is the classroom answer.

            The responses were interesting. About half the group said that the question was crazy; patients were always human, right? They had the classroom answer, and they were, of course, right. Patients are always human beings with full rights and value.

            But a few were like me. I knew exactly what the other intern meant. After the anesthesia, after the skin prep, after the sterile drape, the patient doesn’t have a face anymore. That makes it seem so much more natural to open their skin with a knife (that we call a scalpel so it doesn’t sound like a weapon). It is then possible to dissect through things that have names like omentum, and duodenum, and gall bladder. Because if we remember their face and call their inner parts by common names attached to them by possessive grammar (Joe’s guts, for example), surgery couldn’t be done–not by anyone who wasn’t a psychopath. At some point all surgeons do an emotional step back, dissociating ourselves temporarily from the humanity in order to deal the anatomy and the pathology.

            But we never talk about it. Except for that one time when one young doctor found the words to ask. Emotional distance goes up when the sterile drape is laid down.

            I like to think he was right. If we recognized the emotional distance we put up to operate, it was because these people already meant something personal to us, something very human, very connected, and we needed the separation. And maybe those who didn’t distance themselves, or at least didn’t recognize that they did, was that possible only because patients had never been “real” people to them from the beginning? Patients had always been patients, never people, so dissociation wasn’t necessary? I don’t know.

            Often I have emotionally distanced myself from a patient to do what I believe is good for him or her. But I know my capacity to dissociate is not limited to the operating room, or even the office or the bedside. Sometimes there is a person who is so old, or so intellectually limited, or so drunk or so crazy or so high, or so dirty or so foreign that they could not possibly be like me because I don’t want to be like them. And since I can never be like them, and since I must be a real person, they can’t possibly real. I put up the drape. I take an emotional step back. But now I’m not doing it for them; I’m doing it for me.

            Maybe you’ve done this. When you walked past that homeless guy or drove past that panhandler at the freeway exit. When you visited the nursing home. When the guy in the store speaks Spanish or the woman in the checkout line wears a burka. When the drunk at the next table talks too loud or the crazy guy walking down the street talks to people who aren’t there.

Maybe you put up the drape, take a step back. Then those people aren’t completely real, and somehow we feel safer.

            We come by this “step back” naturally. It’s literally in our DNA. One of the first social tasks of a newborn is to begin the process of distinguishing between the “us” and the “them” of the world. Mom first, then the family, then other caregivers, then the people who look like them–they become the “us.” Everyone else is “them,” which is understandable, but it can limit us. For example, studies have demonstrated that if children are not exposed to persons of another race before the age of four, their initial response to a person of that other race will be negative. The response can be mitigated by education and experience, but it is always there, an unconscious tendency to put up a drape, to step back, to racially profile, and thereby carry a weighty piece of baggage in a poly-cultural world.

            Then there’s another kind of emotional step back, the giant step, the one that says that a person isn’t human anymore, not now, not ever, not as a result of emotional bias but as a result of evilly rationalized doctrine. This is the step taken when a lie becomes imbedded in the mind ignoring the pleas from the heart: They aren’t like us, they can’t help us, they want to destroy us. They aren’t real people. We should separate them, put them in camps, make them work for us, take their stuff, kill them off if they don’t pull their weight. That’s the step back taken by the Nazis, but they are not the only ones who have taken that step in the past, nor will they be the only ones to take that step in the future. From this we should guard our hearts.

            Now I repeat the question that intern asked so many years ago in a slightly different fashion: When does a person become real?

            Is it at the moment of conception?

            The moment the heart beats?

            The moment the brain takes shape?

            Or is it the moment of birth?

            I ask because New York State recently passed a law that allows abortions well past the time (24 weeks) that a newborn could survive independently of the mother. The permissible reasons for late term abortion are: 1.) the life or health of the mother is threatened, or 2) the fetus is deemed non-viable. Furthermore, decisions are to be made by a licensed healthcare provider, not necessarily a physician. Since the health of the mother and the skills of the healthcare provider are not defined, the statute conceivably permits, for vague and possibly trivial reasons, abortion up until the moment of full term birth. In one delivery room a baby, now called a fetus, could be murdered or abandoned, while in the next delivery room a baby of the same gestational age would be treasured and loved.

            Nobody wants this. Nobody wants to kill babies. We can make better laws. For our doctors, for our women, for our children. For our souls.

            So the question returns: When does a person, a baby, become real?

            When you answer, let whatever is imbedded in your mind be guided by the pleas from your heart.

Posted on

Old Faithful

We met by coincidence at Old Faithful, the geyser that is so predictable in a National Park known for unpredictable events like blizzards in August. This particular day was in October, cool with bluebird skies and fluffy clouds, patches of snow in the shadows, a remembrance of summer and a promise of winter.

“It must be great to be a neurosurgeon,” she said to me. “Everybody always knows you’re smart.”

She is easily three decades younger than me, beautiful, brilliant, charming, with a great job, a handsome husband and an adorable toddler. The question surprises me. I know it is more about her than me. I hear years of frustration at not being heard, not being appreciated, her voice, probably the smartest in the room, frequently being drowned out by “man talk.”

I don’t really know how to answer her so I laugh it off. I tell her that’s it so much worse these days. Now when I do something dumb, people shake their heads and say, “He used to be a neurosurgeon. So sad.”

