Posted on

Ray of Hope

Dean

I drove home from the emergency room at 4AM feeling tired, frustrated, and depressed.  As I angled off Beach Boulevard onto Hogan Road I passed a low, triangular-shaped black building topped with a cross formed by lighted letters.  Horizontal letters read Jesus Saves; Vertical letters proclaimed Jesus Heals.  Nobody believes that, I thought.  Otherwise the ambulance would have come here instead of the ER.  And I wouldn’t have blood on my shoes.

The victim that night was a twenty-one year-old man named Ray.  He had been in a single-car accident after midnight and looked brain dead on arrival.  He had been intubated in the field, was now on a respirator without motor tone or reflexes, and his pupils were fixed and dilated.  But he was drunk and hypothermic, so an official diagnosis of brain death could not be made.  Resuscitation continued.

A CT scan showed a diffusely swollen brain and multiple facial fractures.  He was placed on a respirator, given heating blankets, IV fluids, anticonvulsants, steroids, antibiotics, a room in the ICU, and little hope.  Blood dripped onto my shoes when I drilled a small hole through his skull to place a tube to monitor the pressure inside his head (the ICP).

I left him in the ICU after giving his nurse instruction on his care then looked for family or friends.  No one.

Driving home I felt like I’d performed a great exercise in futility.  Ray’s prognosis was dismal.  If he survived (an unlikely event in my estimation), he would likely be left with severe brain injuries and exist (at best) for a few years institutionalized in a neuro-vegative state.  I wished the ambulance had taken him to the faith healers; the outcome was likely to have been the same.

After a few hours of sleep I returned.  Ray’s temperature had been restored to normal and his alcohol level had fallen below the legally drunk range.  His ICP was controlled with minimal intervention, but his pupils were fixed and he still had no muscle tone or reflexes.

Again, he looked brain dead.  But since he was sedated for the respirator, an official diagnosis could not yet be made.  I felt as if I was not so much treating Ray as I was keeping his organs viable as a possible transplant donor.

This morning Ray’s parents were in the ICU waiting room.  I went to meet them and steeled myself to deliver bad news.

The first thing I noticed was they were surprisingly well dressed–he in a coat and tie, she in stockings and heels.  The second thing I noticed were the little gold crosses–one on his lapel, another on her necklace.

I told them what I must while their eyes searched me, listening carefully for the words I knew they wanted to hear–okay, recovery, rehabilitation–words I did not speak.  I said coma, paralysis, brain damage, blindness and, yes, even death.

Then we faced each other, silent for a moment.  Her face begged for better news; tears welled up and overflowed, creating fall lines in her makeup.  He studied me and asked about chances, searching for the thin comfort of statistics.  “I know you can’t say for certain,” he said.

“Less than fifty-fifty,” I replied.  It was worse than that, but I was unwilling to lie but didn’t want to hurt them more than necessary.  It was the best I could do.

“When will you know?” he asked.

“A day, a week, a month,” I said.  “I don’t know.  Everyday he lives, he’s beaten the odds.”

“There’s hope?”

I pause.  I am careful dispensing hope.  Too much is a lie called false hope.  Too little is another kind of lie.

“His response to the treatments we started last night gives us some hope,” I said cautiously.  Some hope.

His shoulders dropped a fraction, perhaps shrugging off the worst, but his eyes narrowed as he continued to fix his gaze on me.  She breathed now without sobbing.

“If he continues to get better there will be room for more hope,” I say, dispensing the possibility of more hope.  “But if he gets worse…”

“Yes?”

“If there is no hope, I will tell you.”  The possibility of no hope.

He nodded.  She sniffed.  “We will pray for him,” she said.

“And for you, too, Doctor,” he said.

“Thank you,” I said.  I wished without much faith that the prayers would help.

I’d like to report that I went back to the ICU and witnessed a miracle healing.  But it was not so simple.  Ray had a rocky course, fighting for his life for the next month.  His ICPs gradually came under control and he was weaned from the respirator and sedative medications.  He woke from his coma and, although his vision was impaired from bruised optic nerves caused by the skull base fractures, he was otherwise neurologically intact.  Then, a few days later, he had an attack of meningitis–a complication from his basilar skull fracture.  After a course of antibiotics, he required an operation to seal the cerebrospinal fluid spaces and prevent another bout of meningitis.