She laughed, I laughed. But it made me wonder about what being smart had to do with being a neurosurgeon.

To be honest, being seen as smart was something that was important to me back when I was a teen-ager. But what I really wanted was what Holden Caulfield wanted: to be the catcher in the rye, the one who caught children playing in the fields before they fell off the cliff.  A meaningful life meant saving lives.

But saving lives is an illusion. By medical school I realized what should have been obvious from the first: Lives are never saved; only prolonged.

I learned to imagine death as a large predatory cat–a lion, a tiger, a jaguar, or a black panther–something sinister and lurking somewhere behind my left shoulder, and everyone has his own big cat lurking behind his own left shoulder. He (and it always is a he) waits for a chance to pounce, and my job became to recognize when this creature is about to leap, then run between him and his prey, shoo him off, make him wait.

Because he only waits. He never goes away. In the end, he will have his prey. A complete win sends the big cat into the bushes for years. A small win sends him away for only a few days. An attack leaves pain, disability, scars, fears, until the inevitable end. He is relentless.

What is it to run between the big cat and his prey? What’s it like to be the neurosurgeon?

It’s standing there when the beautiful young woman with the winning smile and the great mind who can write poetry and play music and draw pictures and run with the wind comes into the ER because she has bled in her brain and can no longer smile, can no longer think, can no longer use her right hand and can no longer run or even walk. And she will die in a few minutes unless just the right things are done in just the right order and done right now. It’s standing in the OR an hour later carefully sucking blood clots out of a damaged brain wondering about the smile, the hand, the leg, and even the piano lessons, and wondering if they will be okay, but not worrying too much about that now because something caused the bleed, something like an AVM or an aneurysm, something that I know is there but don’t know what or where because there was no time to find out if she was to have more time in this life, and any moment whatever it is can explode and bleed again and maybe this time it won’t stop. It’s looking through an operating microscope for the next three hours dissecting arteries, ligating bad ones and saving good ones–they all look so much alike even under the microscope. And one mistake will lead to a lost smile, a lost hand, a lost leg, a lost mind, or even the end of time for her if I, or the cadre of techs and nurses and doctors that hold me up, make that one mistake. Then the big cat does not run back into the jungle, and her time is up.

And when it is over and all the blood is gone and all the arteries are open and there is no more aneurysm or AVM, I do not fist pump like Tiger Woods or knee slide like Mia Hamm or flip my bat while jogging around the bases like Babe Ruth. When it is over, I say Thank you Jesus and feel not triumph but only a cautious relief because the big cat has slunk off for now but I know he is still nearby, still waiting to pounce; the game is not over. The game is never over.

But, yes. Everyone thinks I’m smart.

I’m tempted to lapse into a Ecclesiastes theme: Vanity, vanity, all is vanity. It doesn’t matter if people think you’re smart. There is nothing new under the sun. People have always gotten sick, healers have always fought the losing battle against disability and death. From ashes we come, to ashes we return. All of which is true, of course, but a thin and obvious truth. It’s where Solomon started his book, not where he finished.

There is a time, he said, for all seasons–to be born and die, to kill and heal, to weep and laugh, to make war and to make peace. And this is the profound truth: Time is our gift. We have time for all the moments of our lives that gives us windows into eternity–birth and death, weeping and laughter, war and peace–because there is One who is even older and more faithful than the geyser by the same name, and He cares about the days of our lives.

She returned to her husband and son; they are expecting another child soon. I returned to my wife; we are expecting another grandchild soon. There is a time to be born. Together we all walked to the geyser basin to see it erupt again. Right on time.

Posted on

Big Enough


I had my pediatric rotation during the third year of medical school. My first assignment was in the Newborn Intensive Care Unit of St. Paul-Ramsey County Hospital.  The NICU in those days was a new idea, and our unit was modest–a mere eight incubators with monitors and respirators.  My first patient: a premature baby boy weighing 500 grams (about 17 ounces).

The NICU director taught me how to intubate a premie struggling to breath, how to take advantage of the umbilical artery and veins during the first day of life, how to start an IV in a scalp vein. I learned to calculate fluids and nutrition within very narrow margins of error by the barest of guidance from limited labs, weight and physical examination. I learned about respirator settings for tiny human beings, the perils of too little and too much oxygen. I worked hard and learned a lot. The NICU director gave me great autonomy and an experienced nurse gave me lots of help. And I believed my little patient would live.

Then, forty-eight hours later, the baby died.

I was shocked. I had done everything right, done everything I could, and he died anyway. My knowledge and skill and willingness to work were not enough. The baby was too fragile.

The NICU staff was not surprised. Because the one thing I didn’t know, and everybody else did, was that a 500 gram baby had never survived. They had worked with me treating the baby because they hoped he would survive. I didn’t know any better; I believed he would.

Though we failed with that child, there now are a few babies who have survived, even thrived, from sub-500 gram birth weights because another generation of doctors not only hoped, but believed, the most fragile could survive.

I learned three things: babies are fragile, hope is good, belief is better.

This Christmas season I’ve found myself wondering about the baby Jesus and remembering that baby in the NICU.

History tell us that about two thousand years ago, the creator of the universe gave up being God and chose to become the frailest of human creatures, a baby. A very fragile baby. We know what happened next: The baby survived, grew in wisdom and strength, sacrificed himself thirty years later for the salvation of mankind.

But babies are frail. Did God risk the salvation of mankind by coming as a baby? Did He have an alternative plan if the baby Jesus had not survived? I don’t know. I feel that with the alignment of the stars, the signs in the heavens, the specific prophecies about Jesus going back several centuries, Jesus’ birth and life were planned since the beginning of time.

Maybe part of God’s message is about fragility. The nation of Israel had been hoping for a Messiah for hundreds of years, expecting some kind of celestial Superman who could save them from their enemies and restore their political and religious dominance.

Then Jesus arrived as a fragile baby, someone who needed constant care simply to survive, and a message from angels to keep him from being slaughtered with the other infants in Bethlehem by the evil King Herod. I mean, really, if you were there–say, a shepherd who had heard about this miracle from angels in the field–and you had to change a diaper, would you really believe this little guy was the Son of God?

I don’t know why God does things the way He does. The story we have about Jesus is so much more beautiful than the stories we have about the great political and military saviors in the Bible–Moses, Joshua, David, for example. But though the Jesus story is beautiful, it remains puzzling.

This Christmas season, I am thinking of Jesus as a metaphor. A baby Jesus is born into my heart. He represents all those beliefs that are beautiful and true: that I am a beloved child God, that my current experience only touches a true and deeper reality, that my life is not limited by time and space, that order reigns over chaos, that good triumphs over evil, that mercy is better than justice, that true wealth is in the heart, and love is real and stronger than fear and hate.

But He is small and frail.

I have moments, maybe many moments, when I can believe that reality is limited to the cold facts demonstrable by science, that life is limited to a short time on this small planet, that human law is the best we can expect out of justice, that mercy is weakness, fear is self-preservation, forgiveness is foolish, success is getting more, and that love is an illusion based on hormones and reproductive drive.

These are easy beliefs in our secular age. As a flinty-eyed realist, I should be able accept them and dismiss my hope for Jesus as sentimental foolishness.

But I can’t.

When Jesus was born in the stable at Bethlehem, He was small, fragile. Maybe He only weighed 500 grams. But by the grace and love of His Father, our Father, He survived.

He was big enough.

My baby Jesus, born in my heart, has been small sometimes, maybe only 500 grams. Who can measure these things? Sometimes He seems frail. But, by the grace and love of our Father, He survives.

He is big enough.

Posted on

Winter is Coming

The multi-hues of Minnesota summer green fade to dark browns and dull yellows, the pines now deep emerald accents in late autumn.  The light is different, too, flat and muted even in midday.  Clouds are the rule, light rain is common, and blue sky is rare; it is my least favorite time of the year.  I am always coldest in October, perhaps because every year I forget how cold winter is, perhaps because I haven’t dressed in my very warmest jacket yet, perhaps because of the wet-cold of the Fall drizzle.  Everything is dying, but winter with its stark white snow, ink-like outlines of trees, crystal blue sky around the bright, cold sun is still a half season away, but I can already feel it.  Winter is coming.

My mother’s ashes are in the trunk of the car when we stop by the nursing home where Mary’s 93-year-old Aunt Iris lives.  She has been there for about five years now and has given up walking.  There is a faint urea smell in the background and it takes Iris a few minutes to recognize Mary.  We talk about old times because that is what she is capable of discussing and because it is the things we want to hear before it is too late, stories about Mary’s mother and how Iris met her husband, Uncle Arthur.

Then she tells us about a vision he has been having lately.  She finds herself in a hallway, the walls glowing with a white-gray light.  She walks along the passage until she comes to two large, dark wooden doors and considers going through then hears voices that call her back.  When she is back in the hallway, someone tells her that if she had taken two more steps she would have been in heaven.

“Were you afraid, Auntie?” Mary asks.

“Oh, no,” she said, “it just wasn’t quite my time.  But every night now when I close my eyes I see those doors in front of me.”

We leave soon afterward and returned to the hill above Green Lake and the surrounding marshes where we walk a long way in the muted colors and wet, gray air, and again I think: winter is coming.

We shift to Minneapolis.  Mary has lunch with her two cousins who have recently lost their husbands.  We have dinner with a lifelong friend, David, whom we have not seen in five years (how time slips by!).  We did not know about his Huntington’s Disease diagnosed a few months before his second wedding two years ago.  He reminds of the motto his first wife carried through her star-crossed journey with Type I diabetes: Life is Now.  David and his new wife are beautiful and courageous.  But I am reminded: winter is coming.

The next morning we find out about a family emergency back home.  I take Mary to the airport and check into a hotel alone.  In two days a memorial service is scheduled for my mom, an opportunity for her friends and family from the Midwest to gather and exchange stories, see each other and see her off.  The following day we will have her ashes interred with my father at a nearby cemetery.  My sister and her husband have come and they are a great comfort.  My brother cannot come; his disabilities have recently become too great.  I need to go see him after this trip.  Winter is coming.