But he exceeded my expectations.  He recovered and was discharged home walking and talking.  Eventually, he made a near complete recovery and has led a normal life, left with only a moderate visual impairment and a well-controlled seizure disorder.

As I look back, this was when I started to wonder if the prayers helped.  At the time, I thought he got better because of good neurosurgical care.  But he looked dead, I thought his care was futile, and, in spite of my expectations, he lived.

Later, when he came in for office appointments, Ray always wore a little gold cross somewhere, usually a pin on the collar of his shirt.  It made me remember the night I had no hope and the lighted cross I saw.  Jesus Saves, Jesus Heals

Could the faith healers at that little black triangular-shaped building have done better?  Almost certainly not.  But I know now that there is room for both kinds of healers.  Some are called to don latex gloves and get blood on their shoes; others are called to fold their hands and fall on their knees.  Ray needed both.

Posted on

The Best Thing

Being cured and being healed are usually the same thing.  But not always.

A few years ago I was already driving home at the end of a long day when I got a call from the ER.  A thirty-something year-old mother of two had been driving home from work when her car was struck broadside from someone running a red light. She had been briefly unconscious at the scene, but was alert and able to give a coherent history on arrival at the ER. Then she unexpectedly lapsed into a coma, the right pupil dilating.

By the time I arrived, a CT scan had confirmed my suspicions of an intracranial hemorrhage, specifically an acute subdural hematoma.  If the clot could be removed before she suffered permanent damage to the critical life-support and consciousness areas of her brainstem, she could live.  But the window of opportunity was narrow.  She had less than two hours.

An emergency OR team was called and the patient resuscitated with assisted breathing through a mechanical airway and medications to minimize brain swelling.  Blood for transfusion was reserved, labs were processed.  The clock continued to tick.  I shaved her hair in the ER while waiting for the OR to be ready.

Finally, she got to surgery.  I made a big incision and cut a big window in her skull to allow room to evacuate the blood clot and find the source of bleeding.  A large surface vein had been torn due to the accident, but the brain itself looked normal.  Once the clot was out and the bleeding controlled, the tension level in the OR dropped and the surgery finished without any problems.  I bandaged her head in a classic turban dressing.

Her post-op scan showed complete resolution of the intracranial bleed, and she quickly regained consciousness.  Early in the morning of the second post-op day I visited her in her ICU room surrounded by her celebrating family.  She had made a full neurologic recovery and, other than a black eye and a bandage, looked perfectly normal.

I needed to change her bandage.  Although it looked pristine on the outside, undoubtably the inner layers of gauze had blood and serum from the incision, and I wanted it clean there, too.  I cut away the old bandage and reached for the new gauze wraps when she quickly put her hand to her head and grabbed a mirror.

“My hair,” she wailed. “What happened to my hair?”  Tears welled up.

I re-bandaged her head and assured her that her hair would grow back.  Her family comforted her and told her how glad they were to have her alive and how little they cared about her hair.  But she was inconsolable.

I was disappointed.  She had a perfect medical result.  Yet, she would need many months of psychiatric treatment for post traumatic stress disorder (PTSD).  She had been cured by her surgery, but not healed.

A few months later I received a consult to see a patient that I knew I couldn’t help.  This patient had suffered paralysis due to a gunshot wound to the thoracic spine several weeks before and had been treated at another hospital before transfer to the rehabilitation facility in my neighborhood.  The question on the consult was whether or not she needed to continue to wear a brace (she did not).

All I had to do was talk to the patient, do a brief exam to confirm my findings and write a note explaining what I already knew from looking at her hospital records and x-rays.

“Can you tell me what happened?” I said.

“The best thing in my whole life,” she replied.

I stared at her, a thirty-something year-old woman who looked older than her stated age.  Her hair was prematurely gray, disheveled and greasy from too many weeks in the hospital.  She must have misunderstood me.