On Saturday the rain stops.  Sunshine sometimes peeks through the cloud cover and the temperatures rise to the low 50’s–like a winter day in Jacksonville, but a balmy day in Minneapolis October.  I take the opportunity to walk through Minnehaha Falls Park.  Every step evokes a memory.  This is where my dad taught my brother to ride a bicycle.  This is where we pretended to be pioneer woodsmen at the age of seven when we found springs of clear water hidden in the forest of the lower glen.  This is where a few dads took their sons on a hike to the mighty Mississippi, built a bonfire, roasted wieners and told scary stories.  Here one of my high school classmates died after a fall from the rock.  There a friend from junior high fell to his death from the Soldier’s Home bridge.  A slope covered with brush seems smaller than when my brother and I fled the family picnic to play while grown-ups inexplicably sat and talked.  A ski jump used to stand on this hillside; our Norwegian friends came every winter Saturday to test their skills–back in the fifties before the city discovered something called potential liability.  Farther up the valley I played softball with my college friends.  The falls are magnificent; I remember summers when the creek bed was dry and only a trickle of water came over the cliff, I remember winters when the falls turned into giant icicles colored red and green pastels by the limestone bed.

Above the falls I stop to pay homage to the statue of Hiawatha holding Minnehaha, carrying her across the creek, an icon to all south Minneapolis lovers.  I cross the creek and find the spot where we got married, not far from the historic railroad station where once the circus train stopped and elephants marched.

Time becomes slippery on walks like this.  Old memories seem new.  Old roads not taken still seem like possibilities.  Old friends live again; I can almost hear them; I can almost feel their their touch.  Nostalgia sets in and I am tempted to mourn for the things I hoped would happen but didn’t.  Then I regain my center and celebrate things that did happen, and the choices and chances that took me on this journey.

The next day dozens of friends and family gathered to remember Mom and get reacquainted with each other.  Healing comes with the laughter at all the absurdities of her life and character, how she started as a hurt person in a broken family and transformed her life into a helping person full of joy.  We remember the others of her generation, and in our remembrance thanked them for the legacy that turns mourning into dancing.

In the morning, a few of us gather at the cemetery, exchange a few words of love and remembrance, say the Twenty-third Psalm and the Lord’s Prayer.  We all touch the small box that contains the earthly remains of a big life.  In a few hours she will be buried with my father.

Winter is coming soon.

We got a phone call this week from my daughter back in Florida.  She is nineteen weeks pregnant and just completed a high definition ultrasound of her growing daughter (now the size of an avocado I’m told).  She could see all ten fingers and watch the chambers of her tiny heart beat.  The little one is shy; she remained curled up with her little hands before her face.  We’ll have to wait to meet her until sometime in March.

Winter may be here.  But Spring is coming.

Posted on

Saloons and Seeing Clearly

I stumbled into Dornan’s Saloon at the end of a long and amazing day.  Early that morning a pronghorn antelope had rushed across the high prairie as my car drove along the aptly named Antelope Flats Road, as if running to greet me, then tip-toeing across the road after I passed.  I then saw the Teton range reflected in the still waters of Jackson Lake, walked in snow in the Yellowstone Park, watched a lone buffalo graze in the Yellowstone basin unconcerned about either the eruption of Old Faithful or the large herd of humans who had come to watch.  Now I envisioned the perfect closure to the day: a beer and pizza while quietly watching the sun set over the mountains through the generous west-facing windows of that venerable saloon.

That didn’t happen.

Monday nights are “hootenanny” nights at Dornan’s.  Open mic for any and all locals.  Food available by lining up at a window to place an order and the bar is open.  The place was packed.  Lacking any alternative plan, we took the last three available chairs just off the right side of the tiny stage and re-considered our options.

While we made alternative plans, an old man took the mic first.  He had performed every Monday for the past twenty years or so, always first.  He had been introduced as a local legend in the ski world, performing some incredible backcountry feat, the details of which were lost on me, and becoming a founding father of extreme skiing.

He didn’t look like an extreme skier or talk like a singer.  His voice was raspy with age and hard use, but the room immediately silenced.  He pointed to the mountains and identified the Grand Teton.  Then he outlined a snowfield halfway down and told us it had snow all summer, more than last year, and although he had heard there was global warming, that snow field told him the year had been cooler than the year before.

With no further introduction, he started playing an autoharp beautifully, a tune vaguely familiar.  Then he started singing the lyrics with little improvement over the tonal quality of his talking voice.  But the words and melody were clear and sung with unwavering courage, a song from the 70’s made famous by Jimmy Cliff and Johnny Nash.

I can see clearly now; the rain is gone.

I can see all obstacles in my way.

Gone are the clouds that got me down.

Gonna be a bright, bright sunshiny day.

Then something magic happened.  My ears heard his raspy voice, but my mind played the sweet melody, the mountains and snowfields came into focus, and the cold blue of the sky and fading orange of the few clouds became something felt more than seen.  He continued:

Oh yes, I can make it now–the rain is gone.

All of the bad feelings have disappeared.

Here is the rainbow I’ve been waiting for.

It’s gonna be a bright, bright sunshiny day.

He finished the song, and we slipped out the side door with me still seeking a better setting for alcohol and food consumption.  Yet, I felt like I’d been given a gift of some sort with that song.

I thought about the times I couldn’t see clearly.  When I went to medical school, there were no CT scanners.  We had no way to X-ray the brain.  Our imaging studies were angiograms that x-rayed the arteries of the brain, or pneumoencephalograms that x-rayed the fluid containing spaces of the brain.  We would have to deduce from the displacements of these structures whether or not a mass was present.  Often we would resort to exploratory burr holes or biopsies.

We could not see clearly.

We had a CT scanner at Yale by the time I was a first-year neurosurgery resident.  For the first time, we could get direct x-ray images of the brain.  By today’s standards the resolution was poor and the length of time to do a CT scan made the procedure very restrictive–fifteen minutes for a single cross-section, one hour for a “complete” scan consisting of four sections.  (Today’s scan’s have near anatomic resolution and a twenty section brain study can be done in two minutes.)

We could see clearly now.  But we could not see the obstacles in our way.

About six years after I finished medical school, during my last year as a neurosurgery resident, I talked to a neurosurgeon in Kansas City who had been a resident at the Mayo Clinic in Rochester when the one of the first CT scanners was installed in the U.S.  He described a post op patient who had deteriorated after a brain tumor removal.  The staff did an angiogram which showed nothing amiss.  So then they decided they might as well do one of these new-fangled CT scans just for the experience.

The CT scan showed a big white spot in the surgical bed, something we all know now represents a big blood clot.  But then the Mayo staff, certain of their familiar angiogram and experience, didn’t believe it.  The first thing they did was to contact the manufacturer’s representative to tell them the CT machine must be broken.  Then, when he assured them the machine was just fine, they grumbled and took the patient back to the OR to remove the clot they were so sure was not there.

They could see clearly now, but they did not.  Obstacles remained: in this case, understandable ignorance.

So I wondered if the singer in Dornan’s Saloon was just singing his favorite folksy kind of hit from the 70’s.  Or did he have a special message about the things he could see clearly now, but had not in the past?  Or maybe a prophecy for me?

Was this about global warming?  We had come from the warmest September on record in Florida to a place where the mountain spoke to those who listened to tell them the year had been cooler.  Is that what he saw more clearly?

Or was just my reaction to a very special day?  After being surrounded for several days in the strange and wonderful natural beauty of the Grand Teton range and Jackson Hole valley, the traffic jams, urban noise, and city lights that dim all but a few of the stars faded away as I re-discovered that we live in a place more majestic than cities and suburbs and airports.  Sometimes I need to touch the wilderness to remember.  To see clearly.

Or was it all about the rainbow?

We had come to Jackson Hole to celebrate the wedding of two young men, one of whom we have known since his birth.  We love his parents and we love him, so he is more like a nephew to us than simply the son of our friends.  And now he is getting married.  How could we not celebrate the greatest joy of his life with him?  How could we not encourage two people to do the hardest thing in the world: to love each other to the best of their ability for the rest of their lives?  So I showed up in spite of the qualms I have when I see two guys kiss.  I smiled, celebrated, listened, and watched.

I watched two men who love Jesus and love each other.  I watched two families–big families–who love Jesus and love their sons for how they have been created and who they have become.

I returned home the next morning without qualms.  Maybe I can see more clearly now.  I can see that the North American continent is warming now, but there has been a cool summer on the Grand Teton.  I can see new gas stations and tawdry apartment houses in my city, but the sun still rises over the Atlantic and sets over the St. John’s River with spectacular displays of color.  The rain has gone and here is the rainbow I’ve been waiting for.

And I can see that there are wise and ancient guidelines that are God-ordained so that His people can live with justice and joy.  But, I can also see that God creates His children just as they are, and loves them profoundly.

Paul starts a paragraph in I Corinthians 13:8 with the sentence, Love never fails.  He goes on the list the things that pass: prophecy, tongues, knowledge.  These are the things he confesses to being unable to see clearly now.  He finishes the paragraph with verse 12: Now we see but a poor reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.

In other words, when in doubt, trust love.  What prophecy you may have heard, what words you may have spoken, what you think you know, are but a shadow of a deeper truth that is about love, a love that never fails.

I, like Paul, look forward to the day I can see clearly, when the rain is gone, all obstacles are clear, the clouds no longer get me down, and I find the rainbow I’ve been waiting for.  It’s gonna be a bright, bright sunshiny day.

Posted on

Memories and Gifts

Mom and Dean, 1950

Losing Mom, the last of her generation, leaves me feeling responsible as the Keeper of the Memories, memories that have been stored in cardboard boxes and manila envelopes and dusty file cabinets and in the back of closets.  I am going through this as a journey through memories of love and sorrow, regret and gifts.  Yes, gifts.

I found a letter I wrote to my mother forty years ago.  I don’t remember writing it, but it is mailed in a Yale University Section of Neurosurgery envelope and appears to have been sent instead of a traditional Christmas card.  It includes a poem that is copied from an unidentified medical journal, written by a doctor identified only as David to his mother on the occasion of her birthday.  I told my mother that it spoke clearly from my heart about what gifts she had given me.  Here’s the poem:

What gift can I give you

On this birthday? You have

Pain in your shoulder. In

Darker moments you have

Sighed and said

Two-thirds of my life are over.

 

Your children are scattered

Your womb gone. Nature’s trick

So strong in you to gather

And protect, nurture and

Help us bloom like flowers

Yet now, in your Indian Summer

We seem to turn from yellow dandelions

To white, evanescent hairs

Emanating from a seed

Floating where?

Where has your love, your tears

That caring water gone?