“No, no,” I said.  “I meant about the spinal cord injury, the gunshot wound.”

“Yes, of course,” she said. “It was the best thing that ever happened to me.”

I realized that I was not going to have a normal conversation with this new paraplegic.  “Okay, I’ll bite,” I said. “I’ve seen lots of people with spinal cord injuries. Some adjust better than others, some adjust quicker, but I have never heard anybody say it was the best thing that ever happened to them.”

“I was an addict working as a prostitute to support my habit,” she said.  “A family of Christians lived in my neighborhood.  They knew what I was doing.  Every day I would walk by their house, and these little children would say something like, ‘Miss JoAnn, won’t you come in?’ or ‘Miss JoAnn, Jesus loves you.’  The last time it was the little boy. He said, ‘Miss JoAnn, Jesus loves you and we are praying for you.’

“I remember thinking I’d come and visit the next day, after one more high.  But that’s what I told myself every day.  A couple hours later I got shot in a drug deal gone bad.  I woke up three days later in the hospital unable to move my legs.”

She paused, collecting her thoughts and trying to form an explanation.

“But three great things happened to me that day.  The first–I was delivered from 20 years of addiction to crack cocaine. The second–I was delivered from 18 years of prostitution. The third–I found Jesus Christ as my Lord and Savior.  I have joy in my heart for the first time since I was a child.  So if never walk again, which is what they are telling me, it’s a pretty good trade.”

I couldn’t offer her a cure.  But then, she didn’t need it.  She had already been healed.

Posted on

The Hard Place

It was a Sunday of August 1991. I was lying/sitting in the hospital bed. The doctors had come and explained what they were going to do. My parents had gone to the hotel. I was sixteen, looking at the prospect of brain surgery. Earlier that day my mother tearfully told me that she didn’t know if I would live two days, two weeks, two months or twenty years. She did say that God had something for me to do and that he would give me the time to do it. There was a lot riding on the next morning’s procedure. If the biopsy came back badly, I would likely be dead by Christmas. If they didn’t put the shunt in I wouldn’t live long enough to care about the biopsy.

At sixteen I had a plan for salvation. I was going to become more and more holy and eventually become perfect as my father in heaven is perfect.

How could I have come up with such a doomed plan?

Hurt, pride and determination–they were what moved me from being a failing dyslexic in the 4th Grade to a thriving dyslexic at one of the best schools in the state by the10th grade. The lesson I had learned was that any problem could be overcome with hard work and uncompromising determination. Why should salvation be any different?

The problem I had lying in that hospital bed was that I’d run out of time. I could no more become spiritually perfect than I could write a book in a single night. I didn’t know if I would wake up from the surgery with brain damage. I didn’t know if the biopsy would come out malignant. I was in a hard place. I didn’t have any more wiggle room. I was scared and I needed a savior.

“Dear Lord, I always planned to become more holy and a better Christian. I’ve run out of time. Could you please just take me as I am?”

As far as salvation prayers go it was pretty pathetic. I didn’t even mention Jesus or even ask for my sins to be forgiven, but the Lord reckoned even my pathetic prayer as righteousness and I could feel the warmth of the Holy Spirit flowing into me. It hadn’t taken surgery or brain damage to change me. The Holy Spirit made me a new person. Since that day I’ve worried about many things: pain, incapacitation, isolation, and what would happen to my wife and children if I died. But I’ve never worried about death.

Everyone comes to hard places. Sometimes they are dramatic, like the night before brain surgery. Sometimes they are in the middle of sustained challenges, like depression or addiction. Other times they are awakenings to the fact that our salvation plans, like most human plans, are wholly insufficient. What are the hard places you have experienced in your life? What spiritual fruit has grown out of those experiences?

Posted on

Resurrection

Healing is the great intersection of faith and science, the eternal and the incarnate, where hope and truth are inextricably entwined.  Names and identifying details have been changed to protect patient confidentiality, but the stories are true and deserve to be shared.  Here’s the first:

I stood at the bedside in the ICU of a patient I’ll call Sandra.  I had run out of options, knowing the battle was lost and wondering why.  I wondered who would mourn her death, why a capable, attractive young woman would disappear, a death notice in the local paper, a vacancy to fill at work, an abandoned apartment somewhere.  I wanted to weep for a life lost before it appeared to have been lived.  I wanted to shout in frustration over the operation that had seemed perfect yet turned out to be lethal.

I had met her two weeks before.  She was thirty-seven, single, without children, and worked as a manager at a dental office in a nearby city.  Recently she had a severe headache at work followed by collapse and evacuation to the nearest emergency room.  A CT scan and subsequent MRI confirmed a colloid cyst of the third ventricle.  She appeared in my office the next day with the scans and a world of questions.

A colloid cyst is uncommon but benign in terms of malignancy.  Yet for some, like her, the cyst causes a potentially lethal obstruction to cerebrospinal fluid (CSF) circulation, leading to headache, loss of conciousness, and frequently sudden death.  As we talked she described headaches that were becoming increasingly frequent with two other episodes involving a brief collapse and loss of consciousness.

I recommended surgery.

A few days later she underwent an operation that seemed to go smoothly.  She awoke with minimal headache and transferred to the ICU with a ventricular drainage tube to monitor her intracranial pressure (ICP) and drain CSF if necessary, a common post-op precaution.

Eight hours later her, ICPs went up.  Initial treatment with CSF drainage brought the pressure back to normal for a few hours.  Then the ICP rose again to dangerous levels.  Post-op CT scans showed an inexplicably swollen brain.

The swollen brain caused a severe headache, then confusion.  Without dramatic treatment she would soon lapse into a coma and die, exactly the thing the operation was expected to prevent.  Anesthetic levels of sedation, control of her breathing, medications to reduce brain swelling were all used with only temporary benefit.  Artificial coma by use of high-dose barbiturates and hypothermia (lowering her body temperature) were used as desperate measures–again with only temporary benefit.

Now, as I stood by her bedside, she was in coma on a respirator and, by the only measurable criteria, brain dead.  Brain death is usually diagnosed by a clinical examination that shows no sign of brain function coupled with an EEG showing no activity.  For the diagnosis to be accurate, the patient must be free of sedative drugs and have a normal body temperature.  Since Sandra was sedated and cooled, the brain death diagnosis could not be made by the usual means.

But neurosurgeons and those who care for patients in coma from increased ICP know that when the ICP is equal to the systemic blood pressure, the blood cannot circulate in the brain and the brain cells die rapidly from lack of oxygen and nutrition.  A clear record of ICP equal to blood pressure for several hours also demonstrates brain death.  This was Sandra’s situation.

In despair, I laid my hand on her bandaged forehead.  I talked to Jesus.  I told Him how I couldn’t see this death as a good thing, how that even if He has a bigger plan, her life now couldn’t exactly be a bad thing.  I confessed that I lack any proximity to perfection and may have messed up my life, and may even have messed up the operation.  But as far as I can tell, I did the best operation I knew how to do without a known error and gave her the best post-op care available.  Why take out divine retribution on this innocent woman?

I reminded Him that once He raised the dead, like Lazarus.  Maybe He still did.  I told Him that this one didn’t even have to be a big publicity stunt; I was the only one who knew she was dead.

I stood there for another moment, one hand on her forehead, another on her arm, hoping to hear from heaven, but expecting nothing.  I raised my eyes to the monitors.  They beeped the same lethal numbers.   I turned to leave the room.

Her nurse stood at the door, chart and clipboard in hand.  She tilted her head, curious, as if seeing something she had never seen before.  “Were you praying?” she asks.

I wanted to say no.  Because I’m a doctor, a scientist.  But I said, “Yes.”

I left the ICU and saw hospital patients with more mundane problems, then went to the office to see more patients, all of whom were suffering to one degree or another but were still blessed with the illusion of their own immortality.  For the next several hours I expected to be interrupted at any moment by a call from the ICU telling me that Sandra’s ICP was out of control again.  The ICPs had to be out of control, and the nurse should be calling to ask what else to do.  I had no answers, but I still expected the questions.  Finally, I phoned the ICU to speak to the nurse.