Swallowed by a hungry

Seemingly ungrateful earth

The sunlight of your warmth

May seem at times reflected back

Unfelt, unchanged.

 

And yet, did you know

That when I put my hand

On a crying child’s head

Whispering ssssh

It is you whispering softly

Rocking him close to my chest

That love that I feel for a wide

Eyed baby that I never saw before

That is your love for me

That I can take anywhere, and

Give anytime so filled am I

With this love. I am so grateful

If you take this, my thanks

For your birthday gift

I hope that it will give you

Some peace. It has for me.

Love, David

 

I’m glad I told Mom what David told his mother:  Her care for me turned into my care for someone else, actually lots of other someones.

Recently I watch a documentary about the life of Fred Rogers of Mr. Rogers’ Neighborhood.  At a college address near the end of his life he said, “You smile because someone once smiled at you; you love because someone first loved you.”

Fred and David had both discovered this important truth.  Love is never wasted.  Hate fails, anger fails, pleasure fails.  But love is never wasted.  It beats off the chaos and the darkness, it plants seeds that grow into the greatest of shrubs, it gives hope to the hopeless, and gives to the warrior and caregiver alike, courage.

The letter and poem remind me that my bigger responsibility is not as Keeper of the Memories, but as Giver of the Love.  So thank you, Fred Rogers, and thank you, Doctor David wherever you are.

And thanks, Mom.

Posted on

Good Bye Mom

Mom celebrating her 99th birthday

Although we had plans for a big 100th birthday party on Thanksgiving Day, Mom is celebrating early in the arms of the angels.  She died peacefully with family at her bedside at 7 PM on Thursday evening, August 30, 2018.

Eunice, along with her four older siblings, was raised by a single mother in the tiny hamlet of Plaza, North Dakota early in the last century.  After high school she attended a business school in Fargo then went on to Minneapolis working as a secretary at Jean Lang Dresses.  There she made lifelong friends with her co-workers, and, up until they were all well into their eighties, the six “Jean Lang Girls” got together for their annual Christmas party.  Eunice is the last survivor of that group.  She never let a friend go. 

During the war she met a handsome young Army officer, the brother of her fellow worker, Florence, and fell in love.  She married Larry Lohse in 1947 and gave up work to raise her two sons, Bruce and Dean, and her daughter Jean Marie.  The other mothers in the neighborhood became lifelong friends.  At the age of 90, Eunice traveled with her old neighbor, Lois, by train across Canada.  She never let a friend go.

When she felt the children were old enough, she returned to work to be certain they could all afford a college education, a special priority for her and Larry.  She worked as a secretary for a regional airline, and this afforded her the opportunity to travel throughout the country and the world, which she did, dragging her much more reluctant husband along for the adventure.  She still exchanges Christmas cards with her old boss.  She never let a friend go.

She retired to Florida in 1986, less for the weather than to be close to her youngest grandchildren, whom she spoiled outrageously at every opportunity.  Here she became active in Southside United Methodist Church where she volunteered in the kitchen helping with Wednesday night dinners up until she had to give up driving at the age of 94.  Last Christmas, her kitchen co-workers, also now retired and living out of town, got together again for lunch.  She never let a friend go.

In 1999, her beloved Larry became severely disabled as a result of Parkinson’s Disease and a stroke.  She shouldered the responsibility of primary care giver for the difficult years until his death in 2005.  Because she never let a loved one go, either.

She is survived by her three children, her son-in-law, Claude Garvin, her daughter-in-law and best friend, Mary, her grandchildren and their spouses, her great-grandchildren, a cadre of nephews and nieces, and various honorary step-children, all of whom are grateful for her love and wisdom.  She never let any of us go.

A memorial service will be held at Southside United Methodist Church, 3120 Hendricks Ave., Jacksonville, Florida, on Sunday, September 9 at 4PM.  Internment and a second memorial service will be at the Fort Snelling National Cemetery in Minneapolis on October 15.

Posted on

Choose Life

A friend, a high school teacher, recently told me about a bad week in his school.  A sophomore girl committed suicide.  Whatever reasons she may have had seemed inadequate to her friends and family who were left behind to pick up the pieces.  The teachers were depressed, the kids were frazzled and confused.

I remembered a kid named Mark, the first person I knew to attempt suicide.  At the age fourteen, despondent over the breakup from his first girlfriend, he started a car in a closed garage and sat behind the wheel, waiting for the end.  Fortunately, someone came along, opened the door, shut off the car, and got help.  For a few months, he disappeared from school.  I never found out what he had been thinking or feeling.  To me what he did remained a curiosity.

A few years later, midway through my first year as a neurosurgery resident I got a stat call to the emergency room to take care of the victim of a motorcycle accident.  By this time, I was already inured to trauma.  Tragedies happened every week, and the victims were often complicit in their demise.  The car accident victims had often been drinking; the motorcycle riders rarely wore helmets.  And most fatalities were well over the speed limit as they approached their final crash.

So I wasn’t surprised to find a twenty-one-year-old man with a gut full of cheap wine and a head split open by a telephone pole.  As I worked alongside the rest of the ER crew trying to save his life, more details of the accident flowed in.  He had hit the pole at the bottom of the hill at a T-intersection in West Haven.  Every intern and resident knew the intersection because it was on the route to the VA hospital where all of us took some of our rotations.