“The ICPs are normal,” she said.

I didn’t believe her.  Prayers don’t reverse brain death.

Not trusting the nurse, I left my office and returned to the ICU to see for myself.  I checked lines and re-calibrated the ICP monitor.  Still normal.  Blood flow to the brain was now restored.  Her pupils were constricted due to the barbiturates, but they were reactive to light, a sign of life.

The lethally uncontrolled ICP was now controlled.  Still, whether the ICP would remain normal as her body temperature returned to normal and the barbiturates were discontinued remained unknown.  More importantly, had irreversible brain damage already occurred?

I left orders to discontinue the cooling measures.  By the following morning, the ICPs had remained normal and I discontinued the barbiturates.  Next, she was weaned from the respirator.  Finally, the ventricular drainage catheter was no longer necessary to monitor the ICP.  I hesitated to remove it, having spent ten days worrying over each pressure reading.

But she had awoken.  Weak and confused, she could speak and move all her extremities purposefully.  Her vision was normal.  Her wounds from the original surgery seemed healed.  I pulled the ventricular catheter.  A few hours later she started out of bed for the first time in two weeks.

In a few days she was transferred to a rehabilitation hospital, and three weeks later she went home, aware of her life, but unaware of her resurrection.

I have a scientific theory on what post-op complication led to the uncontrollable brain swelling.  Possibly a large vein had a thrombus that formed at the time of surgery and resolved spontaneously a week later, the morning I prayed for her.  Perhaps she did not suffer extensive brain damage because of the protection offered by barbiturate coma and body cooling.  Perhaps the important faith was not in God but in the power of medicine.

But then again, if you ask God for a miracle and it occurs at the very moment you ask, can you honestly tell yourself it was a coincidence?

Posted on

Shock!

It was a Friday in August of 1991. I was sixteen. I’d been driving alone for six-months. The whole world was in front of me. I could do whatever I wanted, except on the day before I’d had an MRI and been diagnosed with a malignant brain tumor. It was killing me, blocking the water from draining out of my brain, putting pressure on the area that controlled my eyes.

There are times when those who get bad news, really bad news, lack the emotional and cognitive capacity to absorb that news. In other words it’s like trying to eat an entire elephant in one bite. Like a deer in the headlights of a huge truck I had no idea of how to process what was happening or what was about to happen. The doorbell rang and my Mom ushered in the minister from our church. He was new to our church and didn’t know anyone well. In retrospect I think he was as shocked as I was. Ministers were supposed to fix things, to make people feel better, to boldly proclaim that God is good and that he will shepherd us through the valley of the shadow of death. That’s was a tall order when he didn’t even know me. After a few pleasantries he took me into the library and asked “How are you?”

There is a story of a man who jumped off a ten story building at each floor they asked him how he was doing at every floor he said, “So far, so good.” How we are doing in our body, mind, heart, spirit and soul is a complex question. I wasn’t much of a Christian back then. I’d read enough of the Bible, gone to church enough and prayed enough to be a very promising Pharisee. My understanding of grace was sorely lacking. My experience with the Holy Spirit was miniscule. I didn’t want or even know how to be vulnerable in front of the minister. In this moment of crisis I fell back on one of the stories I’d heard in church. It was the familiar story of the footsteps in sand. I man had a dream where he was walking on a beach. As he looked back he saw two pairs of footsteps in the sand. The footsteps represented the journey of his life. When it came to the really difficult times in his life one of the sets of footsteps disappeared. The man asked God, “Why did you abandon me during those difficult times?” God said those were the times I carried you.” In the pressure to respond to the question of “How are you?” I said, “I don’t feel that God has abandoned me.” That was the best I had at that moment.

When we get pressed and shocked beyond our human capacity to respond we fall back on the spiritual tools we’ve learned and absorbed. What are some of the spiritual tools that work best for life’s unexpected and often dreaded surprises?