I tried to imagine how the motorcycle could get up to a high speed and miss everything soft to hit that pole, and started wondering if this was truly an accident.  Then one of the nurses looked at the patient’s name and said the story seemed familiar.  She pulled the records and found that his brother had hit the same pole with his motorcycle on the same day two years earlier.

Little doubt remained.  This was no accident.

I have a brother who is a year older than me.  We both rode motorcycles.  Since I knew the corner and the pole, had a brother, and rode a motorcycle, I couldn’t help but envision the accident, and try to understand why he had made the decision he did.  I couldn’t.  So I worked hard with the rest of the team to save his life so he could have a second chance like my friend Mark.  But he died within twenty-four hours, and I was left to wonder.

I didn’t understand.  Because up until then, I had never experienced true despair. 

Then, a few years later, in the months and years following my wife and oldest son’s cancer diagnoses, I faced the certainty of mortality for the first time–not as an idea, but as a gut-true reality.  Every one I loved would die, maybe soon, maybe years later, but their death and my death was certain.  Any accomplishments and experiences of ours were temporary and nebulous.  Existence seemed meaningless.  I began to wonder not why people committed suicide, but why people didn’t.  When I came up against the reality of death and the inevitability of chaos, I found it impossible to turn away.  Only ties of love to my family and my duties to my patients kept me from complete despair.

Then, one Good Friday, I sat in my back yard and smoked a cigarette (a little suicide, I called it) and observed that this was the day that even the church recognized death as inevitable.  Because the only thing certain in life are death and taxes.  Then I asked myself what other things were certain, in other words, what composed reality.

I came up with time and space and matter.  The first two were infinite, the last is not currently comprehensible, our theories of physics taking us into smaller and smaller particles or waves all behaving under the odd rules of quantum theory, and the more recent the untestable hypothesis of string theory.  And all three, time–space–matter, are interchangeable by Einstein’s equation.  I was overwhelmed by the vastness and complexity of the universe and my tiny part in it.

Then the thought came to me (I like to think of this as a vision from God) that all of this incomprehensible but orderly universe was a manifestation of the mind of God.  And though my part is small, I am a thought in the mind of God.  I am created, I am part of the magnificent whole, I am not forgotten.

After Jesus got baptized and spent forty days being tempted in the wilderness, he moved to Capernaum and started preaching His primary message, the one subsequently referred to as “The Good News.”  Crowds gathered to hear this message which is summarized as: Repent, for the kingdom of heaven has come near. (Matt. 4:17, NIV)

When I read this I thought repent meant to stop sinning, so the passage seemed to say stop sinning or you’ll be punished, a message that is obvious and what religious people and parents have preached to the rest of us since before the beginning of history.  I couldn’t understand why this was either “good” or “news.”

But repent means something much simpler that makes the passage much more complicated (and surprising).  It means turn away.

But turning away from the reality of chaos, pain and death is difficult.  That reality is so overwhelming that it seems there is no other choice but to accept the inevitability of darkness.

But there is a separate reality, just as real, that involves order, healing and life.  This is the kingdom of heaven.

The Good News is that you can turn away from chaos, pain and death–the kingdom of darkness–and choose to believe in the kingdom of heaven–the kingdom of light and life.  It’s right here, right before your eyes, an arm’s length away.  Just turn around.  You can choose life.

Posted on

Big Man Down and the Procession of Life

There was a man in New Haven known for his size, his vast appetite for food and drink, his violence, and he feared not man nor God.  He stood six-foot-six and weighed an estimated 400 pounds.

One night he angered his girlfriend.  She revved his car, a sizable 1970’s style sedan, and threatened to run him down on Howard Avenue.  He stood in the middle of the street and dared her to do it.  She made one pass and swerved at the last minute narrowly missing him.  She turned the car around, and he laughed, daring her to try again.  This time she didn’t swerve and she didn’t miss.  After the impact he was dragged another full city block before falling free in front of the ER entrance at Yale-New Haven Hospital.  An ambulance still had to be called because none of the hospital personnel who rushed out could lift his massive frame onto a hospital gurney.

Once in the emergency room, he proved equally difficult to evaluate.  He was too large for the CT scanner, and X-Rays penetrated his thick flesh poorly leaving blurry images and much guessing about internal injuries. Cervical spine x-rays had been able to penetrate only as low as C-3.  Normally all seven cervical vertebrae can be seen on x-ray, or in very large individuals perhaps only five or six, but in his case the lower four vertebrae were completely obscured by his massive shoulders.

One thing that was clear: he was paralyzed from the waist down from a fracture at the lower thoracic/upper lumbar spine.  Surgery was scheduled for the following day.

The operation was long and difficult with much blood loss. Whether it was successful or not became quickly irrelevant when he woke in the recovery room now paralyzed from the neck  down.  Further efforts at x-rays of his cervical spine determined that he had a fracture at C-4 and now a new cervical spinal cord injury.  Unable to breathe adequately, he was left on the respirator, an endotracheal tube placed during surgery remaining as his airway.

Up until this point I had little involvement in his care.  My primary responsibilities were in the research labs, and I covered the clinical patients only one night per week and one weekend per month.  But when Saturday rolled around, he was still intubated, and dependent on the respirator in the Neuro ICU, and I was the sole resident on-call for the weekend.

On Saturday morning rounds, the staff neurosurgeon, also covering for the weekend, told me the patient needed a tracheostomy and we should do it that day.  I had done enough tracheostomies–the procedure itself didn’t intimidate me–but this case frightened me.  I argued that the procedure would be difficult, and ENT consult should be considered, and it wasn’t an emergency.  The procedure could be done the following week when plenty of back-up help was available, perhaps even in the OR where adequate light and and equipment would be available.

The surgeon would have none of it.  Back then, neurosurgeons did tracheostomies on their own patients.  To consult ENT or another surgical service would a sign of weakness, and neurosurgeons never admit to weakness.  Why mess up a busy operating room schedule with an annoying procedure like a tracheostomy that could be done off hours in the ICU?

I argued my other responsibilities to the seventy-odd patients under my care.  He simply said to call him as soon as my routine work was done.

My routine work was not done until six PM.  I called the staff physician, hoping the late hour would put him off, but he remained undeterred.  He showed up a the NICU at eight PM determined to help.

A trachea is normally immediately beneath the surface of the skin at the throat, often less than a quarter inch from the surface.  In this patient the trachea was a good four inches deep in the neck.  The standard retractors and indeed the tracheostomy tubes themselves were too small.  The light was poor, and we struggled for two hours over a procedure that normally takes thirty minutes.

At last he had an airway in the trachea.  I sutured it in place and tied it around his neck for good measure.  The staff physician went home, and after fielding the calls and tasks that had accumulated during the time I was involved in the procedure, I went to bed.

At two AM, the phone rang.  The patient had coughed out his airway and was now in respiratory distress.  I ran to the NICU and tried to replace the tube, but after the recent procedure the path from the skin to the trachea is no longer easy.  All the recently dissected tissue planes provide false passageways even in normal individuals.

I struggled to find the trachea and a tube large enough to reach it, but working alone and with poor light, I was frustrated and unsuccessful.  His breathing became more and more labored.  I called the resuscitation team, but they too were unable to re-intube him in the conventional manner.  His heart rate slowed and he lost consciousness as I struggled to find his trachea.

Then he died.

It’s a great thing to do a good tracheostomy.  Lives are saved in hospitals (and sometimes restaurants) frequently.  But sometimes it doesn’t work.  It’s been over forty years.  I stood between the big man and his death, and I failed.

I didn’t kill him exactly.  His girlfriend in her fury bore the legal responsibility.  Alcohol intoxication, lust, anger, and hubris (standing in front of a speeding car twice!) had a lot to do with it.  And I was only the last person in a line of medical providers who failed to stand between him and the hereafter, and between the girlfriend and a murder charge.

There is a poignant story in the Luke 7:11-16 in which Jesus and his followers are entering the town of Nain just as a funeral procession meets them on the road.  The dead man is the only son of a widow. Jesus, against all common sense and against the Jewish tradition that to touch the dead that renders one ritually unclean, stops the procession, touches the body, and raises the young man to life.

It’s an easy story to slide over.  Jesus was healing people all the time; now he stepped up the game and healed a dead kid, a widow’s son no less.

And it is all of that.

But Jeff Hoy in his Words of Faith (Stopping the Procession. Words of Faith.5-11-18.Dr.Jeffrey D. Hoy © 2018 jeff.Hoy@faithfellowshipweb.com) draws attention to the metaphor.  Normal life in the world is a procession toward death.  It’s where we’re all headed.  We fear it, we avoid thinking about it–we don’t touch it.

We handle our despair in different ways.  Some of us party–eat, drink and be merry, for tomorrow we die.  Some of us exercise, diet, take vitamins, avoid germs, obsess about safety, putting off for today the looming disaster of our end.  Some of us become religious, earning our place in heaven so we don’t have to worry about our end on earth.

Some of us, for example, me, learn about medicine and how to cheat disease and death, and, as we win daily battles, we hold onto the illusion that we will win the war.  But sooner or later, we meet the procession of death.

Backed by 2500 years of medical tradition, a 500 year history of surgery, an armamentarium of drugs and surgical procedures, my medical procession is powerful against impending death.  I put out my hand, I touch the corpse, the boy rises, the procession stops.

Sometimes.  This time I put up my hand, I touched the corpse, and the procession rolled over me.

Because I’m not Jesus.

In reality, the death procession never stops.  The medical procession can only slow it down.  The death procession only stops when the people weeping and wailing and those carrying the coffin stop believing in chaos and death and start believing in purpose and life.  Believe you are a child of God, believe you are loved, believe you are made for a purpose, believe that when your body dies you will exist on a new plane of experience–even when all that belief is beyond your intellect and your sensory experience.  Then the procession stops.  Then you can turn around and join the procession of life.  You can walk with Jesus.

The death of the big man with the failed tracheostomy is but one of many experiences that haunt me after forty years in medicine.  The sense of failure is pretty big when someone dies and you feel like you could have, should have, done something better to prevent that death.  It is easy to slip into despair camouflaged as a supposed “realism,” which is only cynicism after all.  One learns to go on, live in the moment, do the good one can do, and let the rest go.  It’s possible to live like that.

But if I want to live with joy instead of despair, I have to turn around and join the procession of life.  I have to walk with Jesus.